| 抄録 |
BACKGROUND: EUS-guided celiac plexus neurolysis(EUS-CPN)is an established treatment for upper abdominal cancer pain. Recently, two alternative techniques such as, EUS-guided celiac ganglia neurolysis(CGN) and EUS-guided broad plexus neurolysis(BPN) for abdominal pain management have been reported. However, these 3 procedures are not always effective. We determined the predictive factors for response to these EUS guided neurolysis. PATIENTS AND METHODS: In a retrospective analysis of a EUS database tracking patients and complications at this institution, data for consecutive 134 patients (CPN:54, BPN:33, CGN:5,CPN+CGN:11,BPN+CGN:31) between April 2003 and March 2013 was analyzed. To evaluate the neurolytic spread, Post-procedure computed tomography scanning was performed after injection of alchol mixed with contrast and neurolytic spread area divided into six areas was assessed in each patients. Pain intensity was measured according to a standardized visual 11-pointed continuous analog scale (VAS). Good pain relief was defined when the VAS scores decreased by more than 3 points after the procedures.The efficacy in pain relief was evaluated at day 7 after procedure. RESULTS: Pain relief was obtained in 108 patients (81%). Narcotic using dose (>60mg/day), tumor size (>30mm), and neurolytic spread area (<3 areas) were significant factors for a negative response to EUS-guided neurolysis. There were transient hypotension (9.3%), pain increase (3.4%), and drunkeness (1.7%), but no sever complication related to these EUS-guided neurolysis. CONCLUSION: EUS-guided neurolysis should be considered at earlier stage for management of cancer pain. |
