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
© Georg Thieme Verlag KG Stuttgart · New York

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

A Rossi
1   USL Umbria 2, Gastroenterology and Endoscopy Unit, Orvieto, Italy
,
M Piciucchi
1   USL Umbria 2, Gastroenterology and Endoscopy Unit, Orvieto, Italy
,
D Castellani
1   Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
,
H Bertani
1   Azienda Ospealiera/Univeristaria di Modena, Ospedale di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
,
A Sbrozzi-Vanni
1   Apuane Hospital USL Toscana Nord-Ovest, Gastroenterology and Endoscopy Unit, Massa, Italy
,
U Germani
1   Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
,
O Morelli
1   Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
,
R Conigliaro
1   Azienda Ospealiera/Univeristaria di Modena, Ospedale di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
,
R Manta
1   Azienda Ospedaliera/Universitaria di Perugia, Ospedale Santa Maria della Misericordia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    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.


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