Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2021; 27(1): 69-79
Published online Jan 7, 2021. doi: 10.3748/wjg.v27.i1.69
Predictors of pain response after endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain caused by pancreatic malignancy
Chao-Qun Han, Xue-Lian Tang, Qin Zhang, Chi Nie, Jun Liu, Zhen Ding
Chao-Qun Han, Xue-Lian Tang, Qin Zhang, Chi Nie, Jun Liu, Zhen Ding, Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Han CQ performed the literature search and data extraction and drafted of the manuscript; Tang XL and Zhang Q collected the data; Nie C and Liu J contributed important intellectual content; Ding Z designed the study and edited the manuscript as corresponding author.
Supported by National Natural Science Foundation of China, No. 81800467 and No. 81770637.
Institutional review board statement: The study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG No: IORG0003571).
Informed consent statement: Written informed consent was obtained from the patients.
Conflict-of-interest statement: There is no conflict of interest in this study.
Data sharing statement: Dataset available from the corresponding author at 271914799@qq.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Ding, MD, PhD, Doctor, Professor, Teacher, Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. 2017xh0122@hust.edu.cn
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: August 8, 2020
Revised: August 15, 2020
Accepted: November 12, 2020
Article in press: November 12, 2020
Published online: January 7, 2021
Abstract
BACKGROUND

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) has gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. However, response to treatment is variable.

AIM

To identify the efficacy of EUS-CPN and explore determinants of pain response in EUS-CPN for pancreatic cancer-associated pain.

METHODS

A retrospective study of 58 patients with abdominal pain due to inoperable pancreatic cancer who underwent EUS-CPN were included. The efficacy for palliation of pain was evaluated based on the visual analog scale pain score at 1 wk and 4 wk after EUS-CPN. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response.

RESULTS

A good pain response was obtained in 74.1% and 67.2% of patients at 1 wk and 4 wk, respectively. Tumors located in the body/tail of the pancreas and patients receiving bilateral treatment were weakly associated with a good outcome. Multivariate analysis revealed patients with invisible ganglia and metastatic disease were significant factors for a negative response to EUS-CPN at 1 wk and 4 wk, respectively, particularly for invasion of the celiac plexus (odds ratio (OR) = 13.20, P = 0.003 for 1 wk and OR = 15.11, P = 0.001 for 4 wk). No severe adverse events were reported.

CONCLUSION

EUS-CPN is a safe and effective form of treatment for intractable pancreatic cancer-associated pain. Invisible ganglia, distant metastasis, and invasion of the celiac plexus were predictors of less effective response in EUS-CPN for pancreatic cancer-related pain. For these patients, efficacy warrants attention.

Keywords: Endoscopic ultrasound, Celiac plexus neurolysis, Pancreatic cancer, Pain, Predictor

Core Tip: Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely used to treat pancreatic cancer-associated pain. However, response to treatment is variable. The procedure is not always effective, is often variable, and yields transient results. The data on determinants of pain relief response following EUS-CPN are limited and still need to undergo further exploration. Our study found that invisible ganglia, presence of distant metastases, and celiac plexus invasion were considered to be significantly negative variables. The strongest predictor of response was celiac plexus invasion. Moreover, tumors located at the body/tail predicted a better response than those with tumors at the pancreatic head/neck.