Original articleClinical endoscopyEUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study
Section snippets
Patients
Patients were eligible for EUS-guided direct celiac ganglion irradiation if they had moderate to severe narcotic-dependent pain resulting from biopsy-proven unresectable PC. Tumors were deemed unresectable if there was superior mesenteric artery or celiac encasement greater than 180 degrees, unreconstructable superior mesenteric vein/portal occlusion or metastases to lymph nodes beyond the field of resection.12 Patients were excluded from the study if they had (1) uncorrectable coagulopathy
Results
Twenty-seven patients were initially enrolled in the study from January 2009 to December 2011. Four patients underwent the standard CPN procedure because the celiac ganglia could not be clearly identified. The celiac ganglia could be seen and accessed in 85.2% (23/27) of patients. As a result, a total of 23 patients underwent direct ganglion implantation with 125I seeds. The patients (14 men and 9 women) were between 38 and 77 years of age, with an average age of 64 years. Of all patients
Discussion
Chemotherapy is the first-line treatment in the majority of PC patients at a palliative stage and has been observed to have the ability to reduce pain, but the analgesic effect is limited and weak.18 The standard approach to the management of cancer pain follows the WHO 3-step analgesic ladder, beginning with nonopioid analgesics, followed by weak opioids, and finally strong opioids as necessary.13 Virtually all PC patients require increasing doses of opioids. Inevitably, intolerable adverse
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2022, Best Practice and Research: Clinical GastroenterologyNerve Injury and Regeneration after Neurolysis: Ethanol Alone versus Ethanol with Brachytherapy in Rabbits
2022, Journal of Vascular and Interventional RadiologyCitation Excerpt :Compared with neurons, nerve fibers account for a more significant proportion of peripheral nerves, and the disintegration of axons is an essential factor affecting the transmission of pain electrical signals. However, it takes time for the 125I radioactive seed to take effect, and some patients may experience a temporary increase in pain during the initial implantation stage (21). Thus, a combination of ethanol injection, which can produce immediate effects, and 125I radioactive seed implantation is a more reasonable solution.
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2020, Gastrointestinal EndoscopyCitation Excerpt :All enrolled EUS-FNA procedures were performed with a linear-array echoendoscope (GF-UC240P-AL5/GF-UCT260 [Olympus, Tokyo, Japan] or EG-580UT [Fuji Film, Tokyo, Japan]) and a 22-gauge or 25-gauge needle. Immediately before the procedure, patients were placed in the left lateral decubitus position and underwent anesthesia-assisted sedation with intravenous propofol (2.0-2.5 mg/kg for initialization, then 8-10 mg/kg/h for maintenance).25 Other patients who could not be anesthetized because of cardiopulmonary or other comorbid conditions underwent sedation with intravenous diazepam (5 mg) and Demerol (50 mg).
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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Li at [email protected].
See CME section; p. 1020.
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Drs Wang and Jin contributed equally to this article.