A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: One injection or two?

Julia K. Leblanc, Mohammad Al-Haddad, Lee McHenry, Stuart Sherman, Michelle Juan, Kathleen McGreevy, Cynthia Johnson, Thomas J. Howard, Keith D. Lillemoe, John Dewitt

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Background: The technique of alcohol injection during EUS-guided celiac plexus neurolysis (CPN) in patients with pancreatic cancerrelated pain has not been standardized. Objective: To compare pain relief and safety of alcohol given as 1 versus 2 injections during EUS-guided CPN (EUS-CPN). Secondary outcomes examined were characteristics that predict response and survival. Design: Single-blinded, prospective, randomized, parallel-group study. Setting: Tertiary-care center. Patients: This study involved patients with pancreatic cancerrelated pain. Intervention: EUS-CPN done by injecting 20 mL of 0.75% bupivacaine and 10 mL 98% alcohol into 1 or 2 sites at the celiac trunk. Participants were interviewed by telephone at 24 hours and weekly thereafter. Main Outcome Measurements: Time until onset of pain relief, duration of pain relief, complications. Results: Fifty patients (mean age 63 years; 24 men) were enrolled and randomized (29 in 1-injection, 21 in 2-injections groups). Pain relief was observed in 37 (74%) patients: 20 (69%) in the 1-injection group and 17 (81%) in the 2-injection group (chi-square P =.340). Median onset of pain relief was 1 day for both 1-injection (range 1-28 days) and 2-injection (range 1-21 days) groups (Mann-Whitney P =.943). Median duration of pain relief in the 1-injection and 2-injection groups was 11 weeks and 14 weeks, respectively (log-rank P =.612). Complete pain relief was observed in 4 (8%) patients total, 2 in each group. There were no long-term complications. Limitations: Single-blinded study. Conclusion: There were no differences in onset or duration of pain relief when either 1 or 2 injections were used. There was no difference in safety or survival between the 2 groups. (Clinical trial registration number: NCT00583479.)

Original languageEnglish (US)
Pages (from-to)1300-1307
Number of pages8
JournalGastrointestinal endoscopy
Volume74
Issue number6
DOIs
StatePublished - Dec 1 2011

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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