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David L. Kreulen - One of the best experts on this subject based on the ideXlab platform.

  • Gene Therapy of the Peripheral Nervous System: Celiac Ganglia.
    Methods in molecular biology (Clifton N.J.), 2016
    Co-Authors: Bradley D Hammond, David L. Kreulen
    Abstract:

    Gene therapy has played an integral role in advancing our understanding of the central nervous system. However, gene therapy techniques have yet to be widely utilized in the peripheral nervous system. Critical targets for gene therapy within the PNS are the neurons in sympathetic Ganglia, which are the final pathway to end organs. Thus they are the most specific targets for organ-specific neuron modification. This presents challenges because neurons are not viscerotopically organized within the Ganglia and therefore cannot be targeted by their location. However, organ-specific neurons have been identified in sympathetic Ganglia of some species and this offers an opportunity for targeting and transducing neurons by way of their target. In fact, alterations in sympathetic neurons have had pathological effects, and transducing organ-specific sympathetic neurons offer an exciting opportunity to selectively modify sympathetic pathology. In this chapter, we describe a method to virally transduce the Celiac ganglion (CG), a prevertebral sympathetic ganglion that innervates abdominal organs, with AAV serotypes 1 and 6; thereby, providing a potential avenue to modulate specific subsets of neurons within the Celiac ganglion.

  • Abstract 201: Direct but not Indirect Activation of Sympathetic Ganglia Leads to Higher Neuronal Activation in Normotensive Than Deoxycorticosterone-salt Hypertensive Rats
    Hypertension, 2012
    Co-Authors: Amit H. Shah, Bradley D Hammond, Gregory D. Fink, David L. Kreulen
    Abstract:

    Sympathetic activity is chronically elevated in hypertensive human patients and in many animal models of hypertension, including the deoxycorticosterone (DOCA)-salt rat model. Sympathetic Ganglia receive signals from the central nervous system and relay them to blood vessels and peripheral organs. How sympathetic Ganglia respond to activation signals differently in hypertension is not fully understood. We examined how direct and indirect activators of sympathetic Ganglia would influence neuronal activation. 2-deoxy-D-glucose (2-DG) is a glucose analog that causes hypoglycemia leading to centrally-mediated, indirect activation of Celiac Ganglia, a prevertebral sympathetic ganglion. Nicotine directly activates sympathetic Ganglia by acting on cholinergic receptors found on most sympathetic neurons. Acute neuronal activation was examined by measuring c-fos immunoreactivity (ir). We hypothesized that since there is higher chronic sympathetic activity in DOCA-salt hypertensive than normotensive rats, both direct and indirect acute activators will induce higher c-fos expression in sympathetic Ganglia of normotensive than hypertensive rats. Maximal c-fos expression for 2-DG (800mg/kg i.p.) and nicotine (2mg/kg s.c.) treatments was observed 2hrs post-treatment and for all following experiments, Celiac Ganglia were dissected and fixed 2hrs post-treatment. Following nicotine treatment, c-fos expression was significantly higher in Celiac Ganglia of normotensive (25.5 ± 9.7 c-fos ir neurons/m^2) than hypertensive (12.0 ± 4.8 c-fos ir neurons/m^2) rats. However, following 2-DG treatment, c-fos expression was similar in Celiac Ganglia of normotensive (49.1 ± 17.6 c-fos ir neurons/m^2) and hypertensive (49.4 ± 16.0 c-fos ir neurons/m^2). In contrast with our hypothesis, only the direct but not the indirect activation of sympathetic Ganglia induced higher sympathetic neuronal activation in normotensive than hypertensive rats. Thus, a centrally-mediated metabolic stimulus does not activate pathways to sympathetic Ganglia differentially in normotension versus hypertension. However, direct ganglionic stimulation leads to greater neuronal activation in normotensive than hypertensive Ganglia.

