The Experts below are selected from a list of 8217 Experts worldwide ranked by ideXlab platform
Maurits J. Wiersema - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic Ultrasound-Guided Pain Control for Intra-abdominal Cancer
Gastroenterology Clinics of North America, 2006Co-Authors: Michael J. Levy, Maurits J. WiersemaAbstract:This article summarizes percutaneous and surgical methods for performing celiac plexus Neurolysis and focuses on the technical aspects of endoscopic ultrasound-guided celiac plexus Neurolysis. Published literature concerning endoscopic ultrasound-guided celiac plexus Neurolysis is reviewed, indications are proposed, and opinions are offered concerning potential future applications and investigational needs as they apply to this technique.
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EUS-guided celiac plexus Neurolysis and celiac plexus block
Gastrointestinal Endoscopy, 2003Co-Authors: Michael J. Levy, Maurits J. WiersemaAbstract:addition, patients with chronic pancreatitis risk narcotic dependence. Therefore, nonpharmacologic therapies, such as celiac plexus Neurolysis (CPN), are often given with the goal of improving pain control and quality of life while reducing the risk of drug-related side effects. Some use the term celiac plexus block (CPB) to refer to the use of steroids and/or a local anesthetic to temporarily inhibit celiac plexus function in patients with benign disease (chronic pancreatitis). The term celiac plexus Neurolysis is often applied to techniques that inject alcohol or phenol to induce Neurolysis in patients with pancreatic cancer and other malignancies. Many use these terms interchangeably. This review summarizes the percutaneous (PQ) and surgical methods of CPN and focuses on the technical aspects of EUS-guided CPN (EUS CPN). Publications specific to EUS CPN are reviewed, and evidence-based guidelines regarding the indications and role of EUS CPN are developed. Potential future areas of investigation are raised where evidence is incomplete.
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A prospective study of EUS-guided celiac plexus Neurolysis for pancreatic cancer pain☆
Gastrointestinal endoscopy, 2001Co-Authors: Naresh T. Gunaratnam, Aruna V. Sarma, Ian D. Norton, Maurits J. WiersemaAbstract:Abstract Background: Celiac plexus Neurolysis, a chemical splanchnicectomy of the celiac plexus, is used to treat pain caused by pancreatic cancer. Most commonly, celiac plexus Neurolysis is performed percutaneously under CT or fluoroscopic guidance, but can also be performed with EUS. The aim of this study was to prospectively assess the efficacy of EUS celiac plexus Neurolysis in the management of pain caused by pancreatic cancer. Methods: In this prospective study conducted in a community-based referral hospital, 58 patients with painful and inoperable pancreatic cancer were evaluated at 8 observation points before and after EUS celiac plexus Neurolysis for up to 6 months. The following data were collected: age, gender, tumor location, vascular invasion, adjuvant therapy, and laboratory tests including prothrombin time, and complete blood counts were obtained at baseline (before EUS celiac plexus Neurolysis); pain scores, morphine use, and adjuvant therapy were assessed at each observation. Results: Pain scores were lower ( p = 0.0001) 2 weeks after EUS celiac plexus Neurolysis, an effect that was sustained for 24 weeks when adjusted for morphine use and adjuvant therapy. Forty-five of the 58 patients (78%) experienced a decline in pain scores after EUS celiac plexus Neurolysis. Chemotherapy with and without radiation also decreased pain after EUS celiac plexus Neurolysis ( p = 0.002). Procedure-related transient abdominal pain was noted in 5 patients; there were no major complications. Conclusions: EUS celiac plexus Neurolysis is safe and controls pain caused by unresectable pancreatic cancer. (Gastrointest Endosc 2001;54:316-24.)
Michael J. Levy - One of the best experts on this subject based on the ideXlab platform.
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Editorial: Neurolysis for pancreatic cancer pain: same song, different verse?
