EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video) - 11/08/11
Reprint requests: Afonso Ribeiro, MD, Division of Gastroenterology, 1475 NW 12th Avenue, Suite 1175, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136Résumé |
Background |
EUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.
Objective |
To determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.
Design |
Retrospective analysis of prospective database.
Setting |
Academic medical center.
Patients |
Sixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.
Interventions |
EUS-CPN injected directly into celiac ganglia when visible by linear EUS or bilateral injection at the celiac vascular trunk.
Main Outcome Measurements |
Predictors of pain improvement at week 1 by univariate and multivariate analysis.
Results |
At week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P < .001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.
Limitations |
Retrospective design and lack of blinding.
Conclusions |
Visualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy.
Le texte complet de cet article est disponible en PDF.Abbreviations : CPN, EUS-CPN, EUS-CPN-G, EUS-CPN-T, EUS-FNA, VAS
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 73 - N° 2
P. 267-274 - février 2011 Retour au numéro
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