Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.110
Revised: November 1, 2013
Accepted: November 18, 2013
Published online: January 7, 2014
Pain in pancreatic cancer is often a major problem of treatment. Administration of opioids is frequently limited by side effects or insufficient analgesia. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) represents an alternative for the palliative treatment of visceral pain in patients with pancreatic cancer. This review focuses on the indications, technique, outcomes of EUS-CPN and predictors of pain relief. EUS-CPN should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The effect on quality of life is controversial and survival is not influenced. The approach could be done in the central position of the celiac axis, which is easy to perform, or in the bilateral position of the celiac axis, with similar results in terms of pain alleviation. The EUS-CPN with multiple intraganglia injection approach seems to have better results, although extended studies are still needed. Further trials are required to enable more confident conclusions regarding timing, quantity of alcohol injected and the method of choice. Severe complications have rarely been reported, and great care should be taken in choosing the site of alcohol injection.
Core tip: Endoscopic ultrasound-guided celiac plexus neurolysis should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The central technique is easy to perform, but intraganglia injection seems to give better results. This review focuses on methods of celiac neurolysis, with details about endoscopic ultrasound-guided celiac plexus neurolysis, indications and outcomes with regard to efficacy and safety, novel techniques, and predictors of pain response.