EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)

Abstract

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.