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

Jang, Hee Yoon; Cha, Sang‐Woo; Lee, Byung Hoo; Jung, Han Yong; Choo, Ji Yung; Cho, Yun-Ju; Ju, Hye Young; Cho, Young Deok

doi:10.5946/ce.2013.46.3.306

Cited by 32 publications

(16 citation statements)

References 8 publications

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“…Retroperitoneal bleeding occurred in two patients treated using the bilateral technique . Ischemic complications were lethal in three cases . These vascular injuries and ischemic complications were probably as a result of injecting alcohol into an inappropriate site or an excessive number of sessions of EUS‐CPN.…”

Section: Complicationsmentioning

confidence: 97%

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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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Section: Complicationsmentioning

confidence: 97%

“…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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“…Other vascular severe complications have been published as clinical cases, including a case of gastric ischemia, one case of medulla and two of hepato-splenic infarctions. [25][26][27][28] Ischemic complications, which can be fatal, are considered the most serious adverse events. Four cases of acute paraplegia have been reported; in all four cases, the paraplegia was permanent.…”

Section: Eus Technicsmentioning

confidence: 99%

Eus-guided therapy for pancreatic pain: easy, effective and safe. why isn´t the first therapeutic approach?

Carbajo¹,

Andrés²,

Navarro³

et al. 2018

GHOA

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Visceral pain is often a disabling symptom that appears in many chronic digestive diseases. In the case of pancreatic disease it´s especially important, being most of the times the main symptom and interfering with nutrition, emotional state and life quality of these patients. The etiology of pancreatic pain is multifactorial, having neuropathic paths a main role. The current management of pancreatic pain follows the World Health Organization three-step ladder for pain control, but this classic model seems sometimes insufficient in pancreatic disease. Lately, therapeutic endoscopic ultrasound (EUS) has emerged as an effective alternative in pancreatic pain treatment, since the first descriptions of EUS-guided celiac plexus block and plexus neurolysis. Several studies confirm the effectiveness of these techniques, showing better results compared with those performed under fluoroscopy guidance, with less adverse effects and complications. In addition, they are easy and safe interventions, which can be performed by any endoscopist trained in basic therapeutic EUS. Both celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are performed using a lineal therapeutic echoendoscope, injecting different substances in order to reduce the effects of celiac plexus activity. CPB is mainly recommended in pain due to chronic pancreatitis a well as CPN is preferred in pancreatic cancer, being more effective than CPB even with only one session. In this review we pretend to summarize the state-of-art in EUS-guided therapy, focusing in treatment of chronic pancreatic pain, neoplastic and benign, reviewing the main studies of effectiveness and comparing with other invasive techniques. In addition, we would like to evaluate the effectiveness of combined treatment, according to recent publications.

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“…reported a fatal case with hepatic and splenic infarction, as well as ischemia of the stomach and proximal small bowel after EUS-CPN (central injection). [ 27 ] Diffusion of ethanol into the celiac artery resulting in arterial vasospasm, the sclerosing effect of absolute alcohol and arterial embolisms after injection are a plausible mechanism for injury. [ 22 27 ]…”

Section: Complications Of Endoscopic Ultrasound-celiac Plexus Neurolymentioning

confidence: 99%

EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer

2014

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Patients with pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) can develop abdominal pain that can be debilitating. Celiac plexus neurolysis (CPN) is a chemical ablation of the celiac plexus that can be used to treat pain caused by pancreatic malignancy. It can be performed by an anterior or posterior approach, and also can be done percutaneously or under guidance of transabdominal ultrasound, computed tomography, intra-operatively or most recently under linear endoscopic ultrasound (EUS) guidance (EUS-CPN). EUS is well-suited for identification of the celiac plexus due to the close proximity of the gastric wall to the origin of the celiac artery. EUS-CPN is now widely practiced, and different EUS approaches have been developed in order to improve the efficacy of this technique. Our objective is to review the use of EUS-CPN in PDAC, including a description of different techniques, review of its efficacy, predictors of pain response, and describe its limitations and safety, as well as new developments.

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

Cited by 32 publications

References 8 publications

Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Eus-guided therapy for pancreatic pain: easy, effective and safe. why isn´t the first therapeutic approach?

EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer

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