Endoscopic Ultrasound-guided Celiac Plexus Neurolysis in the Management of Pain in Abdominal Non-pancreatic Malignancies
| Status: | Completed |
|---|---|
| Conditions: | Cancer, Cancer, Chronic Pain |
| Therapuetic Areas: | Musculoskeletal, Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/8/2014 |
| Start Date: | August 2010 |
| End Date: | June 2013 |
| Contact: | Raj N Keswani, MD |
| Email: | rkeswani@nmff.org |
| Phone: | (312)-695-8174 |
Endoscopic Ultrasound (EUS)-Guided Celiac Plexus Neurolysis (CPN) in the Management of Pain in Abdominal Non-pancreatic Malignancies
Celiac plexus neurolysis (CPN) has been performed for nearly 100 years to alleviate the
abdominal pain associated with pancreatic malignancy and other conditions, and is usually
undertaken at a late stage in the disease process, when analgesic options have been largely
exhausted or have led to significant and often unacceptable side effects. Until recently,
CPN was most commonly performed under radiographic guidance; however, in the last 10 years,
CPN has been routinely performed under endoscopic ultrasound (EUS) guidance. Several case
series have demonstrated the efficacy and safety of this technique when used to treat the
pain associated with pancreatic malignancy and/or chronic pancreatitis. However, the
efficacy of EUS-guided CPN in the treatment of pain related to non-pancreatic malignancies
has yet to be described. The goal of this study is to assess the efficacy of EUS-guided CPN
in the management of pain in patients with abdominal non-pancreatic malignancies. Our
hypothesis is that EUS-guided CPN will provide adequate pain relief in these patients.
abdominal pain associated with pancreatic malignancy and other conditions, and is usually
undertaken at a late stage in the disease process, when analgesic options have been largely
exhausted or have led to significant and often unacceptable side effects. Until recently,
CPN was most commonly performed under radiographic guidance; however, in the last 10 years,
CPN has been routinely performed under endoscopic ultrasound (EUS) guidance. Several case
series have demonstrated the efficacy and safety of this technique when used to treat the
pain associated with pancreatic malignancy and/or chronic pancreatitis. However, the
efficacy of EUS-guided CPN in the treatment of pain related to non-pancreatic malignancies
has yet to be described. The goal of this study is to assess the efficacy of EUS-guided CPN
in the management of pain in patients with abdominal non-pancreatic malignancies. Our
hypothesis is that EUS-guided CPN will provide adequate pain relief in these patients.
Inclusion Criteria:
- Diagnosis of an unresectable, non-pancreatic malignancy, including gastric, small
intestinal, or proximal colonic malignancies, as well as malignancies of the liver
and bile ducts (based on above celiac plexus innervations)
- Pain directly related to the primary malignant process, as determined by the
referring oncologist
- Pain determined to be refractory to standard medical therapy, or when the medical
therapy is ineffective due to certain limitations (such as severe constipation), as
determined by the referring oncologist
- Willingness to undergo EUS-guided CPN
- Age > 18 years
- ECOG performance status of grades 0-3 [7]
- The patient will need to sign informed consent prior to inclusion in this study
Exclusion Criteria:
- Unable or unwilling to undergo an EUS-guided CPN
- Contraindication to anesthesia, as determine during the preoperative clearance
process
- Refractory coagulopathy (INR > 1.5) or thrombocytopenia (platelet count < 50,000), or
aspirin and/or clopidogrel use within 7 days of procedure
- Current pregnancy
- Prior celiac plexus block/neurolysis
- Allergy to local anesthetics
- ECOG performance status of grade 4 or higher
We found this trial at
1
site
Northwestern Memorial Hospital Northwestern Memorial is an academic medical center hospital where the patient comes...
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