Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis
Abstract
:1. Introduction
2. Literature Review Methodology
3. Indications for EUS-Guided Neurolysis
4. Anatomy Relevant to Pancreatic Cancer Pain
5. Endoscopic Procedures in EUS-Guided Neurolysis
5.1. Pretreatment Procedure
5.2. Endoscopic Procedure
5.2.1. EUS-Guided Celiac Plexus Neurolysis (EUS-CPN)
5.2.2. EUS-Guided Celiac Ganglia Neurolysis (EUS-CGN)
5.2.3. EUS-Guided Broad Plexus Neurolysis (EUS-BPN)
6. Efficacy of EUS-Guided Neurolysis
6.1. EUS-CPN
6.2. EUS-CGN
6.3. EUS-BPN
7. Complications of EUS-Guided Neurolysis
8. Determinants of Pain-Relief Response
9. Conclusions and Future Directions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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First Author (Year) [Reference] | Study Design | No. of Patients | Procedure | Outcomes | Complications |
---|---|---|---|---|---|
Wiersema (1996) [8] | Prospective? Non-randomized | 30 | EUS-CPN Bilateral | Pain improvement in 79 to 88% of patients with a median follow-up of 10 weeks | Self-limited complications Diarrhea 13.3% Pain increase 3.3% |
Gunaratnam (2001) [15] | Prospective Non-randomized | 58 | EUS-CPN Bilateral | Decline in pain score after EUS-CPN in 78% of patients | No major complications Pain increase 8.6% |
Tran (2006) [16] | Retrospective Non-randomized | 8 | EUS-CPN Unilateral | Pain improvement in 70% of 10 procedures (8 patients) | Not described |
Sakamoto (2006) [17] | Retrospective Non-randomized | 13 | EUS-CPN Bilateral | Pain improvement in 84.6% of patients | Self-limited complications Inebriation 7.7% Pain increase 7.7% Hypotension 15.4% |
Levy (2008) [10] | Retrospective Non-randomized | 36 (Malignant 18) | EUS-CGN | Pain improvement in 94% of patients | Pain increase 36.1% Hypotension 33.3% Diarrhea 16.6% |
Ramirez-Luna (2008) [18] | Retrospective Non-randomized | 11 | EUS-CPN Unilateral | Pain improvement in 72% of patients at 4 weeks after CPN | No major complications Transient pain increase 45.4% |
Sahai (2009) [19] | Retrospective Non-randomized | 160 (Malignant 81) | EUS-CPN Bilateral 89 Unilateral 71 | Pain improvement; 70.4% (bilateral) vs 45.9% (unilateral) Bilateral CPN is more effective than unilateral CPN | Retroperitoneal bleeding 1% (bilateral CPN) |
Sakamoto (2010) [11] | Retrospective Non-randomized | 67 | EUS-CPN 34 EUS-BPN 33 | Reduction in pain score on days 7 and 30; EUS-BPN > EUS-CPN | No serious complications No cases of prolonged hospitalization |
Ascunce (2011) [25] | Retrospective Non-randomized | 64 | EUS-CGN 40 EUS-CPN 24 | Pain improvement at 1 week after neurolysis; 65.0% (CGN) vs. 25.0% (bilateral CPN) | Transient pain increase 1.6%, Diarrhea 23.4%, Hypotension 1.6% |
Iwata (2011) [26] | Retrospective Non-randomized | 47 | EUS-CPN Unilateral | Pain improvement; 68.1% Complete pain relief; 36.2% | Transient hypotension 17.0%, Inebriation 8.5%, Diarrhea 23.4% |
Wyse (2011) [27] | Prospective Randomized | 48 | EUS-CPN Bilateral | Randomized trial; EUS-CPN vs conventional drug-based pain management Pain relief at 3 months; CPN > drug-based pain management | No evidence of early or late complications |
LeBlanc (2011) [28] | Prospective Randomized | 50 | EUS-CPN Bilateral 21 Unilateral 29 | Randomized trial; bilateral CPN vs unilateral CPN Pain relief and survival; no difference between the groups | Transient pain increase 36%, Hypotension 2% |
Wiechowska-Kozłowska (2012) [29] | Retrospective Non-randomized | 29 | EUS-CPN Bilateral | Pain improvement; 86% Complete pain relief; 14% | Transient diarrhea 10.3%, Hypotension 3.4%, Pain increase 6.9% |
Wang (2012) [32] | Prospective Non-randomized | 23 | EUS-guided irradiation | EUS-guided celiac ganglion irradiation (iodine-125 seeds) Pain improvement in 82.6% of patients at 2 weeks | No major complications Constipation 21.7% Nausea 8.7% |
Leblanc (2013) [33] | Prospective Randomized | 20 | EUS-CPN Unilateral (+EUS-CGN) | Randomized trial; EUS-CPN using 10 mL vs. 20 mL alcohol Similar clinical outcomes between the groups | Self-limited complications Lightheadedness 5% Diarrhea 10% Nausea 15% |
Seicean (2013) [34] | Retrospective Non-randomized | 32 | EUS-CPN Unilateral | Pain improvement in 75% of patients | No complications |
