End-organ ischemia as an unforeseen complication of endoscopic-ultrasound-guided celiac plexus neurolysis

Ahmed, Hassan M.; Friedman, Shari; Henriques, H. F.; Berk, B. S.

doi:10.1055/s-0029-1214941

Cited by 27 publications

(11 citation statements)

References 2 publications

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“…In one case report, the patient developed splenic infarction and gastric ischemia following EUS-guided CPN 4. In another case report, the patient developed hemorrhagic gastritis and duodenitis after EUG-guided CPN 1…”

Section: Discussionmentioning

confidence: 99%

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Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

et al. 2013

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Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is a well-established intervention to palliate malignant pain. We report a patient who developed hepatic and splenic infarction and bowel ischemia following EUS-CPN. A 69-year-old man with known lung cancer and pancreatic metastasis was transferred for debilitating, significant epigastric pain for several months. The patient underwent EUS-CPN to palliate the pain. After the procedure, the patient complained continuously of abdominal pain, nausea, and vomiting; hematemesis and hematochezia were newly developed. Abdominal computed tomography revealed infarction of the liver and spleen and ischemia of the stomach and proximal small bowel. On esophagogastroduodenoscopy, hemorrhagic gastroduodenitis, and multiple gastric ulcers were noted without active bleeding. The patient expired on postoperative day 27 despite the best supportive care.

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Section: Discussionmentioning

confidence: 99%

“…We postulate that the diffusion of ethanol into the celiac artery and subsequent vasospasm resulted in the injury pattern. At nontoxic concentrations, ethanol can produce vasoconstriction severe enough to cause vascular and smooth muscle cell death 4,6…”

Section: Discussionmentioning

confidence: 99%

Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

et al. 2013

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“…In most cases, these complications are not serious. However, several major adverse events have been reported (Table ) . Most of them, especially infectious complications, were reported in patients with chronic pancreatitis.…”

Section: Complicationsmentioning

confidence: 99%

Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Yasuda

Wang

2017

Digestive Endoscopy

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Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real-time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS-CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS-guided direct celiac ganglia neurolysis (EUS-CGN) was introduced recently. Pain relief is achieved by EUS-CPN in 70-80% of patients with pancreatic cancer and in 50-60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS-CGN may provide greater pain relief than conventional EUS-CPN. Procedure-related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur.

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“…The late side effects include diarrhea, hypotension, fever, and paraplegia [154]. Several severe side effects have been reported, e.g., permanent lower paraplegia due to spinal cord infarction [155,156], hepatic, splenic, and renal infarction [157], and lethal perforation of aorta and stomach [158].…”

Section: Pain Palliation By Eus-guided Celiac Plexus Neurolysismentioning

confidence: 99%

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Seicean¹

2014

Pancreatic Cancer - Insights Into Molecular Mechanisms and Novel Approaches to Early Detection and Treatment

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End-organ ischemia as an unforeseen complication of endoscopic-ultrasound-guided celiac plexus neurolysis

Cited by 27 publications

References 2 publications

Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

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