Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update

Table 1 Contraindications of endosonography-guided celiac plexus neurolysis

Absolute	Relative
Resectable pancreatic cancer	Esophagueal or gastric varices[21,26]
Coagulopathy (INR > 1.5)	Previous gastric surgery[2,14]
Low platelet count (< 50000 units)	Anomalies of celiac trunk[12]

Table 2 Endosonography-guided celiac plexus neurolysis efficacy in current literature

Ref.	Design	n	Technique	Neurolytic agent	Pain control (follow up)	Complications
Wiersema et al[6]	Retrospective	30	Bilateral	3 mL bupivacaine (0.25%) + 10 mL ethanol (98%)	88% (10 wk)	Diarrhea 13.3%, Pain 3.3%
Gunaratnam et al[17]	Prospective	58	Bilateral	3-6 mL bupivacaine (0.25%) + 10 mL ethanol (98%)	78% (24 wk)	Pain 8.6%
Levy et al[11]	Retrospective	17	Direct	8 mL bupivacaine (0.25%) + 12 mL ethanol (99%)	94% (2-4 wk)	Hypotension 35%, pain 41% and diarrhea 16%
Sahai et al[9]	Prospective	160	Central vs Bilateral	10 mL bupivacaine (0.5%) + 20 mL ethanol	45.9% vs 70.5% (7 d). P < 0.05	Bleeding 0.7%
Sakamoto et al[18]	Retrospective	67	Broad vs bilateral	3 mL lidocaine (1%) + 9 mL ethanol (98%)	Mean VAS scores 3.9 vs 2.5 (7 d) and 4.8 vs a 3.4 (30 d) P < 0.05	None
Wyse et al[7]	RCT	48	Bilateral vs analgesia	10 mL bupivacaine (0.50%) + 20 mL ethanol	Likert scale reduction 28% (4 wk) + 60% (12 wk) P < 0.05	None
LeBlanc et al[10]	RCT	50	Central vs bilateral	20 mL lidocaine (0.75%) + 10 mL ethanol (98%)	69% vs 81% (61.9%)(14wk)	Hypotension 2% pain 36%
Iwata et al[19]	Retrospective	47	Central, direct or bilateral	2-3 mL bupivacaine + 20 mL ethanol	68% (7 wk)	Hypotension 17%, diarrhea 23% and inebriation 8%
Ascunce et al[20]	Retrospective	64	Bilateral	10 mL lidocaine (1%) + 20 mL ethanol (98%)	50% (1 wk). OR 15.61 of response if celiac ganglia was detected	Hypotension 2%, pain 2% and diarrhea 23%
Wiechowska-Kozłowska et al[12]	Retrospective	29	Central vs bilateral	2 mL lidocaine (2%) + 20 mL ethanol (98%)	86% (1-2 wk)	Hypotonia 3.4%, pain 6.9% and diarrhea 10.3%
Téllez-Ávila et al[21]	Retrospective	53	Central vs bilateral	10 mL lidocaine (1%) + 10-20 mL ethanol (98%)	48% vs 56% (4 wk)	Transitory pain 0% vs 3%
Seicean et al[22]	Retrospective	32	Central	10 mL lidocaine (1%) + 10-15 mL ethanol	75% (2 wk)	None
Doi et al[13]	RCT	68	Direct vs central	1-2 mL bupivacaine (0.25%-0.5%) + 10-20 mL ethanol	73.5% vs 45.5% (7 d) P < 0.05	Hypotension 2.9% vs 6%, pain 29.4% vs 21.2% and diarrhea 5.9% vs 9.1%. No diferences
Ishiwatari et al[16]	Retrospective	22	Direct or bilateral	1-2 mL bupivacaine (0.5%) + 40-60 mL ethanol or 20-25 mL fenol	83% (fenol) vs 69% (ethanol) (7 d)	Diarrhea 9%, hypotension 4.5%, pain 4.5% and inebriation 4.5%
Hao et al[23]	Retrospective	41	Central or direct	10 mL bupivacaine (2%) + 20 mL ethanol	Pain < 3 mo improve 84% (3 d), 96% (7 d) and 68% (90 d). Pain > 3 mo improve 75% (3 d), 81% (7 d) and 50% (90 d)	Hypotension 4.9%
Minaga et al[14]	Retrospective observational	112	Broad ± direct	3 mL lidocaine (1%) + 9 mL ethanol (98%)	Pain improvement 77. 7% (1 wk)+ 67.9% (4 wk)	Inebriation 8%, hypotension 4.5%, pain 3.6% and diarrhea 3.6%
Levy et al[24]	RCT	110	Direct vs bilateral	4 mL bupivacaine (0.25%) + 20 mL ethanol (99%)	Pain improvement 46.2% vs 40.4%. No changes on quality of life	Hypotension 11.7% vs 20%, diarrhea 10% vs 12.2%. Pain 8.3% vs 44.9% (P < 0.05)

VAS: Visual analogue scale. RCT: Randomized clinical trial.