Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis

The most common symptom of advanced pancreatic cancer patients is abdominal pain. Traditionally, it has been treated with non-steroidal anti-inflammatory drugs and opioid analgesics. However, these treatments lead to inappropriate pain management or drug-related adverse reactions in some patients. Another way to alleviate pain is celiac plexus nerve lysis, in which the celiac plexus is chemically resected. This procedure was performed percutaneously or intraoperatively until 1996 when endoscopic ultrasound (EUS) -induced celiac plexus neuronal was first described. In this transgastric approach, a nerve lysing agent is injected around the peritoneal nerve trunk under the guidance of EUS. This method has become widespread as a minimally invasive method and is currently widely used for the treatment of pancreatic cancer related pain. We will focus on two relatively new EUS guided neurological techniques: EUS guided celiac ganglion neuronolysis and EUS guided plexus nerve lysis, which were developed to improve efficacy. While these techniques are generally safe and effective, as this approach is widespread, several serious adverse events have been reported including ischemic and infectious complications. Clinical outcome of EUS-oriented pancreatic cancer neuronal lysis (from PubMed and Embase databases) was summarized in order to provide information to support the development of pancreatic cancer-related pain relief strategies. View full text

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In a recent study, ultrasound endoscopy (EUS) assessment of pancreatic cancer was considered an independent predictor of survival and improvement in patients with focal pancreatic cancer. We will focus on all aspects of the role of EUS in the treatment of pancreatic cancer.

The most common symptom of advanced pancreatic cancer patients is abdominal pain. Traditionally, it has been treated with non-steroidal anti-inflammatory drugs and opioid analgesics. However, these treatments lead to inappropriate pain management or drug-related adverse reactions in some patients. Another way to alleviate pain is celiac plexus nerve lysis, in which the celiac plexus is chemically resected. This procedure was performed percutaneously or intraoperatively until 1996 when endoscopic ultrasound (EUS) -induced celiac plexus neuronal was first described. In this transgastric approach, a nerve lysing agent is injected around the peritoneal nerve trunk under the guidance of EUS. This method has become widespread as a minimally invasive method and is currently widely used for the treatment of pancreatic cancer related pain. View full text

Pancreatic cancer is difficult to diagnose. Since the pancreas is deep inside the body, there is usually no pain before the tumor grows. Scientists have more than one way of judging whether a patient is suffering from pancreatic cancer. Ultrasound can be used to examine the pancreas. The sound wave bounces off the pancreas and forms a television screen. Another test is computed tomography or CT scan. This is a special X-ray device that shows how far it spreads across the entire body of the cancer. MRI and magnetic imaging are special devices different from X-ray equipment, and you can show the extent of cancer spread by taking a detailed picture of the whole body. There is also a test called ERCP. During this test the tube was placed in the throat and passed through the stomach into the small intestine. The doctor can see through the flexible tube and can inject different dyes into the bile duct and the pancreatic duct when taking X-rays.