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Frank G Gress - One of the best experts on this subject based on the ideXlab platform.

Anand V. Sahai - One of the best experts on this subject based on the ideXlab platform.

  • Celiac Plexus neurolysis in the management of unresectable pancreatic cancer when and how
    World Journal of Gastroenterology, 2014
    Co-Authors: Jonathan Wyse, Yeni Chen, Anand V. Sahai
    Abstract:

    Pancreatic cancer is the second most common abdominal cancer in North America with an estimated 20% resectability at diagnosis, and overall 5-year survival of 5%. Pain is common in pancreatic cancer patients with 70%-80% suffering substantial pain. Celiac Plexus neurolysis (CPN) is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption. CPN is performed by injecting absolute alcohol into the Celiac Plexus neural network of ganglia. This review sets out to explore the current status of CPN in non-resectable pancreatic cancer. We will examine: (1) the efficacy and safety of percutaneous-CPN and endoscopic ultrasound guided-CPN; (2) specific technique modifications including bilateral (vs central) injections and Celiac ganglia neurolysis; and (3) the issue of CPN timing, early at pancreatic cancer diagnosis vs traditional late use as salvage therapy.

  • fatal complication after endoscopic ultrasound guided Celiac Plexus neurolysis
    Endoscopy, 2012
    Co-Authors: Antonio Z Gimenogarcia, Sarto C. Paquin, A Elwassief, Anand V. Sahai
    Abstract:

    A 57-year-old woman with a diagnosis of idiopathic recurrent pancreatitis and progressive epigastric pain radiating to her back was admitted to the hospital. Abdominal computed tomography (CT) showed a suspicious 3-cm pancreatic head mass involving the superior mesenteric artery (SMA) and vein. Endoscopic ultrasound (EUS) showed the suspicious pancreatic head mass with bile duct and main pancreatic duct dilatation and changes compatible with chronic pancreatitis. However, EUS-guided fine needle aspiration cytology was negative on three occasions. EUS-guided Celiac Plexus neurolysis (EUSCPN) was carried out using a 19-gauge needle. Absolute alcohol (10cc) and bupivacaine 0.5% (5cc) were injected on each side of the Celiac takeoff. Color Doppler imaging after the procedure revealed the permeability of the SMA and Celiac takeoff. After the procedure, the patient experienced stabbing pain radiating to the back, with nausea, hypotension, and fever. CT demonstrated complete thrombosis of the Celiac takeoff, as well as wall thickening and bubble-like pneumatosis of the stomach, duodenum, jejunum, ileum loops, and ascending colon. Signs of hepatic infarction of segments I and III, and near-total right-kidney and splenic infarction were discovered. Conservative management was carried out and the patient died 8 days later. Major complications have rarely been reported using EUS-CPN or EUS-guided Celiac Plexus block (●" Tab.1) [1–7]. The present case is the first to document a fatal outcome. The sclerosing effect of absolute ethanol, arterial embolisms after injection, and vasospasm could explain the necrosis of organs distant to the Celiac takeoff [8]. All cases of major complications due to CPN, except one, were reported in the setting of chronic pancreatitis (●" Tab.1). The issue of using CPN in patients with chronic pancreatitis is still a matter of debate [9]. In conclusion, major complications of CPN can include death. It may be preferable to limit EUS-guided CPN to patients with histologically proven cancers.

  • central vs bilateral endoscopic ultrasound guided Celiac Plexus block or neurolysis a comparative study of short term effectiveness
    The American Journal of Gastroenterology, 2009
    Co-Authors: Anand V. Sahai, Valery Lemelin, Sarto C. Paquin
    Abstract:

    Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness

  • EUS-Guided Celiac Plexus Block and Celiac Plexus Neurolysis
    Techniques in Gastrointestinal Endoscopy, 2007
    Co-Authors: Sarto C. Paquin, Anand V. Sahai
    Abstract:

    EUS-guided Celiac Plexus neurolysis (CPN) and Celiac Plexus block (CPB) are safe and at least as effective as percutaneous approaches. EUS-guided CPN is particularly effective for pain related to malignant involvement of the Celiac ganglia. For patients without cancer, CPB is generally used instead but appears to be less effective. Given the different injectates, needles, and techniques that are available, there are many possible ways to perform the procedure. Further studies are needed to clarify the most effective way to perform the technique and to determine the optimal place for it in the therapeutic algorithms.

