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World J Gastroenterol. Mar 7, 2014; 20(9): 2186-2192
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2186
Celiac plexus neurolysis in the management of unresectable pancreatic cancer: When and how?
Jonathan M Wyse, Yen-I Chen, Anand V Sahai
Jonathan M Wyse, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal H3T 1E2, Quebec, Canada
Yen-I Chen, McGill University Health Center, McGill University, Montreal H3A 1A1, Quebec, Canada
Anand V Sahai, Division of Gastroenterology, Hopital Saint Luc, Centre Hospitaliér de l’Universite de Montréal, Montreal H2X 1P1, Quebec, Canada
Author contributions: All author contributed equally to the preparation of this manuscript.
Correspondence to: Jonathan M Wyse, MD, MSc, Division of Gastroenterology, Jewish General Hospital, McGill University, 3755 Chemin de la Cote-Ste-Catherine, Montreal H3T 1E2, Quebec, Canada. jonathan.wyse@mcgill.ca
Telephone: +1-514-3408286 Fax: +1-514-3408282
Received: October 28, 2013
Revised: December 27, 2013
Accepted: January 3, 2014
Published online: March 7, 2014
Processing time: 129 Days and 3.1 Hours
Abstract

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.

Keywords: Celiac plexus neurolysis, Endoscopic ultrasound, Pancreatic cancer, Pain, Opioid, Gastrointestinal endoscopy

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.