EUS-guided celiac plexus neurolysis and celiac plexus block.
نویسندگان
چکیده
Pancreatic cancer and chronic pancreatitis commonly produce pain that is difficult to control.1,2 Initial therapy with nonsteroidal anti-inflammatory agents (NSAIDs) is often inadequate and necessitates opioid administration. Although opioids effectively relieve pain, they are associated with dry mouth, constipation, nausea, vomiting, drowsiness, delirium, and may impair immune function.3,4 In addition, patients with chronic pancreatitis risk narcotic dependence. Therefore, nonpharmacologic therapies, such as celiac plexus neurolysis (CPN), are often given with the goal of improving pain control and quality of life while reducing the risk of drug-related side effects. Some use the term celiac plexus block (CPB) to refer to the use of steroids and/or a local anesthetic to temporarily inhibit celiac plexus function in patients with benign disease (chronic pancreatitis). The term celiac plexus neurolysis is often applied to techniques that inject alcohol or phenol to induce neurolysis in patients with pancreatic cancer and other malignancies. Many use these terms interchangeably. This review summarizes the percutaneous (PQ) and surgical methods of CPN and focuses on the technical aspects of EUS-guided CPN (EUS CPN). Publications specific to EUS CPN are reviewed, and evidence-based guidelines regarding the indications and role of EUS CPN are developed. Potential future areas of investigation are raised where evidence is incomplete.
منابع مشابه
Pearls & oy-sters: Acute spinal cord infarction following endoscopic ultrasound-guided celiac plexus neurolysis.
• Celiac plexus neurolysis (CPN)/celiac plexus block (CPB) is used to treat excruciating cancerrelated abdominal pain.1 • CPN is done via injecting 50%–100% alcohol into the celiac plexus, which is located under the diaphragm at the level of T12-L1 adjacent to the abdominal aorta and the take-off of the celiac trunk.2 • Endoscopic ultrasound guided neurolysis (EUS CPN) has been found to have 85...
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The technical advances in endoscopic ultrasonograpy (EUS) and accessories have enabled performing EUS-guided intervention in the pancreas and biliary tract. Many research centers have been performing or investigating EUS-guided drainage, EUS-guided celiac plexus neurolysis and block, EUS-guided anastomosis that includes choledocho-enterostomy and choledocho-gastrostomy, EUS-guided ablation and ...
متن کاملEndoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis.
Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approac...
متن کاملAlleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis
The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chem...
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عنوان ژورنال:
- Gastrointestinal endoscopy
دوره 57 7 شماره
صفحات -
تاریخ انتشار 2003