Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2186
Revised: December 27, 2013
Accepted: January 3, 2014
Published online: March 7, 2014
Processing time: 129 Days and 3.1 Hours
Pancreatic cancer is the second most common abdominal cancer in North America with an estimated 20% resectability at diagnosis, and overall 5-year survival of 5%. Pain is common in pancreatic cancer patients with 70%-80% suffering substantial pain. Celiac plexus neurolysis (CPN) is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption. CPN is performed by injecting absolute alcohol into the celiac plexus neural network of ganglia. This review sets out to explore the current status of CPN in non-resectable pancreatic cancer. We will examine: (1) the efficacy and safety of percutaneous-CPN and endoscopic ultrasound guided-CPN; (2) specific technique modifications including bilateral (vs central) injections and celiac ganglia neurolysis; and (3) the issue of CPN timing, early at pancreatic cancer diagnosis vs traditional late use as salvage therapy.
Core tip: The efficacy of salvage celiac plexus neurolysis (CPN) either by percutaneous or endoscopic ultrasound (EUS) guided technique has been modest in its ability to reduce pain and narcotic requirements in patients with unresectable pancreatic cancer, and few studies with rigorous methodology exist. Data for early EUS-CPN at time of diagnosis appears to prevent pain escalation while moderating narcotic use and future studies should explore CPN for patients before rescue therapy is needed. Reports of serious and fatal complications of CPN have surfaced in recent years.