A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?

LeBlanc, Julia K.; Al-Haddad, Mohammad; McHenry, Lee; Sherman, Stuart; Juan, Michelle; McGreevy, Kathleen; Johnson, Cynthia; Howard, Thomas J.; Lillemoe, Keith D.; DeWitt, John

doi:10.1016/j.gie.2011.07.073

« Previous Next »Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1300-1307, December 2011

A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?

Julia K. LeBlanc, MD, MPH
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
- Reprint requests: Julia K. LeBlanc, MD, MPH, Associate Professor of Medicine, 550 N. University Blvd, UH 4100, Indianapolis, IN 46202
Mohammad Al-Haddad, MD
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
Lee McHenry, MD
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
Stuart Sherman, MD
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
Michelle Juan, RN
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
Kathleen McGreevy, RN
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA
Cynthia Johnson, MA
- Department of Biostatistics, Indiana University, Indianapolis, Indiana, USA
Thomas J. Howard, MD
- Department of Surgery, Indiana University, Indianapolis, Indiana, USA
Keith D. Lillemoe, MD
- Department of Surgery, Massachusetts General Hospital, Boston Massachusetts, USA
John DeWitt, MD
- Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA

Received 22 June 2011; accepted 29 July 2011. published online 17 October 2011.

Background

The technique of alcohol injection during EUS-guided celiac plexus neurolysis (CPN) in patients with pancreatic cancer–related pain has not been standardized.

Objective

To compare pain relief and safety of alcohol given as 1 versus 2 injections during EUS-guided CPN (EUS-CPN). Secondary outcomes examined were characteristics that predict response and survival.

Design

Single-blinded, prospective, randomized, parallel-group study.

Setting

Tertiary-care center.

Patients

This study involved patients with pancreatic cancer–related pain.

Intervention

EUS-CPN done by injecting 20 mL of 0.75% bupivacaine and 10 mL 98% alcohol into 1 or 2 sites at the celiac trunk. Participants were interviewed by telephone at 24 hours and weekly thereafter.

Main Outcome Measurements

Time until onset of pain relief, duration of pain relief, complications.

Results

Fifty patients (mean age 63 years; 24 men) were enrolled and randomized (29 in 1-injection, 21 in 2-injections groups). Pain relief was observed in 37 (74%) patients: 20 (69%) in the 1-injection group and 17 (81%) in the 2-injection group (chi-square P = .340). Median onset of pain relief was 1 day for both 1-injection (range 1-28 days) and 2-injection (range 1-21 days) groups (Mann-Whitney P = .943). Median duration of pain relief in the 1-injection and 2-injection groups was 11 weeks and 14 weeks, respectively (log-rank P = .612). Complete pain relief was observed in 4 (8%) patients total, 2 in each group. There were no long-term complications.

Limitations

Single-blinded study.

Conclusion

There were no differences in onset or duration of pain relief when either 1 or 2 injections were used. There was no difference in safety or survival between the 2 groups. (Clinical trial registration number: NCT00583479.)

Abbreviation: CPN, celiac plexus neurolysis, EUS-CPN, EUS-guided celiac plexus neurolysis