Abdominal pain in patients with pancreatic cancer is a common symptom that is often difficult to manage. Opioids are frequently used in an attempt to mitigate pain; however, side effects may develop. Celiac plexus neurolysis (CPN) affords effective pain control in patients with pancreatic cancer and is not associated with opioid side effects. Endoscopic ultrasound (EUS)-guided CPN has demonstrated safety and efficacy due to real-time imaging and anterior access to the celiac plexus from the posterior gastric wall, thereby avoiding complications related to the puncture of spinal nerves, arteries and the diaphragm, and is now practiced widely. Furthermore, two new techniques of EUS-guided neurolysis for abdominal pain management in pancreatic cancer patients have recently been developed. The first technique is EUS-guided celiac ganglia neurolysis (EUS-CGN) in which EUS facilitates CGN by enabling direct injection into the individual celiac ganglion, and the second technique is EUS-guided broad plexus neurolysis (EUS-BPN) which extends over the superior mesenteric artery. This review provides evidence for the efficacy of EUS-CPN. Particular attention is paid to the two new techniques of EUS-guided neurolysis, EUS-CGN and EUS-BPN.

Keywords:
Celiac plexus neurolysis, Endoscopic ultrasound, EUS-guided broad plexus neurolysis, EUS-guided celiac ganglia neurolysis, Pancreatic cancer, Abdominal pain
1.
Brescia FJ, Portenoy RK, Ryan M, Krasnoff L, Gray G: Pain, opioid use, and survival in hospitalized patients with advanced cancer. J Clin Oncol 1992;10:149–155.
2.
Gress F, Schmitt C, Scerman S, lkenberry S, Lehman G: A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999;94:900–905.
3.
Lillence KD, Cameron JL, Kaufman HS, Yeo Cl, Pitt HA, Sauter PK: Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 1993;217:447–455.
4.
Ceyhan GO, Michalski CW, Demir IE, Muller MW, Friess H: Pancreatic pain. Best Pract Res Clin Gastroenterol 2008;22:31–44.
5.
Brescla FJ: Palliative care in pancreatic cancer. Cancer Control 2004;11:39–45.
6.
Cancer Pain Relief and Palliative Care. Geneva, World Health Organization, 1990.
7.
Ventafeidda V, Tamburini M, Caraceni A, De Conno F, Naldi F: A validation study of the WHO method for cancer pain relief. Cancer 1987;59:850–856.
8.
De Cicco M, Matovic M, Balestreri L, Fracasso A, Morassut S, Testa V: Single-needle celiac plexus block. Anesthesiology 1997;87:1301–1308.
9.
Kappis M: Erfahrungen mit Lokalanästhesie bei Bauchoperationen. Verh Dtsch Gesellsch Chir 1914;43:87–89.
10.
Sakamoto H, Kitano M, Kamata K, Komaki T, Imai H, Chikugo T, Takeyama Y, Kudo M: EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle. Am J Gastroenterol 2010;105:2599–2606.
11.
Schmulewitz N, Hawes R: EUS-guided celiac plexus neurolysis-technique and indication. Endoscopy 2003;35:S49–S53.
12.
Collins D, Penman I, Mishra G, Draganov P: EUS-guided celiac block and neurolysis. Endoscopy 2006;38:935–939.
13.
Wang PJ, Shang MY, Qian Z, Shao CW, Wang JH, Zhao XH: CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging 2006;31:710–718.
14.
Eisenberg E, Carr DB, Chalmers TC: Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 1995;80:290–295. Erratum in: Anesth Analg 1995;1:213.
15.
Davies DD: Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med 1993;86:264–266.
16.
Abdalla EK, Schell SR: Paraplegia following intraoperative celiac plexus injection. J Gastrointest Surg 1999;3:668–671.
17.
Montero Matamala A, Vidal Lopez F, Inaraja Martinez L: The percutaneous anterior approach to the celiac plexus using CT guidance. Pain 1988;34:285–288.
18.
Montero Matamala A, Vidal Lopez F, Aguilar Sanchez JL, Donoso Bach L: Percutaneous anterior approach to the coeliac plexus using ultrasound. Br J Anaesth 1989;62:637–640.
19.
Caratozzolo M, Lirici MM, Consalvo M, Marzano F, Fumarola E, Angelini L: Ultrasound-guided alcoholization of celiac plexus for pain control in oncology. Surg Endosc 1997;11:239–244.
20.
Sakamoto H, Kitano M, Nishio T, Takeyama Y, Tasuda C, Kudo M: Value of computed tomography for evaluating the injection site in endosonography-guided celiac plexus neurolysis. Dig Endosc 2006;18:206–211.
21.
Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Kudo M: Small cell carcinoma of the pancreas: role of EUS-FNA and subsequent effective chemotherapy using carboplatin and etoposide. J Gastroenterol 2009;44:432–438.
22.
Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Dote K, Takeyama Y, Das K, Yamao K, Kudo M: Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2009;24:384–390.
23.
Wiersema M, Wiersema L: Endosonography guided celiac plexus neurolysis (EUS CPN) in patients with pain due to intra-abdominal malignancy. Gastrointest Endosc 1996;43:A565.
24.
Gunaratnam NT, Sarma AV, Norton ID, Wiersema MJ: A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc 2001;54:316–324.
25.
Levy M, Rajan E, Keeney G, Fletcher JG, Topazian M: Neural ganglia visualized by endoscopic ultrasound. Am J Gastroenterol 2006;101:1787–1791.
26.
Ha TI, Kim GH, Kang DH, Song GA, Kim S, Lee JW: Detection of celiac ganglia with radial scanning endoscopic ultrasonography. Korean J Intern Med 2008;23:5–8.
27.
Hoffman BJ: EUS-guided celiac plexus block/neurolysis. Gastrointest Endosc 2002;56:S26–S28.
28.
Sahai AV, Lemelin V, Lam E, Paquin SC: Central versus bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol 2009;104:326–329.
29.
Adler DG, Jacobson BC, Davila RE, Hirota WK, Leighton JA, Qureshi WA, Rajan E, Zuckerman MJ, Fanelli RD, Baron TH, Faigel DO, ASGE: ASGE guideline: complications of EUS. Gastrointest Endosc 2005;61:8–12.
30.
Gress F, Ciaccia D, Kiel L, Sherman S, Lehman G: Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (P): a large single center experience. Gastrointest Endosc 1997;45:AB173.
31.
Gleeson FC, Levy MJ, Papachristou GI, Pelaez-Luna M, Rajan E, Clain JE, Topazian MD: Frequency of visualization of presumed celiac ganglia by endoscopic ultrasound. Endoscopy 2007;39:620–624.
32.
Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, et al: Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol 2008;103:98–103.
© 2011 S. Karger AG, Basel and IAP
2011
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