Retrospective Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10512-10517
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10512
Phenol-based endoscopic ultrasound-guided celiac plexus neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients: A pilot study
Hirotoshi Ishiwatari, Tsuyoshi Hayashi, Makoto Yoshida, Michihiro Ono, Hiroyuki Masuko, Tsutomu Sato, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Atsushi Miyamoto, Tomoko Sonoda, Junji Kato
Hirotoshi Ishiwatari, Tsuyoshi Hayashi, Makoto Yoshida, Michihiro Ono, Tsutomu Sato, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Junji Kato, Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo 0600061, Japan
Tomoko Sonoda, Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 0600061, Japan
Hiroyuki Masuko, Atsushi Miyamoto, Department of Hospital Pharmacy, Sapporo Medical University School of Medicine, Sapporo 0600061, Japan
Author contributions: Ishiwatari H designed the research; Ishiwatari H and Hayashi T performed the endoscopic procedure; Ishiwatari H, Hayahi T, Yoshida M, and Ono M collected the data and provided clinical advice; Masuko H and Miyamoto A prepared the neurolytic agent and provided clinical advice; Sato T, Miyanishi K, Sato Y, Takimoto R, Kobune M and Kato J provided clinical advise; Ishiwatari H and Sonoda T analyzed the data; Ishiwatari H wrote the paper; Hayashi T revised the paper; all authors approved the final manuscript for publication.
Correspondence to: Hirotoshi Ishiwatari, MD, PhD, Assistant Professor, Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. ishihiro481019@gmail.com
Telephone: +81-11-6112111-3254 Fax: +81-11-6127987
Received: February 19, 2014
Revised: April 14, 2014
Accepted: May 19, 2014
Published online: August 14, 2014
Abstract

AIM: To investigate the effectiveness of phenol for the relief of cancer pain by endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN).

METHODS: Twenty-two patients referred to our hospital with cancer pain from August 2009 to July 2011 for EUS-CPN were enrolled in this study. Phenol was used for 6 patients with alcohol intolerance and ethanol was used for 16 patients without alcohol intolerance. The primary endpoint was the positive response rate (pain score decreased to ≤ 3) on postoperative day 7. Secondary endpoints included the time to onset of pain relief, duration of pain relief, and complication rates.

RESULTS: There was no significant difference in the positive response rate on day 7. The rates were 83% and 69% in the phenol and ethanol groups, respectively. Regarding the time to onset of pain relief, in the phenol group, the median pre-treatment pain score was 5, whereas the post-treatment scores decreased to 1.5, 1.5, and 1.5 at 2, 8, and 24 h, respectively (P < 0.05). In the ethanol group, the median pre-treatment pain score was 5.5, whereas the post-treatment scores significantly decreased to 2.5, 2.5, and 2.5 at 2, 8, and 24 h, respectively (P < 0.01). There was no significant difference in the duration of pain relief between the phenol and ethanol groups. No significant difference was found in the rate of complications between the 2 groups; however, burning pain and inebriation occurred only in the ethanol group.

CONCLUSION: Phenol had similar pain-relieving effects to ethanol in EUS-CPN. Comparing the incidences of inebriation and burning pain, phenol may be superior to ethanol in EUS-CPN procedures.

Keywords: Celiac plexus neurolysis, Celiac plexus blockade, Endoscopic ultrasound, Phenol, Pain management, Upper gastrointestinal cancer

Core tip: We compared the pain-relieving effect and complications between endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) using phenol on patients intolerant to alcohol and ethanol on patients without alcohol intolerance. Phenol had similar pain-relieving effects to ethanol; using phenol can avoid burning pain and inebriation complications. To date, few data regarding phenol-based EUS-CPN exist, and it is generally believed that phenol has a slightly slower onset and shorter duration of action than ethanol. Consequently, phenol is not routinely used in EUS-CPN. However, approximately half of East Asians lack mitochondrial aldehyde dehydrogenase activity, which causes alcohol intolerance. Our data provide evidence on phenol-based EUS-CPN for patients with alcohol intolerance.