Original articleClinical endoscopyEUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study

BackgroundCeliac plexus neurolysis for the palliative reduction of pain in unresectable pancreatic carcinoma (PC) is safe but provides limited relief. In a previous study, we found that EUS-guided implantation of iodine-125 (125I) around the celiac ganglia is a safe procedure and can induce apoptosis of local neurons in a porcine model.ObjectiveTo evaluate the safety and efficacy of direct celiac ganglion irradiation with 125I seeds for the relief of moderate to severe pain secondary to unresectable PC.DesignProspective study.SettingSingle, tertiary care referral center.PatientsThis study enrolled consecutive patients who had moderate to severe pain resulting from biopsy-proven unresectable PC.InterventionAll patients underwent EUS-guided direct celiac ganglion irradiation with 125I seeds. Follow-up was conducted at least once weekly until death.Main Outcome MeasurementsBlood parameters, Visual Analog Scale (VAS) score, mean analgesic (MS Contin [morphine sulfate]) consumption, and complications were evaluated during follow-up.ResultsTwenty-three patients with unresectable PC underwent the procedure. The mean number of seeds implanted in the celiac ganglion per patient was 4 (range 2-6). Immediately after the procedure, pain relief and analgesic consumption showed no significant changes compared with preoperative values. Six patients (26%) reported pain exacerbation. Two weeks later, the VAS score and mean analgesic consumption were significantly less than preoperative values. No procedure-related deaths or major complications occurred.LimitationsUncontrolled study.ConclusionsEUS-guided direct celiac ganglion irradiation with 125I seeds can reduce the VAS score and analgesic drug consumption in patients with unresectable PC.