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Since the development of percutaneous neurolysis in 1914 by Kappis, many studies have reported about the most efficacious method of celiac plexus neurolysis (CPN). Meanwhile, various methods and options of CPN indicate some controversy and a lack of significant progress. In this multicenter randomized controlled trial, Doi et al. compared the effectiveness of novel endoscopic ultrasound (EUS)guided celiac ganglia neurolysis (CGN) with conventional EUS-guided CPN (EUS-CPN). The CGN (n = 34) and CPN (n = 34) groups were well-randomized in terms of the characteristics of patients and pain score. The visualization of celiac ganglia was available in 88% of CGN group, thus 4 patients in whom the ganglia could not be visualized were treated with EUS-CPN. The procedure was successful in all patients allocated to CPN. The primary endpoint was the difference in treatment response rate between CGN and CPN group at post-procedural day 7 measuring pain intensity using a numeric pain rating scale, ranging from 0 (no pain) to 10 (worst pain). The results demonstrated a higher proportion of patients in CGN group showed a decrease in pain intensity to ≤3 on day 7 compared with CPN by intention-to-treat analysis (73.5% vs. 45.5%, P = 0.026). The complete response, which was defined as a decrease in pain to ≤1 was also higher with CGN than CPN (50.0% vs. 18.2%, P = 0.010). Actual performance of EUS-CGN was the only statistically significant predictive factor for pain relief. The incidence of complications was similar in both groups. The authors concluded that EUS-CGN is significantly superior to conventional EUS-CPN in cancer pain relief. COMMENT

Is endoscopic ultrasound-guided celiac Ganglia neurolysis superior to celiac plexus neurolysis?