Michael A Erdek - One of the best experts on this subject based on the ideXlab platform.

  • time dependent change in pain threshold following neurolytic Celiac Plexus block
    Pain management, 2019
    Co-Authors: Seung Woo Baek, Michael A Erdek
    Abstract:

    Aim: To determine the long-term effect of ethanol relative to the re-occurrence of pain in postneurolytic Celiac Plexus block (NCPB) patients. Patients & methods: A noninterventional study on 31 patients who had undergone NCPB to illustrate the average change of pain score over time. Results: All NCPB patients reported a pain score decrease of 83.8% right after the procedure. 73% of patients reported 50-66% decrease in pain 80-100 days postprocedure. The temporal threshold for the return of pain scores to average preblock level was determined to be 103 post-NCPB procedure days. Conclusion: In this study, NCPB patients demonstrate return of pain to baseline subsequent to the analgesic effects of ethanol after a mean 103 days.

  • a comparison of percutaneous and endoscopic guided Celiac Plexus block neurolysis in pancreatic cancer patients
    Journal of Clinical Oncology, 2017
    Co-Authors: Swetha Kambhampati, Elizabeth A Sugar, Joseph M Herman, Michael A Erdek, Eun Ji Shin, Daniel Laheru
    Abstract:

    e15767Background: Celiac Plexus block (CPB) and Celiac Plexus neurolysis (CPN) are options for pain control in pancreatic cancer. Conventionally they are performed percutaneously (PC) with fluoroscopic or CT guidance. However endoscopic ultrasound (EUS) guidance is being increasingly used. The aim of this retrospective study is to compare PC-guided and EUS-guided CPB/CPN for pain control. Methods: Our retrospective cohort study included pancreatic cancer patients who underwent CPN/CPB for pain control from 2008 to 2015 at Johns Hopkins. Patients were assessed immediately post-procedure and at 1 month. Patients were selected using CPT and ICD diagnosis code guided searches of the EHR. Pain intensity was assessed using a Numeric Rating Scale (NRS). A response was defined as a decrease in NRS scores by = > 3 points. The validated FACT-Hep score was used to assess quality of life (QOL). Opiate usage was converted into morphine dosage equivalents. Wilcox rank-sum and Fisher’s exact test were used to compare th...

  • the effectiveness of repeat Celiac Plexus neurolysis for pancreatic cancer a pilot study
    Pain Practice, 2013
    Co-Authors: Kai Mcgreevy, Michael A Erdek, Robert W Hurley, Musa Aner, Steven P Cohen
    Abstract:

    Background:  Celiac Plexus neurolysis (CPN) is an effective but temporary management tool for pancreatic cancer pain (PCP). Clinical studies have shown the duration of benefit with initial CPN to be apaproximately 3 months. When pain recurs, CPN may be repeated, but the outcomes for repeat CPN are not well established. The objective of this study is to determine the success rate and duration of relief following repeat Celiac Plexus neurolysis (rCPN) for PCP. Methods:  Patients who underwent rCPN were identified from a database and their records reviewed. Responses of rCPN were then compared with iCPN for success rates and duration of relief. Success was defined as ≥ 50% pain relief lasting ≥ 1 month. Results:  Overall, there were 24 rCPN performed. The success rate decreased from 67% after initial CPN to 29% following rCPN (P = 0.13). The mean duration of pain relief decreased in parallel from 3.4 months (iCPN) to 1.6 months (rCPN) (P = 0.03). Among those who had a successful rCPN, 2.9 months elapsed from iCPN to rCPN, with disease progression noted in 29%. In those who failed rCPN, 7.8 months elapsed, with disease progression apapreciated in 71% of cases. Conclusions:  rCPN does not provide as much pain relief as iCPN. Disease progression as detailed on imaging appears to be a major factor in the limitations of rCPN. Further prospective studies are warranted to confirm these results and investigate the utility of rCPN.

