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Efficacy of EUS-guided celiac plexus neurolysis in combination with EUS-guided celiac ganglia neurolysis for pancreatic cancer-associated pain: a multicenter prospective trial

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Objectives

This study evaluated the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in combination with EUS-guided celiac ganglia neurolysis (EUS-CGN) for pancreatic cancer-associated pain.

Methods

This multicenter prospective trial was registered in the University Hospital Medical Information Network (UMIN000031228). Fifty-one consecutive patients with pancreatic cancer-associated pain who presented at one of five Japanese referral centers between February 2018 and March 2021 were enrolled. EUS-CGN was added in cases of visible celiac ganglia. The primary endpoint was effectiveness, defined as a decrease in the numerical rating scale (NRS) by ≥ 3 points. NRS data were prospectively acquired at 1 week after the procedure to evaluate its effectiveness and the extent of pain relief.

Results

The technical success rates of EUS-CPN and EUS-CGN were 100% and 80.4%, respectively. The overall efficacy rate was 82.4% [90% confidence interval (CI) 71.2–90.5, P < 0.0001]. The complete pain relief rate was 27.4%. The adverse events rate was 15.7%. The average pain relief period was 72 days. The efficacy rate was higher in the EUS-CPN plus EUS-CGN group than in the EUS-CPN alone group. EUS-CPN plus EUS-CGN was superior to EUS-CPN alone for achieving complete pain relief (P = 0.045). EUS-CGN did not improve the average length of the pain relief period.

Conclusions

EUS-CPN combined with EUS-CGN is safe, feasible, and effective for pain relief in patients with pancreatic cancer. The patients who received additional EUS-CGN had a better short-term response.

Clinical trial number

UMIN000031228.

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Abbreviations

CI:

Confidence interval

CPN:

Celiac plexus neurolysis

EUS:

Endoscopic ultrasonography

EUS-CGN:

Endoscopic ultrasound-guided celiac ganglia neurolysis

EUS-CPN:

Endoscopic ultrasound-guided celiac plexus neurolysis

NRS:

Numerical rating scale

SD:

Standard deviation

QOL:

Quality of life

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan

    Ken Kamata, Mamoru Takenaka & Masatoshi Kudo

  2. Department of Gastroenterology, National Hospital Organization Minami Wakayama Medical Center, Wakayama, Japan

    Makiko Kinoshita & Ikuharu Kinoshita

  3. Department of Gastroenterology, Okanami General Hospital, Mie, Japan

    Hajime Imai

  4. 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

    Takeshi Ogura

  5. Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Hisakazu Matsumoto & Kosuke Minaga

  6. Clinical Research Center, Kindai University Hospital, Osaka, Japan

    Yasutaka Chiba

  7. Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan

    Masayuki Kitano

Authors
  1. Ken Kamata
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  2. Makiko Kinoshita
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  3. Ikuharu Kinoshita
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  4. Hajime Imai
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  5. Takeshi Ogura
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  6. Hisakazu Matsumoto
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  7. Kosuke Minaga
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  8. Yasutaka Chiba
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  9. Mamoru Takenaka
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  10. Masatoshi Kudo
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  11. Masayuki Kitano
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Contributions

KK: wrote the manuscript, conceived and designed the study, and performed data collection and endosonography studies. MK, IK, HI, TO, HM, and KM: performed data collection, endosonography studies, and critically revised the manuscript with respect to important intellectual content. YC: performed statistical analysis of data. MT, MK, and MK: critically revised the manuscript with respect to important intellectual content.

Corresponding author

Correspondence to Ken Kamata.

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All authors have no COI to disclose.

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Kamata, K., Kinoshita, M., Kinoshita, I. et al. Efficacy of EUS-guided celiac plexus neurolysis in combination with EUS-guided celiac ganglia neurolysis for pancreatic cancer-associated pain: a multicenter prospective trial. Int J Clin Oncol 27, 1196–1201 (2022). https://doi.org/10.1007/s10147-022-02160-6

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  • DOI: https://doi.org/10.1007/s10147-022-02160-6

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