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Medline ® Abstract for Reference 29

of 'Endoscopic ultrasound-guided celiac plexus and ganglia interventions'

EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle.
Sakamoto H, Kitano M, Kamata K, Komaki T, Imai H, Chikugo T, Takeyama Y, Kudo M
Am J Gastroenterol. 2010;105(12):2599. Epub 2010 Sep 7.
OBJECTIVES: Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle.
METHODS: Consecutive patients referred to our quaternary EUS centers were eligible for inclusion. To evaluate the neurolytic spread, contrast was mixed with the neurolytic agent and post-procedure computed tomography scanning was performed. The regions containing the celiac, superior, and inferior mesenteric arteries were divided on the frontal plane into six areas: upper right and left, middle right and left, and lower right and left. The number of contrast-bearing areas after EUS-CPN and EUS-BPN were related to the degree of pain relief achieved.
RESULTS: A total of 67 patients with advanced abdominal cancer were included (34 EUS-CPN and 33 EUS-BPN). The qualitative variables ofthe two groups did not differ significantly. The EUS-BPN group had more patients with six contrast-bearing areas (42%) than the EUS-CPN group (0%). These patients had significantly better short-term and long-lasting pain relief than patients with less than five contrast-bearing areas. EUS-BPN patients exhibited significantly greater reductions in days 7 and 30 visual analog pain scale scores than EUS-CPN patients.
CONCLUSIONS: Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama City, Osaka, Japan. hiroki.sakamoto@nifty.com