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Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma
Author(s) -
Facciorusso Antonio,
Di Maso Marianna,
Serviddio Gaetano,
Larghi Alberto,
Costamagna Guido,
Muscatiello Nicola
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13478
Subject(s) - medicine , neurolysis , celiac plexus , pancreatic cancer , endoscopic ultrasound , visual analogue scale , ablation , surgery , cancer
Background and Aim Endoscopic ultrasonography guided‐celiac plexus neurolysis relieves pain in patients with pancreatic cancer but with often suboptimal and transient results. The study aims to compare the efficacy and safety of endoscopic ultrasound‐guided tumor ethanol ablation combined with celiac plexus neurolysis with respect to celiac plexus neurolysis alone for pain management in patients with pancreatic cancer. Methods Among 123 patients with unresectable pancreatic cancer referred to our Institution between 2006 and 2014, 58 treated with endoscopic ultrasound‐guided celiac plexus neurolysis (Group 1) and 65 with the combined approach (Group 2) were compared. Logistic regression models were applied to identify predictors of pain relief. Results The two groups presented similar baseline clinical and tumoral parameters. Pre‐procedural visual analog scale score was 7 in both groups ( P = 0.8), and tumor max diameter was 38 mm (range 25–59) in Group 1 and 43 mm (22–59) in Group 2 ( P = 0.4). The combined treatment increased pain relief and complete pain response rate ( P = 0.005 and 0.003, respectively). Median duration of pain relief was 10 (7–14) and 18 (13–20) weeks in the two groups, respectively ( P = 0.004). At multivariate regression, initial visual analog scale score and endoscopic technique adopted resulted significantly associated with pain relief. No severe treatment‐related adverse events were reported. Median overall survival was 6.5 months (5.1–8.6) in Group 1 and 8.3 months (6–11.4) in Group 2 ( P = 0.05). Conclusions Endoscopic ultrasound‐guided tumor ablation combined with celiac plexus neurolysis appears to be superior to celiac plexus neurolysis alone in terms of pain control and overall survival.