Endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer

Background: The treatment of pain in patients with pancreatic cancer is a difficult topic for the patients and their physicians. There are different treatment modalities with variable results. Celiac plexus neurolysis (CPN) is a technique with good previous results using fluoroscopy, CT guidance and recently, guided by endoscopic ultrasound (EUS). The aim of this study is to report the experience of EUS guided CPN (EUS CPN) for treatment of abdominal pain in patients with unresectable pancreatic cancer. Methods: Patients with inoperable pancreatic cancer diagnosed by CT, MRI and/or EUS were included. The measurement of pain was made with a visual analog pain scale applied before and after the procedure. Follow up was made at weeks 2 and 4 after the procedure. The use of morphine before and after EUS CPN was evaluated. Complications related to the procedure were recorded. Results: Eleven patients (five men and six women) underwent to the procedure, the mean age was 59 years (range 43-82). In follow-up at four weeks after the procedure, pain scores were reduced by at least 5 points of visual analog pain scale in 9 (72.2%) patients. At least a fifty percent reduction in pain or more was documented in 7 (63.6%) patients. Five patients substantially reduced their pain medication. No complications were seen in this study. Conclusions: The EUS NPC is an efficient and safe method for pain treatment in those patients with inoperable pancreatic cancer.