SAFE AND EFFICACY OF SINGLE CENTRAL ENDOSCOPIC ULTRASOUND GUIDED NEUROLYSIS OF CELIAC PLEXUS FOR PAIN RELIEF IN UNRESECTABLE PANCREATIC CANCER PATIENTS

A Rossi; M Piciucchi; D Castellani; H Bertani; A Sbrozzi-Vanni; U Germani; O Morelli; R Conigliaro; R Manta

doi:10.1055/s-0040-1704569

Endoscopy, Table of Contents

Endoscopy 2020; 52(S 01): S183
DOI: 10.1055/s-0040-1704569

ESGE Days 2020 ePoster Podium presentations

Friday, April 24, 2020 14:30 – 15:00 Pancreatic EUS-guided interventions ePoster Podium 3

SAFE AND EFFICACY OF SINGLE CENTRAL ENDOSCOPIC ULTRASOUND GUIDED NEUROLYSIS OF CELIAC PLEXUS FOR PAIN RELIEF IN UNRESECTABLE PANCREATIC CANCER PATIENTS

Authors

A Rossi

¹USL Umbria 2, Gastroenterology and Endoscopy Unit, Orvieto, Italy
M Piciucchi

¹USL Umbria 2, Gastroenterology and Endoscopy Unit, Orvieto, Italy
D Castellani

¹Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
H Bertani

¹Azienda Ospealiera/Univeristaria di Modena, Ospedale di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
A Sbrozzi-Vanni

¹Apuane Hospital USL Toscana Nord-Ovest, Gastroenterology and Endoscopy Unit, Massa, Italy
U Germani

¹Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
O Morelli

¹Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
R Conigliaro

¹Azienda Ospealiera/Univeristaria di Modena, Ospedale di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
R Manta

¹Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy

Abstract

Full Text

Aims Unresectable Pancreatic Cancer (UPC) is strongly associated to severe pain difficult to treat with opiate. Endoscopic-Ultrasound-guided celiac plexus neurolysis (EUS-CPN) significant improve pain reducing opiate need in UPC. Recent guidelines suggest combined bilateral EUS-CPN approach, however technical difficulty related to strictly anatomic rapport with vessels it could limit its wide clinical spread. In this view a single central EUS-CPN approach appears easier and faster to implement and learn.

Our aim is to evaluate the safety and efficacy of EUS-CPN performed with a single injection of anesthetic followed by alcohol in the central celiac plexus area.

Methods Retrospective analysis of multicenter prospective-enrolled UPC-patients with uncontrolled pain treated with single central EUS-CPN. Early/late complications and VAS score after EUS-CPN were recorded after 1 and 2 months follow-up.

Results 102 UPC-patients (56 male; median age 55 years) with median baseline VAS for pain of 8 and median opiate requiring of 14 mg/day were enrolled in 5 years from 3 regional referral centers. The most part of UPC were large (median 38 mm) head (75.5%) neoplasm. All patients survived at 1-month follow-up; 19 patients had died at 2-months follow-up. 48-hours after a simple short-time treatment (median duration 35 minutes) a significant pain response (minimum 2 points VAS decrease from baseline) was achieved in 85 (83.5%) patients (mean VAS-pre=8 ±2.3 vs mean VAS-post= 3.6 ±1.5 p< 0.0001). Significant pain improvement (mean VAS-pre=8 ±2.3 vs mean VAS-post=2.2 ±0.8 p< 0,0001) was stable observed 30-days after CPN. VAS resulted 2.8 in alive cases at 2-months follow-up.No several complications were observed whereas 14 patients (13.7%) had mild self-limiting side effects (diarrhea, hypotension, worsening of pain) resolving within 48 hours from CPN.

Conclusions In our retrospective analysis EUS-guided single anesthetic/alcohol injection in central celiac plexus appear to be a relatively quick and highly safe procedure for effective long-time pain-relief in UPC.