ORLANDOThe delivery of neurolytic chemicals to the celiac
plexus, guided by endoscopic ultrasound, has been shown to be an
effective, convenient, and safe technique to provide pain relief for
pancreatic cancer patients.
At the Digestive Disease Week meeting, gastroenterologist Marc
Catalano, MD, described the findings from a study done at the
Pancreatic Biliary Center, St. Lukes Medical Center, Milwaukee. The
research involved 16 patients with unresectable pancreatic cancer and
In the past, this kind of pain has been managed with
narcotics, Dr. Catalano said, or the celiac plexus nerve
has been destroyed percutaneously, with the drugs injected under the
guidance of CT scan. However, this region is difficult to
locate under CT guidance, he said, in part because of all the tissue
that the needle must traverse. Also, the CT scan, being an external
modality, offers only fuzzy images, he added.
Complications of percutaneous delivery of the neurolytic drugs with
CT guidance have included bleeding and paralysis, through accidental
destruction of nearby spinal nerves.
Its easy to precisely identify the target structures with
endoscopic ultrasound, which brings the transducer right into the
area, Dr. Catalano said. Alcohol is then injected to deaden the
nerves causing the pain. He noted that this method was pioneered by
Dr. Maurits Wiersema of the Mayo Clinic and by Dr. Frank Gress of
Winthrop University Hospital, Mineola, New York.
In this study, patients were asked to rank their pain on a scale of
10 both before and after the procedure. The researchers obtained
post-procedure pain scores at 2, 4, 8, and 12 weeks. While the mean
pain score was 7.8 before the block, by 12 weeks it had dropped to
1.5. Eleven of 13 patients (85%) followed at 12 weeks had also
reduced their pain medication. Three patients experienced mild
diarrhea, which was treated successfully with medication.
Physicians can stage pancreatic cancer patients and treat their pain
simultaneously using an endoscopic ultrasound probe, Dr. Catalano
said. For the experienced endosonographer who does fine-needle
aspiration, there is little or no learning curve involved with this
method, he added.