The Experts below are selected from a list of 894 Experts worldwide ranked by ideXlab platform

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)

Shinpei Doi - One of the best experts on this subject based on the ideXlab platform.

  • EUS-guided Celiac Plexus Neurolysis
    Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases, 2017
    Co-Authors: Ichiro Yasuda, Shinpei Doi, Masatoshi Mabuchi
    Abstract:

    EUS-guided Celiac Plexus Neurolysis (EUS–CPN) can be performed for alleviating pain originating from the upper abdominal organs and, particularly, when the primary indication for pain is pancreatic cancer pain. Two different techniques are currently used when applying EUS–CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the Celiac axis, and the second approach, the bilateral technique, involves injection of the neurolytic agent on both sides of the Celiac axis. Moreover, it was recently established that Celiac ganglia can be examined and visualized by EUS. Therefore, EUS-guided direct Celiac ganglia Neurolysis (EUS–CGN) has been introduced as a new promising method. These techniques are performed with real-time imaging and with Doppler assessment of the interposing vessels. Therefore, they are more accurate, safe, and convenient than other classic approaches such as radiographic, fluoroscopic, or CT guidance. The effective rates reportedly vary from 50 to 90%. Common complications included transient diarrhea, transient pain exacerbation, transient hypotension, and inebriation, but they are not serious.

  • 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)

  • predictive factors for pain relief after endoscopic ultrasound guided Celiac Plexus Neurolysis
    Digestive Endoscopy, 2011
    Co-Authors: Keisuke Iwata, Shinpei Doi, Ichiro Yasuda, Tsuyoshi Mukai, Masamichi Enya, Masanori Nakashima, Takuji Iwashita, Eiichi Tomita, Hisataka Moriwaki
    Abstract:

    Background:  Celiac Plexus Neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy. Patients and Methods:  Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the Celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN. Results:  Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the Celiac Plexus and distribution of ethanol only on the left side of the Celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively). Conclusion:  EUS-CPN seems to be less effective in patients with direct invasion of the Celiac Plexus. Ethanol should be injected on both sides of the Celiac axis to obtain greater pain relief.

Tsuyoshi Hayashi - One of the best experts on this subject based on the ideXlab platform.

  • EUS-guided Celiac Plexus Neurolysis by using highly viscous phenol-glycerol as a neurolytic agent (with video)
    Gastrointestinal endoscopy, 2015
    Co-Authors: Hirotoshi Ishiwatari, Tsuyoshi Hayashi, Makoto Yoshida, Michihiro Ono, Tsutomu Sato, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Hiroyuki Masuko
    Abstract:

    4 EUS-guided Celiac Plexus Neurolysis (EUS-CPN) is considered to be a reliable treatment for cancer-related pain. However, inadequate distribution of the neurolytic agent to the Celiac Plexus (CP) has been presumed to contribute to the failure of pain relief. Indeed, it has been reported that the distribution of the neurolytic agent to only the left side of the Celiac artery (CA) (as assessed by CT) is a significant predictor of negative response to EUSCPN. Generally, the injected neurolytic agent in EUS-CPN is more likely to flow into the left side of the CA. Further, it often spreads extensively beyond the CP and throughout the retroperitoneal cavity. These tendencies probably relate to the left lateral decubitus position during the procedure and the supine position after the procedure, which allow the neurolytic agent to spread extensively by gravity, preventing it from remaining near the CA. We hypothesized that a highly viscous neurolytic agent would remain around the CP and provide better pain relief. Ethanol and phenol are the neurolytic agents commonly used in CPN. Although they permanently destroy the CP, they have low viscosities. A representative highly viscous neurolytic agent is glycerol, which has been recommended

  • phenol based endoscopic ultrasound guided Celiac Plexus Neurolysis for east asian alcohol intolerant upper gastrointestinal cancer patients a pilot study
    World Journal of Gastroenterology, 2014
    Co-Authors: Hirotoshi Ishiwatari, Tsuyoshi Hayashi, Makoto Yoshida, Michihiro Ono, Hiroyuki Masuko, Tsutomu Sato, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune
    Abstract:

    Phenol-based endoscopic ultrasound-guided Celiac Plexus Neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients: A pilot study

  • 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)

Tsuyoshi Mukai - 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)

  • predictive factors for pain relief after endoscopic ultrasound guided Celiac Plexus Neurolysis
    Digestive Endoscopy, 2011
    Co-Authors: Keisuke Iwata, Shinpei Doi, Ichiro Yasuda, Tsuyoshi Mukai, Masamichi Enya, Masanori Nakashima, Takuji Iwashita, Eiichi Tomita, Hisataka Moriwaki
    Abstract:

    Background:  Celiac Plexus Neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy. Patients and Methods:  Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the Celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN. Results:  Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the Celiac Plexus and distribution of ethanol only on the left side of the Celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively). Conclusion:  EUS-CPN seems to be less effective in patients with direct invasion of the Celiac Plexus. Ethanol should be injected on both sides of the Celiac axis to obtain greater pain relief.

Ichiro Yasuda - One of the best experts on this subject based on the ideXlab platform.

  • EUS-guided Celiac Plexus Neurolysis
    Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases, 2017
    Co-Authors: Ichiro Yasuda, Shinpei Doi, Masatoshi Mabuchi
    Abstract:

    EUS-guided Celiac Plexus Neurolysis (EUS–CPN) can be performed for alleviating pain originating from the upper abdominal organs and, particularly, when the primary indication for pain is pancreatic cancer pain. Two different techniques are currently used when applying EUS–CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the Celiac axis, and the second approach, the bilateral technique, involves injection of the neurolytic agent on both sides of the Celiac axis. Moreover, it was recently established that Celiac ganglia can be examined and visualized by EUS. Therefore, EUS-guided direct Celiac ganglia Neurolysis (EUS–CGN) has been introduced as a new promising method. These techniques are performed with real-time imaging and with Doppler assessment of the interposing vessels. Therefore, they are more accurate, safe, and convenient than other classic approaches such as radiographic, fluoroscopic, or CT guidance. The effective rates reportedly vary from 50 to 90%. Common complications included transient diarrhea, transient pain exacerbation, transient hypotension, and inebriation, but they are not serious.

  • 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)

  • predictive factors for pain relief after endoscopic ultrasound guided Celiac Plexus Neurolysis
    Digestive Endoscopy, 2011
    Co-Authors: Keisuke Iwata, Shinpei Doi, Ichiro Yasuda, Tsuyoshi Mukai, Masamichi Enya, Masanori Nakashima, Takuji Iwashita, Eiichi Tomita, Hisataka Moriwaki
    Abstract:

    Background:  Celiac Plexus Neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy. Patients and Methods:  Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the Celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN. Results:  Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the Celiac Plexus and distribution of ethanol only on the left side of the Celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively). Conclusion:  EUS-CPN seems to be less effective in patients with direct invasion of the Celiac Plexus. Ethanol should be injected on both sides of the Celiac axis to obtain greater pain relief.