Doi (2013) [35] | Prospective Randomized | 68 | EUS-CGN 34 EUS-CPN 34 | Randomized trial; EUS-CGN vs. EUS-CPN (unilateral) Pain improvement; 73.5% (CGN) vs. 45.5% (CPN) Complete pain relief; 50% (CGN) vs. 18.2% (CPN) | Transient hypotension 4.5%, Inebriation 3.0%, Pain increase 25.4%, Diarrhea 7.5% |
Téllez-Ávila (2013) [37] | Retrospective Non-randomized | 53 | EUS-CPN Unilateral 21 Bilateral 32 | Bilateral vs. unilateral CPN No significant difference between the groups | No major complications Transient pain increase 1.9% |
Si-Jie (2014) [36] | Retrospective Non-randomized | 41 | EUS-CGN 26 EUS-CPN 15 | Pain improvement in 90.2% and 61.0% of patients at 1 week and at 3 months, respectively | Transient hypotension 4.9% |
Ishiwatari (2014) [38] | Retrospective Non-randomized | 22 | EUS-CPN Phenol 6 Ethanol 16 | Pain improvement in 83% and 69% of patients in the phenol and ethanol groups, respectively | Minor complications Phenol group 16.7%, ethanol group 37.5% Inebriation 12.5% (ethanol group) |
Ishiwatari (2015) [39] | Prospective Non-randomized | 9 | EUS-CPN Phenol-glycerol | Complete, partial and no pain relief in 44.4%, 44.4% and 11.1% of patients at 7 days after the procedure | Minor complications 33.3% |
Fujii-Lau (2015) [40] | Retrospective Non-randomized | 230 | EUS-CPN or EUS-CGN | EUS-guided celiac neurolysis was associated with longer survival compared with non-EUS approaches | Mild adverse events; 7 patients (1.7%) Moderate to severe adverse events; 5 patients (1.2%) |
Bang (2016) [41] | Prospective Non-randomized | 51 | EUS-CPN Unilateral | Heart rate change during CPN in 49.0% of patients Better pain relief in the heart rate change cohort | Diarrhea 33.3% |
Minaga (2016) [43] | Retrospective Non-randomized | 112 | EUS-BPN 65 EUS-BPN + EUS-CGN 47 | Pain improvement in 78% of patient at 1 week EUS-BPN in combination with EUS-CGN is a predictor of a good pain response | Major; Paraplegia 1% Minor; Inebriation 8.0%, Hypotension 4.5%, Pain increase 3.6%, Diarrhea 3.6% |
Facciorusso (2017) [42] | Retrospective Non-randomized | 123 | EUS-CPN 58 EUS-CPN + ablation 65 | EUS-guided tumor ethanol ablation combined with EUS-CPN increased pain relief and complete pain response rate | No severe treatment-related complications |
First Author (Year) [Reference] | Complications | Procedure | Neurolytic Agents/Anesthetic Agents | Outcomes |
---|---|---|---|---|
Muscatiello (2006) [46] | Retroperitoneal abscess | CPN | Alcohol/Bupivacaine | EUS-guided puncture, complete resolution |
Mittal (2012) [48] | Paraplegia | CGN + CPN | Alcohol/Bupivacaine | No improvement |
Fujii-Lau (2012) [49] | Paraplegia | CGN + CPN | Alcohol/Bupivacaine | No improvement |
Gimeno-García (2012) [50] | Celiac artery thrombosis, hepatic, kidney, splenic infarction, bowel ischemia | CPN Bilateral | Alcohol/Bupivacaine | Conservative treatment, died 8 days later |
Jang (2013) [51] | Hepatic, splenic infarction, bowel ischemia | CPN Unilateral | Alcohol, triamcinolone acetonide/Bupivacaine | Conservative treatment, died 27 days later |
Minaga (2016) [52] | Paraplegia | CPN Bilateral | Alcohol/Lidocaine | No improvement |
Mulhall (2016) [54] | Bilateral diaphragmatic paralysis | CPN | No description | Mechanical ventilation, no improvement |
Köker (2017) [55] | Paraplegia | CPN Bilateral | Alcohol/Bupivacaine | No improvement |
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Minaga, K.; Takenaka, M.; Kamata, K.; Yoshikawa, T.; Nakai, A.; Omoto, S.; Miyata, T.; Yamao, K.; Imai, H.; Sakamoto, H.; et al. Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis. Cancers 2018, 10, 50. https://doi.org/10.3390/cancers10020050
Minaga K, Takenaka M, Kamata K, Yoshikawa T, Nakai A, Omoto S, Miyata T, Yamao K, Imai H, Sakamoto H, et al. Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis. Cancers. 2018; 10(2):50. https://doi.org/10.3390/cancers10020050
Chicago/Turabian StyleMinaga, Kosuke, Mamoru Takenaka, Ken Kamata, Tomoe Yoshikawa, Atsushi Nakai, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Hiroki Sakamoto, and et al. 2018. "Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis" Cancers 10, no. 2: 50. https://doi.org/10.3390/cancers10020050
APA StyleMinaga, K., Takenaka, M., Kamata, K., Yoshikawa, T., Nakai, A., Omoto, S., Miyata, T., Yamao, K., Imai, H., Sakamoto, H., Kitano, M., & Kudo, M. (2018). Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis. Cancers, 10(2), 50. https://doi.org/10.3390/cancers10020050