EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)

BackgroundEUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.ObjectiveTo determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.DesignRetrospective analysis of prospective database.SettingAcademic medical center.PatientsSixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.InterventionsEUS-CPN injected directly into celiac ganglia when visible by linear EUS or bilateral injection at the celiac vascular trunk.Main Outcome MeasurementsPredictors of pain improvement at week 1 by univariate and multivariate analysis.ResultsAt week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P < .001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.LimitationsRetrospective design and lack of blinding.ConclusionsVisualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy.