Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
Michael J LevySuresh T Chari

Abstract

Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P = .84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02-2.19; P = .042), particularly for patients with non-metastatic disease (hazard rati...Continue Reading

Associated Clinical Trials

Jun 8, 2012·Michael Levy

Citations

Jul 25, 2019·Clinical Endoscopy·Yousuke NakaiKazuhiko Koike
Jun 6, 2020·Current Gastroenterology Reports·Raj DalsaniaSaurabh Chawla
Jan 20, 2021·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·A I KoulourisA Clark
Jul 3, 2021·Journal of Community Hospital Internal Medicine Perspectives·Abuzar A AsifSrinivas R Puli
Jun 7, 2021·Current Opinion in Gastroenterology·Christoph F DietrichChristian Jenssen
Sep 10, 2021·Anesthesiology·James P RathmellKeith D Lillemoe

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