  • Increased O2·− Production and Upregulation of ETB Receptors by Sympathetic Neurons in DOCA-Salt Hypertensive Rats
    Hypertension (Dallas Tex. : 1979), 2004
    Co-Authors: Xiaoling Dai, Gregory D. Fink, James J. Galligan, Stephanie W. Watts, David L. Kreulen
    Abstract:

    Superoxide anion (O2*-) production is elevated in the vasculature of hypertensive animals but it is not known if O2*- production is also elevated in the sympathetic nervous system. We measured O2*- levels in prevertebral sympathetic Ganglia of deoxycorticosterone acetate (DOCA)-salt hypertensive rats using the dihydroethidine (DHE) fluorescence method. O2*- was elevated in Ganglia from DOCA-salt rats compared with normotensive sham rats. Treatment of Ganglia with endothelin (ET)-1 (3x10(-8) mol/L) resulted in a 200% increase in fluorescence intensity in neurons, which was attenuated by the ET(B) receptor antagonist BQ788 (10(-7) mol/L). ET-1 also increased the O2*- induced fluorescence in dissociated sympathetic neurons and PC-12 cells via activation of ET(B) receptors, but not ET(A) receptors. To evaluate whether elevated ET-1 levels in the Ganglia might contribute to the elevated O2*- found in Ganglia we measured the amount of ET-1 using an ELISA assay. ET-1 levels in sham rat Celiac Ganglia were 695.6+/-40.9 picogram per gram; they were not different than ET-1 levels in Ganglia from DOCA-salt rats. We then compared ET(B) receptor levels in Ganglia from sham and DOCA-salt animals. ET(B) receptor mRNA levels were 32% higher and ET(B) receptor protein levels were 20% higher in Celiac Ganglia from DOCA-salt rats than from sham rats separately. In conclusion, O2*- is elevated in prevertebral sympathetic Ganglia in DOCA-salt hypertension, and ET-1 is a potent stimulus for the elevation of O2*- levels in sympathetic Ganglia, an effect that may be mediated by the upregulation of ET(B) receptors.

Mark Topazian - One of the best experts on this subject based on the ideXlab platform.

  • Clinical impact of Celiac Ganglia metastasis upon pancreatic ductal adenocarcinoma.
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 2019
    Co-Authors: Thomas Malikowski, Ferga C. Gleeson, Steven R Alberts, Heidi D. Lehrke, Michael R. Henry, Michael L. Kendrick, Ryan J. Lennon, Robert R. Mcwilliams, Naoki Takahashi, Mark Topazian
    Abstract:

    Abstract Background Pre-operative staging of pancreatic adenocarcinoma guides clinical decision making. Limited data indicate that metastasis to Celiac Ganglia (CG) correlates with poor prognosis. We investigated feasibility and safety of endoscopic ultrasound fine needle aspiration (EUS-FNA) detection of CG metastasis and its impact upon tumor stage, resectability, and survival in pancreatic ductal adenocarcinoma (PDAC). Patients We reviewed our prospectively maintained EUS and cytopathology databases to identify patients with FNA proven CG metastasis in patients with PDAC from 2004 to 2017. Clinical demographics, EUS, CT, MRI, cytopathology, cancer stage, and resectability data were analyzed. Survival of PDAC patients with CG metastasis was compared to the expected survival of PDAC patients of similar stage as reported by the United States National Cancer Database. Results Twenty-one patients with PDAC [median age 73 (IQR63-78); 14 (67%) female)], had CG metastasis confirmed by cytopathologic assessment. CG metastasis resulted in tumor upstaging relative to other EUS findings and cross sectional imaging findings in 12 (57%) and 15 (71%) patients, and converted cancers from resectable to unresectable relative to EUS and cross sectional imaging in 7 (37%) and 7 (37%) patients, respectively. In patients with PDAC, the survival of patients with CG metastasis was not significantly different from the overall survival (hazard ratio 0.71; 95% confidence interval 0.44, 1.13; p = 0.15). Conclusions EUS-FNA may safely identify CG metastases. While CG metastasis upstaged and altered the resectability status among this cohort of patients with PDAC, the survival data with regard to PDAC suggest that this may be misguided.

  • combined Celiac Ganglia and plexus neurolysis shortens survival without benefit vs plexus neurolysis alone
    Clinical Gastroenterology and Hepatology, 2019
    Co-Authors: Michael J. Levy, Mark Topazian, Ferga C. Gleeson, Larissa L Fujiilau, Felicity Enders, Joseph J Larson, Kristin C Mara, Barham Abu K Dayyeh, Steven R Alberts, Christopher L Hallemeier
    Abstract:

    Background & Aims Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of Celiac plexus neurolysis (CPN) might result from brief contact of the injectate with Celiac Ganglia. We compared the effects of endoscopic ultrasound-guided Celiac Ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. Methods We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Results Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P = .84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02–2.19; P = .042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95% CI, 1.61–5.45; P Conclusion In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.

