Advertisement

EUS-Guided Celiac Plexus Neurolysis

  • Ichiro Yasuda
  • Shinpei Doi
  • Masatoshi Mabuchi
Chapter

Abstract

EUS-guided celiac plexus neurolysis (EUS–CPN) can be performed for alleviating pain originating from the upper abdominal organs and, particularly, when the primary indication for pain is pancreatic cancer pain. Two different techniques are currently used when applying EUS–CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis, and the second approach, the bilateral technique, involves injection of the neurolytic agent on both sides of the celiac axis. Moreover, it was recently established that celiac ganglia can be examined and visualized by EUS. Therefore, EUS-guided direct celiac ganglia neurolysis (EUS–CGN) has been introduced as a new promising method. These techniques are performed with real-time imaging and with Doppler assessment of the interposing vessels. Therefore, they are more accurate, safe, and convenient than other classic approaches such as radiographic, fluoroscopic, or CT guidance. The effective rates reportedly vary from 50 to 90%. Common complications included transient diarrhea, transient pain exacerbation, transient hypotension, and inebriation, but they are not serious.

Keywords

Celiac plexus neurolysis EUS–CPN EUS–CGN 

References

  1. 1.
    Kappis M. Erfahrungen mit localanasthesie bie bauchoperationen. Verh Dtsch Gesellsch Chir. 1914;43:87–9.Google Scholar
  2. 2.
    Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA. 2004;291:1092–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007;102:430–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Faigel DO, Veloso KM, Long WB, et al. Endosonography-guided celiac plexus injection for abdominal pain due to chronic pancreatitis. Am J Gastroenterol. 1996;91:1675.PubMedGoogle Scholar
  5. 5.
    Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44:656–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Gress F, Schmitt C, Sherman S, et al. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999;94:900–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Gerke H, Silva RG Jr, Shamoun D, et al. EUS characteristics of celiac ganglia with cytologic and histologic confirmation. Gastrointest Endosc. 2006;64:35–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Levy M, Rajan E, Keeney G, et al. Neural ganglia visualized by endoscopic ultrasound. Am J Gastroenterol. 2006;101:1787–91.CrossRefPubMedGoogle Scholar
  9. 9.
    Levy MJ, Topazian MD, Wiersema MJ, et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008;103:98–103.CrossRefPubMedGoogle Scholar
  10. 10.
    Caraceni A, Portenoy RK. Pain management in patients with pancreatic carcinoma. Cancer. 1996;78:639–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Puli SR, Reddy JB, Bechtold ML, et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci. 2009;54:2330–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Ishiwatari H, Hayashi T, Yoshida M, et al. Phenol-based endoscopic ultrasound-guided celiac plexus neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients: a pilot study. World J Gastroenterol. 2014;20:10512–7.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ishiwatari H, Hayashi T, Yoshida M, et al. EUS-guided celiac plexus neurolysis by using highly viscous phenol-glycerol as a neurolytic agent (with video). Gastrointest Endosc. 2015;81:479–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Gleeson FC, Levy MJ, Papachristou GI, et al. Frequency of visualization of presumed celiac ganglia by endoscopic ultrasound. Endoscopy. 2007;39:620–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Ascunce G, Ribeiro A, Reis I, et al. EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video). Gastrointest Endosc. 2011;73:267–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Doi S, Yasuda I, Kawakami H, et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy. 2013;45:362–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Harada N, Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc Clin N Am. 1997;7:237–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Gunaratnam NT, Sarma AV, Norton ID, et al. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc. 2001;54:316–24.CrossRefPubMedGoogle Scholar
  19. 19.
    Gress F, Schmitt C, Sherman S, et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96:409–16.CrossRefPubMedGoogle Scholar
  20. 20.
