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Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience

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Abstract

Objectives

The purpose of this study was to determine the efficacy and safety of contrast-enhanced ultrasound (CEUS)–guided celiac plexus neurolysis (CPN) in patients with upper abdominal cancer pain.

Methods

Thirty-five patients with upper abdominal cancers tortured by intractable upper abdominal pain underwent CEUS-guided CPN with ethanol. The pain alleviation and opioid intake were observed and evaluated during a 3-month follow-up after CPN. The dispersion of alcohol around the aorta was evaluated on 3D-CEUS. Complications were assessed during CPN and at follow-up.

Results

All of the 35 patients’ CPN was successfully achieved. Pain relief was observed in 28 (80%), 20 (57.1%), 27 (77.1%), 20 (57.1%), and 10 (29.4%) patients immediately, 1 day, 1 month, 2 months, and 3 months after CPN, respectively. The agent dispersion around the aorta on CEUS images of 28 patients who showed pain relief was at least 90° of the circumference around the aorta. The median duration of pain alleviation was 2.7 months (95% confidence interval [CI], 2.5–2.9). Less than half of the patients had minor complications including irritant pain at the puncture site (8 of 35; 22.9%), diarrhea (4 of 35; 11.4%), nausea and vomiting (3 of 35; 8.6%), and post-procedural hypotension (1 of 35; 2.9%).

Conclusions

CEUS-guided CPN is a safe and effective method to alleviate refractory upper abdominal pain in patients with upper abdominal cancers. CEUS image allows the visualization of puncture path and observation of drug dispersion. The pain relief is relevant to the dispersion of neurolytic agent around the aorta.

Key Points

• CEUS-guided celiac plexus neurolysis (CPN) is feasible and easy.

• It allows direct visualization of the diffusion of the neurolytic agent in the retroperitoneal anatomic space.

• CEUS-guided CPN improves safety of CPN by clearly delineating the needle path.

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Abbreviations

2D:

Two dimensional

3D:

Three dimensional

CEUS:

Contrast-enhanced ultrasound

CPN:

Celiac plexus neurolysis

CT:

Computed tomography

EUS:

Endoscopic ultrasound

iv:

Intravenous access

MI:

Mechanical index

MR:

Magnetic resonance

ROI:

Region of interest

US:

Ultrasound/ultrasonography

VAS:

Visual analog scales

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Funding

This study has received funding from the Sichuan Province Science and Technology Support Program (grant number SCCHEC-03-2018-002).

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Authors and Affiliations

  1. Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China

    Lu Wang, Man Lu, Xiaobo Wu, Xueqing Cheng, Tingting Li, Yuping Shen, Ting Liu & Yue Ma

  2. Electrical and Computer Engineering, University of Wisconsin Madison, Madison, 53703, USA

    Zirui Jiang

Authors
  1. Lu Wang
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  2. Man Lu
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  3. Xiaobo Wu
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  4. Xueqing Cheng
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  7. Yuping Shen
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  8. Ting Liu
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Correspondence to Man Lu.

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The scientific guarantor of this publication is Man Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Prospective

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• Performed at one institution

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Lu Wang and Man Lu are co-first authors.

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Wang, L., Lu, M., Wu, X. et al. Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience. Eur Radiol 30, 4514–4523 (2020). https://doi.org/10.1007/s00330-020-06705-z

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  • DOI: https://doi.org/10.1007/s00330-020-06705-z

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