  • Accuracy of Endoscopic Ultrasound Imaging in Distinguishing Celiac Ganglia From Celiac Lymph Nodes.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2018
    Co-Authors: Thomas Malikowski, Mark Topazian, Ferga C. Gleeson, Heidi D. Lehrke, Michael R. Henry, Naoki Takahashi, William S. Harmsen, Dai Inoue, Naveen Gara, Barham K. Abu Dayyeh
    Abstract:

    Background & Aims Endoscopic ultrasound (EUS) allows visualization of Celiac lymph nodes (CLNs) and Celiac Ganglia (CG). Reliably distinguishing these structures is important for tumor staging and CG ablative therapies. We aimed to evaluate the accuracy of EUS in distinguishing CLNs from CG using a strict cytopathology reference standard. We also determined the rate of detection of CLN and CG by conventional cross-sectional imaging. Methods From EUS and cytopathology databases, we identified all patients who underwent EUS-FNA of a presumed CLN or CG from October 1, 2004, through March 1, 2017, and compared the findings with those from cytology (reference standard). Indeterminate cytology results were re-reviewed. EUS imaging (ie, index test) results were compared with those from the reference standard. An expert radiologist re-reviewed computed tomography and magnetic resonance images from 100 lesions, from 94 randomly selected patients with a reference standard, to determine the rates of CLN and CG detection. Results A total of 504 patients (mean age, 63.4 ± 13.2 years; 292 men) underwent a median of 7 EUS-FNA passes (range, 1–13) for a total of 566 lesions perceived to be either a CLN or CG; the cytology reference standard was available for 521 lesions (92.1%). When we excluded indeterminate cytology results, the EUS accurately identified 281/286 CLNs (98.3%) and 166/186 CGs (89.2%), for an overall accuracy of 447/472 (94.7%). EUS-FNA distinguished CG from CLNs with a 93.3% sensitivity, 93.7% specificity, a positive predictive value of 96.2%, and a negative predictive value of 89.2%. Of 100 lesions in 94 patients randomly selected for a second expert radiology review, computed tomography and magnetic resonance imaging detected 59/67 CLNs (88.1%) and 13/33 CG (39.4%). Conclusion EUS accurately distinguishes CLNs from CG. EUS might therefore be used to increase the accuracy of tumor staging, to select tumor stage-appropriate therapy, and to guide CG-ablative therapies.

  • Frequency of visualization of presumed Celiac Ganglia by endoscopic ultrasound.
    Endoscopy, 2007
    Co-Authors: Ferga C. Gleeson, Michael J. Levy, Elizabeth Rajan, Georgios I. Papachristou, Mario Pelaez-luna, Jonathan E. Clain, Mark Topazian
    Abstract:

    BACKGROUND AND STUDY AIMS: Celiac Ganglia can be visualized by endoscopic ultrasound (EUS). It is unknown how often Ganglia are visualized during EUS, and what clinical factors are associated with ganglion visualization. The aim of this study was to prospectively evaluate the frequency of visualization of presumed Celiac Ganglia by EUS and to identify factors that predict their visualization. PATIENTS AND METHODS: Clinical, demographic, EUS, and cytologic data were collected prospectively from 200 unselected patients who were undergoing EUS in a tertiary referral centre. When presumed Celiac Ganglia were visualized, their size, number, location, and echo features were noted. When presumed Ganglia were aspirated, the results of cytology were recorded. RESULTS: The most common indication for EUS was investigation of a pancreatic mass or cyst (25 %). Presumed Celiac Ganglia were identified in 81 % of patients overall. Logistic regression analysis determined that female sex and having no prior history of gastrointestinal surgery were independently associated with ganglion visualization. Among patients whose Ganglia were visualized, more Ganglia were seen per patient with linear echo endoscopes (2, range 0 - 5) than with radial echo endoscopes (1, range 0 - 4) ( P = 0.001). Presumed Celiac Ganglia were aspirated in 10 patients; and cytologic examination revealed neural Ganglia in all of these. CONCLUSIONS: Celiac Ganglia can be visualized by EUS in most patients who undergo upper gastrointestinal EUS examinations, and are best seen with linear-array echo endoscopes. Ganglia can usually be differentiated from lymph nodes on the basis of their endosonographic appearance.

