Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma

Facciorusso, Antonio; Maso, M. Di; Serviddio, Gaetano; Larghi, Alberto; Costamagna, Guido; Muscatiello, Nicola

doi:10.1111/jgh.13478

Cited by 65 publications

(37 citation statements)

References 24 publications

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“…The accuracy of the new TPS was thus confirmed. Therefore, in three-dimensional space, the arrangement of radioactive seeds was irregular [ 5 , 13 , 14 ]. At present, the dose calculation at any point on the three-dimensional edge of the tumor, which was not in the puncture section, is difficult.…”

Section: Discussionmentioning

confidence: 99%

An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer

Sun

Min

et al. 2017

Oncotarget

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EUS-guided interstitial brachytherapy is promising in the treatment of unresectable malignant carcinoma adjacent to the digestive tract. The feasible treatment plan is not established. Thus, our study aimed to develop a novel treatment plan and evaluate the feasibility in patients with unresectable pancreatic cancer. A total of 42 patients with unresectable pancreatic cancer (stage III: n = 18; stage IV: n = 24) were retrospectively included. A special treatment-planning system (TPS) for EUS was designed and evaluated by comparing with the traditional TPS. The patients underwent EUS-guided interstitial brachytherapy based on the new software. In the test model, there was no obvious difference of irradiation doses calculated by the two softwares (EUS TPS vs. traditional TPS) (P > 0.05). Under the support of EUS TPS, a novel treatment plan for EUS-guided interstitial brachytherapy was successfully established, which contained seven principles. All patients tolerated the treatment well without any serious complications. In 15 patients (stage III) whose minimal peripheral dose was larger than 90 Gy, partial remission rate was 80% (12/15). Twelve patients (12/18) in stage III were alive for over 12 months with a median peripheral dose of 107.5 Gy. The expected median survival time of the 42 patients was 9.0 months (95%CI 7.6-10.4 months). The results demonstrated that the new EUS TPS will play an important role in EUS-guided interstitial brachytherapy in patients with unresectable pancreatic malignant cancer.

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Section: Discussionmentioning

confidence: 99%

An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer

Sun

Min

et al. 2017

Oncotarget

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“…Recently EUS-guided ethanol injection for patients with a small pancreatic neuroendocrine tumour, who could not be treated with medical therapy, or refused surgery, or were poor surgical candidates, produced effective results with rarely any complications [ 10 – 14 ]. Moreover, EUS-guided ethanol ablation of a tumour combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma were reported with effective pain control and prolongation of overall survival(OS) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ethanol ablation of the normal porcine pancreas was reported using EUS guidance [ 6 – 8 ]. Furthermore, treatments by EUS-guided ethanol injection for pancreatic cystic tumours, pancreatic neuroendocrine tumours, pancreatic adenocarcinoma, and metastatic lesions in humans have been reported [ 9 – 15 ]. However, the details of image changes in the area of ablation after the injection of ethanol have not been shown.…”

Section: Introductionmentioning

confidence: 99%

Time-dependent image changes after ethanol injection into the pancreas: an experimental study using a porcine model

Matsumoto

Kato

Tsutsumi

et al. 2016

ecancer

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BackgroundEthanol, a commonly available agent, has been used to successfully ablate cystic and solid lesions in the pancreas. The aim of this study is to investigate the effects of an ethanol injection into the porcine pancreas and observe the time-dependent image changes in the pancreatic parenchyma.MethodsPure ethanol was injected into the pancreatic tail using a 25-gauge EUS needle with direct ultrasound guidance under celiotomy: 1 mL and 2 mL were injected, respectively. The abdomen was closed after the injection. MRI was performed before the procedure, immediately after, and on postoperative day (POD) seven. Blood samples were taken before the procedure and on PODs one, three, five, and seven. The pigs were euthanised on POD seven.ResultsImmediately after the injection, linear high signal areas in the pancreatic tail on T2 and rounded speckled high signal areas on DWI images were detected in both animals, measuring 35 × 32 mm in the 1 mL injected pig and 42 × 38mm in the 2 mL injected pig. After POD seven, rounded high signal areas were noted on T2 images, measuring 22 × 18 mm and 36 × 28 mm respectively. On POD one, the 1 mL injected animal had a 53% elevation in serum amylase while the 2 mL injected animal had a 66% elevation. Histologically, cystic and necrotic changes in the parenchyma were observed, measuring 23 × 22 mm and 40 × 35 mm respectively.ConclusionsOur results, which are limited to normal pancreas, suggested that a 1 mL injection caused localised changes within the pancreas while a 2 mL injection induced more widespread changes beyond the pancreas. The effective area of ethanol was widespread immediately after injection, and then the area was reduced with cystic and necrosis changes.

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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%

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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Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma

Abstract: Endoscopic ultrasound-guided tumor ablation combined with celiac plexus neurolysis appears to be superior to celiac plexus neurolysis alone in terms of pain control and overall survival.

Cited by 65 publications

References 24 publications

An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer

An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer

Time-dependent image changes after ethanol injection into the pancreas: an experimental study using a porcine model

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

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