  • Celiac Plexus Block and Neurolysis for Pancreatic Cancer
    Current Pain and Headache Reports, 2013
    Co-Authors: Bret M. Bahn, Michael A Erdek
    Abstract:

    Neurolytic Celiac Plexus blocks (NCPB) have been performed for many years for the treatment of cancer and some non-cancer pain conditions associated with the upper gastrointestinal tract. The block can provide adequate pain relief from the area of the distal esophagus to the transverse colon, and can be approached from a variety of ways. This is a review of the anatomy, patient selection, technique, medications used, possible complications, and efficacy of the treatment.

  • assessment of Celiac Plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain
    Pain Medicine, 2010
    Co-Authors: Michael A Erdek, Daniel E Halpert, Marlis Gonzalez Fernandez, Steven P Cohen
    Abstract:

    Objective.  To assess demographic and clinical factors associated with Celiac Plexus neurolysis outcomes. Design.  Retrospective clinical data analysis. Setting.  A tertiary care, academic medical center. Patients.  Forty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. Interventions.  Fifty Celiac Plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block. Outcome Measures.  A successful treatment was predefined as >50% pain relief sustained for ≥1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e.g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation. Results.  Those variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block. Conclusions.  Celiac Plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.

Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.

Sarto C. Paquin - One of the best experts on this subject based on the ideXlab platform.

  • fatal complication after endoscopic ultrasound guided Celiac Plexus neurolysis
    Endoscopy, 2012
    Co-Authors: Antonio Z Gimenogarcia, Sarto C. Paquin, A Elwassief, Anand V. Sahai
    Abstract:

    A 57-year-old woman with a diagnosis of idiopathic recurrent pancreatitis and progressive epigastric pain radiating to her back was admitted to the hospital. Abdominal computed tomography (CT) showed a suspicious 3-cm pancreatic head mass involving the superior mesenteric artery (SMA) and vein. Endoscopic ultrasound (EUS) showed the suspicious pancreatic head mass with bile duct and main pancreatic duct dilatation and changes compatible with chronic pancreatitis. However, EUS-guided fine needle aspiration cytology was negative on three occasions. EUS-guided Celiac Plexus neurolysis (EUSCPN) was carried out using a 19-gauge needle. Absolute alcohol (10cc) and bupivacaine 0.5% (5cc) were injected on each side of the Celiac takeoff. Color Doppler imaging after the procedure revealed the permeability of the SMA and Celiac takeoff. After the procedure, the patient experienced stabbing pain radiating to the back, with nausea, hypotension, and fever. CT demonstrated complete thrombosis of the Celiac takeoff, as well as wall thickening and bubble-like pneumatosis of the stomach, duodenum, jejunum, ileum loops, and ascending colon. Signs of hepatic infarction of segments I and III, and near-total right-kidney and splenic infarction were discovered. Conservative management was carried out and the patient died 8 days later. Major complications have rarely been reported using EUS-CPN or EUS-guided Celiac Plexus block (●" Tab.1) [1–7]. The present case is the first to document a fatal outcome. The sclerosing effect of absolute ethanol, arterial embolisms after injection, and vasospasm could explain the necrosis of organs distant to the Celiac takeoff [8]. All cases of major complications due to CPN, except one, were reported in the setting of chronic pancreatitis (●" Tab.1). The issue of using CPN in patients with chronic pancreatitis is still a matter of debate [9]. In conclusion, major complications of CPN can include death. It may be preferable to limit EUS-guided CPN to patients with histologically proven cancers.

  • central vs bilateral endoscopic ultrasound guided Celiac Plexus block or neurolysis a comparative study of short term effectiveness
    The American Journal of Gastroenterology, 2009
    Co-Authors: Anand V. Sahai, Valery Lemelin, Sarto C. Paquin
    Abstract:

    Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness

  • EUS-Guided Celiac Plexus Block and Celiac Plexus Neurolysis
    Techniques in Gastrointestinal Endoscopy, 2007
    Co-Authors: Sarto C. Paquin, Anand V. Sahai
    Abstract:

    EUS-guided Celiac Plexus neurolysis (CPN) and Celiac Plexus block (CPB) are safe and at least as effective as percutaneous approaches. EUS-guided CPN is particularly effective for pain related to malignant involvement of the Celiac ganglia. For patients without cancer, CPB is generally used instead but appears to be less effective. Given the different injectates, needles, and techniques that are available, there are many possible ways to perform the procedure. Further studies are needed to clarify the most effective way to perform the technique and to determine the optimal place for it in the therapeutic algorithms.