  • Preoperative diagnosis of extrapancreatic neural invasion in pancreatic cancer.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2006
    Co-Authors: Michael J. Levy, Elizabeth Rajan, Gary L. Keeney, Mark Topazian, Ferga C. Gleeson, Jonathan E. Clain, Kenneth K. Wang, Maurits J. Wiersema, Michael B. Farnell, Suresh T. Chari
    Abstract:

    Background & Aims: Pancreatic cancer recurs in most patients after resection with curative intent. Recurrence is particularly common in patients with extrapancreatic neural invasion (EPNI), the presence of which correlates with poor prognosis. Macroscopic EPNI may be detected with conventional noninvasive imaging and endoscopic ultrasound (EUS) imaging, but microscopic EPNI has required postoperative pathologic examination of surgical specimens. We report the preoperative diagnosis of cancer infiltration into Celiac Ganglia. We hypothesized that microscopic pancreatic cancer metastasis to neural Ganglia can be detected by EUS-guided biopsy examination. Methods: We performed a retrospective review of patients with pancreatic cancer undergoing EUS in whom Celiac Ganglia were sampled to exclude malignant infiltration. Results: Six patients with pancreatic cancer underwent EUS-guided fine-needle aspiration or trucut biopsy examination of presumed Celiac Ganglia. Metastatic cancer was found in Ganglia of 2 patients. Specimen review identified adenocarcinoma and neural tissue in the absence of lymphocytes. At laparoscopy, 1 of the 2 patients with positive Celiac biopsy specimens also had several unexpected peritoneal metastatic deposits. The other patient was considered to have locally advanced unresectable disease. Both patients are receiving supportive care. Conclusions: EPNI may be shown preoperatively in patients with pancreatic cancer using EUS-guided sampling of Celiac Ganglia. A preoperative diagnosis of EPNI has the potential to improve staging accuracy and patient outcomes.

Ann K. Goodchild - One of the best experts on this subject based on the ideXlab platform.

  • Hydralazine administration activates sympathetic preganglionic neurons whose activity mobilizes glucose and increases cardiovascular function
    Brain research, 2015
    Co-Authors: Lindsay M. Parker, Hanafi Ahmad Damanhuri, Sophie P.s. Fletcher, Ann K. Goodchild
    Abstract:

    Abstract Hypotensive drugs have been used to identify central neurons that mediate compensatory baroreceptor reflex responses. Such drugs also increase blood glucose. Our aim was to identify the neurochemical phenotypes of sympathetic preganglionic neurons (SPN) and adrenal chromaffin cells activated following hydralazine (HDZ; 10 mg/kg) administration in rats, and utilize this and SPN target organ destination to ascribe their function as cardiovascular or glucose regulating. Blood glucose was measured and adrenal chromaffin cell activation was assessed using c-Fos immunoreactivity (-ir) and phosphorylation of tyrosine hydroxylase, respectively. The activation and neurochemical phenotype of SPN innervating the adrenal glands and Celiac Ganglia were determined using the retrograde tracer cholera toxin B subunit, in combination with in situ hybridization and immunohistochemistry. Blood glucose was elevated at multiple time points following HDZ administration but little evidence of chromaffin cell activation was seen suggesting non-adrenal mechanisms contribute to the sustained hyperglycemia. 16±0.1% of T4-T11 SPN contained c-Fos and of these: 24.3±1.4% projected to adrenal glands and 29±5.5% projected to Celiac Ganglia with the rest innervating other targets. 62.8±1.4% of SPN innervating adrenal glands were activated and 29.9±3.3% expressed PPE mRNA whereas 53.2±8.6% of SPN innervating Celiac Ganglia were activated and 31.2±8.8% expressed PPE mRNA. CART-ir SPN innervating each target were also activated and did not co-express PPE mRNA. Neurochemical coding reveals that HDZ administration activates both PPE+SPN, whose activity increase glucose mobilization causing hyperglycemia, as well as CART+SPN whose activity drive vasomotor responses mediated by baroreceptor unloading to raise vascular tone and heart rate.

