Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis

Liu, Fan; Dong, Jifu; Tang, Yuming; Huang, He; Liu, Hui; Song, Li; Zhang, Kexian

doi:10.1007/s00520-017-3888-0

Cited by 35 publications

(19 citation statements)

References 25 publications

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“…In addition, bibliographies of the selected articles were manually searched to find additional relevant articles that were also reviewed in detail. Overall, we identified 50 references on EUS-guided neurolysis comprising 34 original articles [ 8 , 10 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], 11 case reports [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and five systematic reviews [ 5 , 7 , 56 , 57 , 58 ].…”

Section: Literature Review Methodologymentioning

confidence: 99%

“…EUS-CPN can be performed via a unilateral approach or a bilateral approach [ 19 , 56 ]. In the unilateral approach, the neurolytic agent is injected adjacent to a point just above the celiac trunk; in the bilateral approach, the agent is injected on both sides of the celiac trunk.…”

Section: Endoscopic Procedures In Eus-guided Neurolysismentioning

confidence: 99%

“…The most recent meta-analysis comparing the two approaches, by Lu et al included six studies (437 patients); no significant difference was found between the approaches in short-term pain relief or response to treatment. However, EUS-guided bilateral CPN was associated with significantly lesser analgesic consumption than unilateral CPN [ 56 ].…”

Section: Efficacy Of Eus-guided Neurolysismentioning

confidence: 99%

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Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis

Minaga

Takenaka

Yoshikawa

et al. 2018

Cancers

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The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chemically ablated. This procedure was performed percutaneously or intraoperatively until 1996, when endoscopic ultrasound (EUS)-guided celiac plexus neurolysis was first described. In this transgastric anterior approach, a neurolytic agent is injected around the celiac trunk under EUS guidance. The procedure gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. We focus on two relatively new techniques of EUS-guided neurolysis: EUS-guided celiac ganglia neurolysis and EUS-guided broad plexus neurolysis, which have been developed to improve efficacy. Although the techniques are safe and effective in general, some serious adverse events including ischemic and infectious complications have been reported as the procedure has gained widespread popularity. We summarize reported clinical outcomes of EUS-guided neurolysis in pancreatic cancer (from the PubMed and Embase databases) with a goal of providing information useful in developing strategies for pancreatic cancer-associated pain alleviation.

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Section: Literature Review Methodologymentioning

confidence: 99%

Section: Endoscopic Procedures In Eus-guided Neurolysismentioning

confidence: 99%

Section: Efficacy Of Eus-guided Neurolysismentioning

confidence: 99%

See 1 more Smart Citation

Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis

Minaga

Takenaka

Yoshikawa

et al. 2018

Cancers

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“…80 Intra-operative celiac plexus neurolysis (in patients with suspected pancreatic cancer who underwent exploratory laparotomy and found to have histologically proven, unresectable pancreatic cancer) was associated with better analgesia, elevated mood, reduced pain interference, as well as increased life expectancy, compared to saline placebo in an RCT by Staats et al 68,71 However, no difference in QOL or survival was shown in an RCT comparing the effects of early endoscopic celiac neurolysis done during diagnostic endoscopic ultrasound versus conventional medical management. 81 Although several studies looking at different approaches to celiac neurolysis found no difference in results, 61,[82][83][84] an RCT done by Ozyalcin et al suggests that splanchnic neurolysis has superior results compared to celiac plexus neurolysis for pancreatic body and tail cancer. 62 Dehydrated alcohol is the most commonly used agent and has been theorized to perform better for neurolytic procedures that must disrupt diffuse neuronal networks.…”

Section: Celiac Plexusmentioning

confidence: 99%

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

Aman¹,

Mahmoud²,

Deer³

et al. 2021

JPR

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Moderate to severe pain occurs in many cancer patients during their clinical course and may stem from the primary pathology, metastasis, or as treatment side effects. Uncontrolled pain using conservative medical therapy can often lead to patient distress, loss of productivity, shorter life expectancy, longer hospital stays, and increase in healthcare utilization. Various publications shed light on strategies for conservative medical management for cancer pain and a few international publications have reviewed limited interventional data. Our multi-institutional working group was assembled to review and highlight the body of evidence that exists for opioid utilization for cancer pain, adjunct medication such as ketamine and methadone and interventional therapies. We discuss neurolysis via injections, neuromodulation including targeted drug delivery and spinal cord stimulation, vertebral tumor ablation and augmentation, radiotherapy and surgical techniques. In the United States, there is a significant variance in the interventional treatment of cancer pain based on fellowship training. As a first of its kind, this best practices and interventional guideline will offer evidenced-based recommendations for reducing pain and suffering associated with malignancy.

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“…12 Another retrospective study also showed similar amounts of pain reduction in the central and bilateral EUS-CPN groups (50% vs 60%, respectively). 13 The most recent meta-analysis by Lu et al 14 included 437 patients from six eligible studies and analyzed the analgesic efficacy and safety of bilateral EUS-CPN compared to central EUS-CPN. The short-term analgesic effects and general risks of bilateral EUS-CPN were comparable with those of central EUS-CPN, but the study revealed that the bilateral approach significantly reduced postoperative analgesic use.…”

Section: Efficacy and Prognostic Factors Following Treatmentmentioning

confidence: 99%

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

Yasuda

Hanaoka

Takahashi

et al. 2020

Int J Gastrointest Interv

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Endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) is a widely practiced technique. Three sets of guidelines have recently been published and this procedure has become a major EUS technique. However, there are still several unanswered questions. The purpose of this manuscript is to review the recent literature pertaining to EUS-CPN. Currently, the main indication of EUS-CPN is pancreatic cancer pain. It is also performed for patients with chronic pancreatitis, but the indication is controversial due to its limited efficacy and a high incidence of infectious complications. Various techniques, such as central and bilateral EUS-CPN, and EUS-guided direct celiac ganglia neurolysis (EUS-CGN) have been performed. However, the efficacies of these techniques remain controversial. Complications related to the procedures are generally not serious, but major adverse events, such as paraplegia and ischemic complications, have been reported. The impacts of EUS-CPN on survival have also been evaluated. Although increased survival was expected via improvements in the quality of life, data suggests that EUS-CPN related procedures, especially EUS-CGN, might reduce the survival time. However, precise mechanisms have not been elucidated. In addition to conventional techniques, new techniques, such as EUS-guided celiac ganglion radiofrequency ablation (EUS-RFA) and the use of highly viscous phenol-glycerol, dexmedetomidine, and contrast-enhanced agents, have been introduced. However, these techniques are still in experimental stages. Additional studies need to be conducted to address these gaps in the literature.

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Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis

Abstract: The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.

Cited by 35 publications

References 25 publications

Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis

Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

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