Advertisement

Supportive Care in Cancer

, Volume 26, Issue 2, pp 353–359 | Cite as

Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis

  • Fan Lu
  • Jifu Dong
  • Yuming Tang
  • He Huang
  • Hui Liu
  • Li Song
  • Kexian ZhangEmail author
Review Article

Abstract

Context

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) by bilateral or unilateral approach is widely used in palliative abdominal pain management in pancreatic cancer patients, but the analgesic effect and relative risks of the two different puncture routes remain controversial.

Objectives

The aim of this systematic review was to evaluate the analgesic efficacy and safety of bilateral EUS-CPN compared with unilateral EUS-CPN.

Methods

An electronic database search was performed for randomized controlled trials comparing bilateral and unilateral approaches of EUS-CPN using the Pubmed, Cochrane Library, Web of Science, Google Scholar, and CNKI databases. Meta-analysis was performed using RevMan 5.3 after screening and methodological evaluation of the selected studies. Outcomes included pain relief, treatment response, analgesic reduction, complications, and quality of life (QOL).

Results

Six eligible studies involving 437 patients were included. No significant difference was found in short-term pain relief [SMD = 0.31, 95% CI (− 0.20, 0.81), P = 0.23] and response to treatment [RR = 0.99, 95% CI (0.77, 1.41), P = 0.97] between the bilateral and unilateral neurolysis groups. However, only the bilateral approach was associated with a statistically significant reduction in the postoperative use of analgesics [RR = 0.66, 95% CI (0.47, 0.94), P = 0.02] compared to the unilateral approach. A descriptive analysis was performed for complications and QOL.

Conclusion

The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.

Keywords

Endoscopic ultrasound Celiac plexus Neurolysis Bilateral Unilateral Meta-analysis 

Notes

Acknowledgements

The authors thank Dr. Jie Tian and Dr. Bixin Zheng for editorial assistance while preparing this manuscript.

