ENDOSONOGRAPHY-GUIDED CELIAC PLEXUS NEUROLYSIS

Background: We have evaluated the safety and efficacy of performing en dosonography-guided celiac plexus neurolysis (EUS CPN) in patients wit h pain due to intra-abdominal malignancies. Methods: Thirty patients w ith upper abdominal pain requiring narcotic analgesia and suspected or known intra-abdominal malignancy were selected for EUS CPN. This grou p included 25 patients with pancreas carcinoma and 5 patients with int ra-abdominal metastases. Using the linear array ultrasound endoscope a nd a prototype needle catheter, transgastric injection of the celiac p lexus with bupivacaine and 98% dehydrated absolute alcohol was accompl ished. Results: Pain scopes were significantly lower compared with bas eline at 2, 4, 8, and 12 weeks after EUS CPN (median follow-up: 10 wee ks). At these follow-up intervals, 82% to 91% of patients required the same or less pain medication and 79% to 88% of patients had persisten t improvement in their pain score. Comparison of patients with TXNXM1 versus TXNXM0 pancreatic carcinoma revealed higher initial pain scores (7.9 +/- 1.92 versus 5.8 +/- 2.0, p = .02) and a greater decline in p ain scares (decrease of 6.1 +/- 3.1 versus 4.8 +/- 2.0, p = .004). Com plications were minor and consisted of transient diarrhea in four pati ents. Conclusion: EUS CPN is a safe and effective means for improving pain control in patients with intra-abdominal malignancy. The techniqu e may be performed as an outpatient at the same setting as the EUS sta ging examination.