Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial

S. Doi; I. Yasuda; H. Kawakami; T. Hayashi; H. Hisai; A. Irisawa; T. Mukai; A. Katanuma; K. Kubota; T. Ohnishi; S. Ryozawa; K. Hara; T. Itoi; K. Hanada; K. Yamao

doi:10.1055/s-0032-1326225

Endoscopy, Table of Contents

Endoscopy 2013; 45(05): 362-369
DOI: 10.1055/s-0032-1326225

Original article

Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial

S. Doi

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

I. Yasuda

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

H. Kawakami

²Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

,

T. Hayashi

³Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

,

H. Hisai

⁴Department of Gastroenterology, Japan Red Cross Date General Hospital, Date, Japan

,

A. Irisawa

⁵Department of Gastroenterology, Fukushima Medical University Hospital, Fukushima, Japan

,

T. Mukai

⁶Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan

,

A. Katanuma

⁷Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan

,

K. Kubota

⁸Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

,

T. Ohnishi

⁹Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan

,

S. Ryozawa

¹⁰Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

K. Hara

¹¹Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan

,

T. Itoi

¹²Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

,

K. Hanada

¹³Center for Gastroendoscopy, Onomichi General Hospital, Onomichi, Japan, Japan

,

K. Yamao

¹¹Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan

› Author Affiliations

Abstract

Background and study aims: No prospective comparison of endoscopic ultrasonography-guided direct celiac ganglia neurolysis (EUS – CGN) vs. EUS-guided celiac plexus neurolysis (EUS – CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS – CGN and EUS – CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial.

Patients and methods: Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS – CGN or EUS – CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS – CGN and EUS – CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects.

Results: A total of 34 patients were assigned to each group. Visualization of ganglia was possible in 30 cases (88 %) in the EUS – CGN group. The positive response rate was significantly higher in the EUS – CGN group (73.5 %) than in the EUS – CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS – CGN group (50.0 %) than in the EUS – CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups.

Conclusions: EUS – CGN is significantly superior to conventional EUS – CPN in cancer pain relief.

Clinical trial registration: http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536)

Full Text

References

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