  • Neurochemical codes of sympathetic preganglionic neurons activated by glucoprivation.
    The Journal of comparative neurology, 2013
    Co-Authors: Lindsay M. Parker, Natasha N. Kumar, Tina Lonergan, Ann K. Goodchild
    Abstract:

    Glucoprivation or hypoglycemia induces a range of counterregulatory responses, including glucose mobilization, reduced glucose utilization, and de novo glucose synthesis. These responses are mediated in part by the sympathetic nervous system. The aim of this study was to determine the chemical codes of sympathetic preganglionic neurons (SPN) activated by glucoprivation, induced by 2-deoxy-D-glucose (2DG). SPN controlling the adrenal glands and Celiac Ganglia, which ultimately can innervate the liver and pancreas, were targeted together with the superior cervical Ganglia (control). 23.9% ± 1.3% of SPN in the T4–T11 region contained c-Fos immunoreactivity following 2DG; 70.3% ± 1.8% of SPN innervating the adrenal glands and 37.4% ± 3% of SPN innervating Celiac Ganglia were activated. 14.8% ± 3.5% of SPN (C8–T3) innervating superior cervical Ganglia were activated. In the C8–T3 region 55% ± 10% of SPN activated contained PPCART, with only 12% ± 3% expressing PPE mRNA, whereas, in the T4–T11 region, 78% ± 4% contained PPE, with only 6.0% ± 0.6% expressing PPCART mRNA. Thus CART is not involved in glucose mobilization. Two chemically distinct populations of SPN (PPE+ 57.4% ± 5%, PPE− ∼40%) were identified to regulate adrenaline release in response to glucoprivation. Multiple chemically distinct SPN populations innervating a specific target could suggest their graded recruitment. The two distinct populations of SPN (PPE+ 67.6% ± 9%, PPE− ∼30%) projecting to Celiac Ganglia activated by glucoprivation could direct pancreatic and hepatic or other counterregulatory responses. Nearly all SPN that expressed PPE mRNA and projected to the adrenal glands or Celiac Ganglia were activated, suggesting a role for the inhibitory peptide enkephalin in responses evoked by glucoprivation. J. Comp. Neurol. 521:2703–2718, 2013. © 2013 Wiley Periodicals, Inc.

Gerald J. Taborsky - One of the best experts on this subject based on the ideXlab platform.

  • Short-term diabetic hyperglycemia suppresses Celiac Ganglia neurotransmission, thereby impairing sympathetically mediated glucagon responses.
    American journal of physiology. Endocrinology and metabolism, 2015
    Co-Authors: Thomas O. Mundinger, Ellis Cooper, Michael P. Coleman, Gerald J. Taborsky
    Abstract:

    Short-term hyperglycemia suppresses superior cervical Ganglia neurotransmission. If this ganglionic dysfunction also occurs in the islet sympathetic pathway, sympathetically mediated glucagon responses could be impaired. Our objectives were 1) to test for a suppressive effect of 7 days of streptozotocin (STZ) diabetes on Celiac Ganglia (CG) activation and on neurotransmitter and glucagon responses to preganglionic nerve stimulation, 2) to isolate the defect in the islet sympathetic pathway to the CG itself, and 3) to test for a protective effect of the WLD(S) mutation. We injected saline or nicotine in nondiabetic and STZ-diabetic rats and measured fos mRNA levels in whole CG. We electrically stimulated the preganglionic or postganglionic nerve trunk of the CG in nondiabetic and STZ-diabetic rats and measured portal venous norepinephrine and glucagon responses. We repeated the nicotine and preganglionic nerve stimulation studies in nondiabetic and STZ-diabetic WLD(S) rats. In STZ-diabetic rats, the CG fos response to nicotine was suppressed, and the norepinephrine and glucagon responses to preganglionic nerve stimulation were impaired. In contrast, the norepinephrine and glucagon responses to postganglionic nerve stimulation were normal. The CG fos response to nicotine, and the norepinephrine and glucagon responses to preganglionic nerve stimulation, were normal in STZ-diabetic WLD(S) rats. In conclusion, short-term hyperglycemia's suppressive effect on nicotinic acetylcholine receptors of the CG impairs sympathetically mediated glucagon responses. WLD(S) rats are protected from this dysfunction. The implication is that this CG dysfunction may contribute to the impaired glucagon response to insulin-induced hypoglycemia seen early in type 1 diabetes.

