Original articleClinical endoscopyA prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?
Section snippets
Methods
This study was approved by the Institutional Review Board at Indiana University Medical Center/Indiana University Health. This was a single-center, randomized (1:1), single-blinded, parallel-group study. Patients with known or suspected pancreatic cancer–related pain secondary to pancreatic adenocarcinoma were eligible. Consecutive patients with known or suspected pancreatic cancer–related pain were enrolled by a nurse who was involved with data collection. Patients were excluded if they had an
Results
Fifty patients were enrolled over a 70-month period (December 2002 through September 2008). Enrollment is demonstrated in Figure 3. Patient characteristics are shown in Table 1. Twenty-nine (58%) patients had EUS staging and EUS-CPN performed at the same time. One patient had a prior 1-injection EUS-CPN 5 months before study entry and experienced 3 months of pain relief. The other patient had a prior 2-injection EUS-CPN 4.5 months before study entry; however, the duration of pain relief is not
Discussion
There was no difference in onset or duration of pain relief between the 2 groups. Pain relief was achieved in 74% of patients. These results support our hypothesis that altering the technique of injection between 1 and 2 did not alter pain relief onset or duration. This observation is likely explained by the equivalent distribution of the total amount of neurolytic agent into the celiac region, regardless of injection technique. Our study contributes several new findings of EUS-CPN. First,
Conclusions
Our study supports the use of a single injection during EUS-CPN in patients with unresectable pancreatic cancer and pancreatic cancer–related pain. Our results are generalizable to patients with pancreatic cancer–related pain. We found no differences between the 1-injection and 2-injection groups with respect to onset of pain relief, duration of pain relief, complete response, complications, or survival. Although both 1-injection and 2-injection methods were equally safe and efficacious, a
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2021, PancreatologyCitation Excerpt :At week two and four, the proportions reporting analgesic response were 67% (95% CI 56%–79%) (I2 = 72.4%, P < 0.05) and 46% (95% CI 36%–55%) (I2 = 0.00) (P < 0.05) respectively (Figs. 2 and 3). Three parallel group RCTs provided direct comparison between central and bilateral injection techniques [25,33,34]. All of them showed higher response rates in their bilateral injection groups but none of them reached statistical significance.
DISCLOSURE: C. Johnson is a stockholder in Eli Lilly & Co. No other financial relationships relevant to this publication were disclosed.
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