    Sakamoto H, Kitano M, Nishio T, et al. Value of computed tomography for evaluating the injection site in endosonography-guided celiac plexus neurolysis for pancreatic cancer pain. Dig Endosc. 2006;18:206–11.CrossRefGoogle Scholar
  21. 21.
    Tran QN, Urayama S, Meyers FJ. Endoscopic ultrasound-guided celiac plexus neurolysis for pancreatic cancer pain: a single-institution experience and review of the literature. J Support Oncol. 2006;4:460–2, 464; discussion 463–4.Google Scholar
  22. 22.
    Sahai AV, Lemelin V, Lam E, et al. Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol. 2009;104:326–9.CrossRefPubMedGoogle Scholar
  23. 23.
    O’Toole TM, Schmulewitz N. Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series. Endoscopy. 2009;41:593–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Sakamoto H, Kitano M, Kamata K, et al. EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle. Am J Gastroenterol. 2010;105:2599–606.CrossRefPubMedGoogle Scholar
  25. 25.
    Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127–34.CrossRefPubMedGoogle Scholar
  26. 26.
    Iwata K, Yasuda I, Enya M, et al. Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis. Dig Endosc. 2011;23:140–5.CrossRefPubMedGoogle Scholar
  27. 27.
    LeBlanc JK, Al-Haddad M, McHenry L, et al. A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two? Gastrointest Endosc. 2011;74:1300–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Wyse JM, Carone M, Paquin SC, et al. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29:3541–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Wiechowska-Kozlowska A, Boer K, Wojcicki M, et al. The efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis for treatment of pain in patients with pancreatic cancer. Gastroenterol Res Pract. 2012;2012:503098.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Seicean A, Cainap C, Gulei I, et al. Pain palliation by endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. J Gastrointestin Liver Dis. 2013;22:59–64.PubMedGoogle Scholar
  31. 31.
    LeBlanc JK, Rawl S, Juan M, et al. Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer: a prospective pilot study of safety using 10 mL versus 20 mL alcohol. Diagn Ther Endosc. 2013;2013:327036.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Tellez-Avila FI, Romano-Munive AF, Herrera-Esquivel Jde J, et al. Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. Endosc Ultrasound. 2013;2:153–6.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gress F, Ciaccia D, Kiel S. Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): a large single center experience. Gastrointest Endosc. 1997;45:AB173.Google Scholar
  34. 34.
    Mahajan R, Nowell W, Theerathorn P. Empyema after endoscopic ultrasound guided celiac plexus pain block (EUS-CBP) in chronic pancreatitis: experience at an Academic Center. Gastrointest Endosc. 2002;55:AB101.Google Scholar
  35. 35.
    Muscatiello N, Panella C, Pietrini L, et al. Complication of endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2006;38:858.CrossRefPubMedGoogle Scholar
  36. 36.
    Ahmed HM, Friedman SE, Henriques HF, et al. End-organ ischemia as an unforeseen complication of endoscopic-ultrasound-guided celiac plexus neurolysis. Endoscopy. 2009;41(Suppl 2):E218–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Lalueza A, Lopez-Medrano F, del Palacio A, et al. Cladosporium macrocarpum brain abscess after endoscopic ultrasound-guided celiac plexus block. Endoscopy. 2011;43(Suppl 2 UCTN):E9–10.CrossRefPubMedGoogle Scholar
  38. 38.
    Gimeno-Garcia AZ, Elwassief A, Paquin SC, et al. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2012;44(Suppl 2 UCTN):E267.PubMedGoogle Scholar
  39. 39.
    Fujii L, Clain JE, Morris JM, et al. Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis. Endoscopy. 2012;44(Suppl 2 UCTN):E265–6.PubMedGoogle Scholar
  40. 40.
    Loeve US, Mortensen MB. Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis. Gastrointest Endosc. 2013;77:151–2.CrossRefPubMedGoogle Scholar
  41. 41.
    Jang HY, Cha SW, Lee BH, et al. Hepatic and splenic infarction and bowel ischemia following endoscopic ultrasound-guided celiac plexus neurolysis. Clin Endosc. 2013;46:306–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Ichiro Yasuda
    • 1
  • Shinpei Doi
    • 1
  • Masatoshi Mabuchi
    • 1
  1. 1.Department of GastroenterologyTeikyo University Mizonokuchi HospitalKawasakiJapan

Personalised recommendations