  • Impaired activation of Celiac ganglion neurons in vivo after damage to their sympathetic nerve terminals
    Journal of neuroscience research, 2008
    Co-Authors: Thomas O. Mundinger, Qi Mei, Gerald J. Taborsky
    Abstract:

    Because damage to sympathetic nerve terminals occurs in a variety of diseases, we tested the hypothesis that nerve terminal damage per se is sufficient to impair ganglionic neurotransmission in vivo. First, we measured the effect of nerve terminal damage produced by the sympathetic nerve terminal toxin 6-hydroxydopamine (6-OHDA) on ganglionic levels of several neurotrophins thought to promote neurotransmission. 6-OHDA-induced nerve terminal damage did not decrease the expression of neurotrophin-4 or brain-derived neurotrophic factor mRNA in the Celiac Ganglia but did decrease the ganglionic content of both nerve growth factor protein (nadir = -63%) and the mRNA of the alpha-3 subunit of the nicotinic cholinergic receptor (nadir = -49%), a subunit required for neurotransmission. Next, we tested whether this degree of receptor deficiency was sufficient to impair activation of Celiac Ganglia neurons. Impaired fos mRNA responses to nicotine administration in the Celiac Ganglia of 6-OHDA-pretreated rats correlated temporally with suppressed expression of functional nicotinic receptors. We verified by Fos protein immunohistochemistry that this ganglionic impairment was specific to principal ganglionic neurons. Last, we tested whether centrally initiated ganglionic neurotransmission is also impaired following nerve terminal damage. The principal neurons in rat Celiac Ganglia were reflexively activated by 2-deoxy-glucose-induced glucopenia, and the Fos response in the Celiac Ganglia was markedly inhibited by pretreatment with 6-OHDA. We conclude that sympathetic nerve terminal damage per se is sufficient to impair ganglionic neurotransmission in vivo and that decreased nicotinic receptor production is a likely mediator.

T Ohnishi - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic ultrasound-guided Celiac Ganglia neurolysis vs. Celiac plexus neurolysis: a randomized multicenter trial.
    Endoscopy, 2013
    Co-Authors: Shinpei Doi, Ichiro Yasuda, Hiroshi Kawakami, Tsuyoshi Hayashi, Hiroyuki Hisai, Atsushi Irisawa, Tsuyoshi Mukai, Akio Katanuma, Kensuke Kubota, T Ohnishi
    Abstract:

    No prospective comparison of endoscopic ultrasonography-guided direct Celiac Ganglia neurolysis (EUS - CGN) vs. EUS-guided Celiac plexus neurolysis (EUS - CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS - CGN and EUS - CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial. Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS - CGN or EUS - CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS - CGN and EUS - CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects. A total of 34 patients were assigned to each group. Visualization of Ganglia was possible in 30 cases (88 %) in the EUS - CGN group. The positive response rate was significantly higher in the EUS - CGN group (73.5 %) than in the EUS - CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS - CGN group (50.0 %) than in the EUS - CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups. EUS - CGN is significantly superior to conventional EUS - CPN in cancer pain relief. http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536). © Georg Thieme Verlag KG Stuttgart · New York.

  • endoscopic ultrasound guided Celiac Ganglia neurolysis vs Celiac plexus neurolysis a randomized multicenter trial
    Endoscopy, 2013
    Co-Authors: Shinpei Doi, Ichiro Yasuda, Hiroshi Kawakami, Tsuyoshi Hayashi, Hiroyuki Hisai, Atsushi Irisawa, Tsuyoshi Mukai, Akio Katanuma, Kensuke Kubota, T Ohnishi
    Abstract:

    Background and study aims: No prospective comparison of endoscopic ultrasonography-guided direct Celiac Ganglia neurolysis (EUS – CGN) vs. EUS-guided Celiac plexus neurolysis (EUS – CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS – CGN and EUS – CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial. Patients and methods: Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS – CGN or EUS – CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS – CGN and EUS – CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects. Results: A total of 34 patients were assigned to each group. Visualization of Ganglia was possible in 30 cases (88 %) in the EUS – CGN group. The positive response rate was significantly higher in the EUS – CGN group (73.5 %) than in the EUS – CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS – CGN group (50.0 %) than in the EUS – CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups. Conclusions: EUS – CGN is significantly superior to conventional EUS – CPN in cancer pain relief. Clinical trial registration: http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536)