Funding information

This review was supported by funding (fund number: 81500956) from the National Nature Science Foundation of China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Chen W, Zheng R, Zeng H, Zhang S (2016) The incidence and mortality of major cancers in China, 2012. Chin J Cancer 35:73CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    American Cancer Society (2016) Cancer facts and figures. Available from http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/index. Accessed November 21, 2016
  3. 3.
    Carrato A, Falcone A, Ducreux M et al (2015) A systematic review of the burden of pancreatic cancer in Europe: real-world impact on survival, quality of life and costs. J Gastrointest Cancer 46:201–211CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    De Angelis R, Sant M, Coleman MP et al (2014) Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol 15:23–34CrossRefPubMedGoogle Scholar
  5. 5.
    Sirri E, Castro FA, Kieschke J et al (2016) Recent trends in survival of patients with pancreatic cancer in Germany and the United States. Pancreas 45:908–914CrossRefPubMedGoogle Scholar
  6. 6.
    Morgan KA, Adams DB (2010) Solid tumors of the body and tail of the pancreas. Surg Clin North Am 90:287–307CrossRefPubMedGoogle Scholar
  7. 7.
    Yan BM, Myers RP (2007) Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 102:430–438CrossRefPubMedGoogle Scholar
  8. 8.
    Singh P, Chaturvedi A (2015) Complementary and alternative medicine in cancer pain management: a systematic review. Indian J Palliat Care 21:105–115CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Smyth EN, Shen W, Bowman L et al (2016) Patient-reported pain and other quality of life domains as prognostic factors for survival in a phase III clinical trial of patients with advanced breast cancer. Health Qual Life Outcomes 14:52CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kappis M (1914) Erfahrungen mit Lokalansthesie bei Bauchoperationen. Verh Dsch Ges Cire 43:87–89Google Scholar
  11. 11.
    Seicean A (2014) Celiac plexus neurolysis in pancreatic cancer: the endoscopic ultrasound approach. World J Gastroenterol 20:110–117CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Moura RN, De Moura EG, Bernardo WM et al (2015) Endoscopic-ultrasound versus percutaneous-guided celiac plexus block for chronic pancreatitis pain. A systematic review and meta-analysis. Rev Gastroenterol Peru 35:333–341PubMedGoogle Scholar
  13. 13.
    LeBlanc JK, Al-Haddad M, McHenry L et al (2011) A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two? Gastrointest Endosc 74:1300–1307CrossRefPubMedGoogle Scholar
  14. 14.
    Higgins JPT, Green S (eds) (2011) The Cochrane Collaboration’s tool for assessing risk of bias. Part 2: general methods for Cochrane reviews. Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration. Available from http://handbook.cochrane.org
  15. 15.
    Higgins JPT, Green S (eds) (2011) Extracting study results and converting to the desired format. Part 2: general methods for Cochrane reviews. The Cochrane Collaboration. Available from http://handbook.cochrane.org
  16. 16.
    Bhatnagar S, Joshi S, Rana SP et al (2014) Bedside ultrasound-guided celiac plexus neurolysis in upper abdominal cancer patients: a randomized, prospective study for comparison of percutaneous bilateral paramedian vs. unilateral paramedian needle-insertion technique. Pain Pract 14:E63–E68CrossRefPubMedGoogle Scholar
  17. 17.
    Tellez-Avila FI, Romano-Munive AF, Herrera-Esquivel Jde J, Ramirez-Luna MA (2013) Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. Endosc Ultrasound 2:153–156CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    LeBlanc JK, DeWitt J, Johnson C et al (2009) A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain. Gastrointest Endosc 69:835–842CrossRefPubMedGoogle Scholar
  19. 19.
    Ascunce G, Ribeiro A, Reis I et al (2011) EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video). Gastrointest Endosc 73:267–274CrossRefPubMedGoogle Scholar
  20. 20.
    Sahai AV, Lemelin V, Lam E, Paquin SC (2009) Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol 104:326–329CrossRefPubMedGoogle Scholar
  21. 21.
    Loukas M, Klaassen Z, Merbs W et al (2010) A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat 23:512–522CrossRefPubMedGoogle Scholar
  22. 22.
    Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS (2011) CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics 31:1599–1621CrossRefPubMedGoogle Scholar
  23. 23.
    Pereira GA, Lopes PT, Dos Santos AM et al (2014) Celiac plexus block: an anatomical study and simulation using computed tomography. Radiol Bras 47:283–287CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    NCCN (2016) clinical practice guideline in oncology for pancreatic adenocarcinoma version 2. Available from https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed October 25, 2016
  25. 25.
    De Cicco M, Matovic M, Bortolussi R et al (2001) Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions. Anesthesiology 94:561–265CrossRefPubMedGoogle Scholar
  26. 26.
    Brown DL, Bulley CK, Quiel EL (1987) Neurolytic celiac plexus block for pancreatic cancer pain. Anesth Analg 66:869–873PubMedGoogle Scholar
  27. 27.
    Kaufman M, Singh G, Das S et al (2010) Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol 44:127–134CrossRefPubMedGoogle Scholar
  28. 28.
    Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV (2011) Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol 29:3541–3546CrossRefPubMedGoogle Scholar
  29. 29.
    McGreevy K, Hurley RW, Erdek MA et al (2013) The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract 13:89–95CrossRefPubMedGoogle Scholar
  30. 30.
    Wang KX, Jin ZD, Du YQ et al (2012) EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study. Gastrointest Endosc 76:945–952CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Fan Lu
    • 1
  • Jifu Dong
    • 1
  • Yuming Tang
    • 1
  • He Huang
    • 1
  • Hui Liu
    • 2
  • Li Song
    • 2
  • Kexian Zhang
    • 1
    Email author
  1. 1.Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduPeople’s Republic of China
  2. 2.Department of Pain Management, West China HospitalSichuan UniversityChengduPeople’s Republic of China

Personalised recommendations