Original article Clinical endoscopy| Volume 92, ISSUE 1, P120-130, July 2020

Efficacy of EUS-guided celiac plexus neurolysis compared with medication alone for unresectable pancreatic cancer in the oxycodone/fentanyl era: a prospective randomized control study

Published:January 14, 2020DOI:

      Background and aims

      The efficacy of celiac plexus neurolysis (CPN) with EUS guidance (EUS-CPN) has not been confirmed in the era of developed opioids. The aim of this study was to evaluate the efficacy of EUS-CPN for patients with pancreatic cancer–associated pain to compare medication using oxycodone and/or fentanyl with and without EUS-CPN.


      In this randomized control study involving patients who underwent EUS-CPN and those who did not, pain, quality of life (QOL), and opioid consumption were compared. Standard medicinal treatment using oxycodone and/or fentanyl was performed for both groups. The primary endpoint was defined as the pain evaluated by using a visual analog scale (VAS) rated from a 0 to 10, 4 weeks after the baseline.


      For 48 registered patients, the outcomes of 24 patients in the EUS-CPN group and 22 patients in the control group were analyzed. EUS-CPN was successfully performed and did not induce severe procedure-related adverse events for all patients in the EUS-CPN group. Although the average pain VAS scores for both groups significantly decreased in comparison with baseline, scores were not statistically different between the groups at week 4 (1.3 ± 1.3 for the EUS-CPN group vs 2.3 ± 2.3 for the control group, P = .10). There was no statistical difference or tendency in favor of EUS-CPN at evaluation points of weeks 1, 2, 8, and 12. Moreover, the average VAS scores for QOL and the average opioid consumption between the groups were not different at all evaluation points.


      EUS-CPN for patients with pancreatic cancer–associated pain did not appear to improve pain, QOL, or opioid consumption compared with those who did not undergo EUS-CPN and medicated with oxycodone/fentanyl. Although EUS-CPN can be an option, it was not found to have a large enough impact to be routinely performed for all patients with pain. (Clinical trial registration number: UMIN 000037172.)


      CI (confidence interval), CPN (celiac plexus neurolysis), EUS-CPN (EUS-guided CPN), QOL (quality of life), SMA (superior mesenteric artery), UICC (Union for International Cancer Control), VAS (visual analog scale)
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      Linked Article

      • EUS-guided celiac plexus neurolysis versus medication alone for unresectable pancreatic cancer
        Gastrointestinal EndoscopyVol. 92Issue 5
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          We read with great interest the research by Kanno et al,1 in which the authors assessed the effectiveness of celiac plexus neurolysis (CPN) with EUS guidance (EUS-CPN) for patients with pancreatic cancer–associated pain to compare medication using oxycodone and/or fentanyl with and without EUS-CPN. The final result indicated that compared with patients who did not undergo EUS-CPN and who were medicated with oxycodone/fentanyl, EUS-CPN did not seem to improve pain, quality of life, and opioid dosage.
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      • Celiac plexus neurolysis versus opioid analgesic therapy: Are we still guided by the presumptions?
        Gastrointestinal EndoscopyVol. 92Issue 1
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          It is estimated that over 55,000 new cases of pancreatic ductal adenocarcinoma (PDAC) are diagnosed annually in the United States and nearly 500,000 globally.1,2 In addition to nausea, jaundice, and weight loss, pain is frequently reported by patients with PDAC.3 Although approximately 30% of patients with PDAC report abdominal and/or back pain at the time of diagnosis, up to 80% report pain over the course of their disease.4 Although pain in these patients has been correlated with decreased Eastern Co-operative Oncology Group and Karnofsky performance status and shortened survival, causality continues to be debated.
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