The American journal of gastroenterology, 2010Co-Authors: Mark A Virtue, Michael J. LevyAbstract:Since Kappis first performed percutaneous Neurolysis in 1914, investigators have employed innumerable technical variations in an effort to enhance the efficacy. Similar efforts have been underway by endosonographers since Wiersema performed the first endoscopic ultrasound (EUS)-guided celiac plexus Neurolysis in 1996. Although such efforts are important, the availability of multiple procedural options is indicative of the controversy and lack of meaningful progress. If one particular method was clearly superior, the other techniques would have become obsolete. Sakamoto et al. present a new method of EUS-guided Neurolysis in an attempt to improve the outcomes. Although their data are promising, we eagerly await rigorously designed studies that may validate their findings.
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Endoscopic Ultrasound-Guided Pain Control for Intra-abdominal Cancer
Gastroenterology Clinics of North America, 2006Co-Authors: Michael J. Levy, Maurits J. WiersemaAbstract:This article summarizes percutaneous and surgical methods for performing celiac plexus Neurolysis and focuses on the technical aspects of endoscopic ultrasound-guided celiac plexus Neurolysis. Published literature concerning endoscopic ultrasound-guided celiac plexus Neurolysis is reviewed, indications are proposed, and opinions are offered concerning potential future applications and investigational needs as they apply to this technique.
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EUS-guided celiac plexus Neurolysis and celiac plexus block
Gastrointestinal Endoscopy, 2003Co-Authors: Michael J. Levy, Maurits J. WiersemaAbstract:addition, patients with chronic pancreatitis risk narcotic dependence. Therefore, nonpharmacologic therapies, such as celiac plexus Neurolysis (CPN), are often given with the goal of improving pain control and quality of life while reducing the risk of drug-related side effects. Some use the term celiac plexus block (CPB) to refer to the use of steroids and/or a local anesthetic to temporarily inhibit celiac plexus function in patients with benign disease (chronic pancreatitis). The term celiac plexus Neurolysis is often applied to techniques that inject alcohol or phenol to induce Neurolysis in patients with pancreatic cancer and other malignancies. Many use these terms interchangeably. This review summarizes the percutaneous (PQ) and surgical methods of CPN and focuses on the technical aspects of EUS-guided CPN (EUS CPN). Publications specific to EUS CPN are reviewed, and evidence-based guidelines regarding the indications and role of EUS CPN are developed. Potential future areas of investigation are raised where evidence is incomplete.
Piotr Milkiewicz - One of the best experts on this subject based on the ideXlab platform.
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the efficacy and safety of endoscopic ultrasound guided celiac plexus Neurolysis for treatment of pain in patients with pancreatic cancer
Gastroenterology Research and Practice, 2012Co-Authors: Anna Wiechowskakozlowska, Klaudiusz Boer, Maciej Wojcicki, Piotr MilkiewiczAbstract:Introduction. Celiac plexus Neurolysis is used in pain management of patients with advanced and unresectable pancreatic cancer. We retrospectively analyzed efficacy and safety of endoscopic ultrasound- (EUS-) guided celiac plexus Neurolysis in patients treated in our unit. Methods. Twenty nine subjects with unresectable pancreatic cancer and severe pain despite pharmacological treatment underwent EUS-guided celiac plexus Neurolysis with 98% ethanol. Patients scored their pain according to a 0–10 point scale and were interviewed 1-2 weeks and 2-3 months after the procedure. Results. Twenty five (86%) patients reported improvement in their pain at 1-2 weeks following the procedure. Of these, 7 (24%) reported substantial improvement (decrease in pain by more than 50%) and 4 (14%) complete disappearance of pain. Pain relief was still present in 76% of patients after 2-3 months. Treatment-related side effects included hypotonia in 1 patient, severe pain immediately postprocedure in 2 patients, and short episodes of diarrhea in 3 patients. Conclusion. Endoscopic ultrasound- (EUS-) guided celiac plexus Neurolysis is a safe and effective treatment of severe pain from advanced pancreatic cancer.
Frank G Gress - One of the best experts on this subject based on the ideXlab platform.
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Celiac Plexus Block and Neurolysis: A Review
Gastrointestinal endoscopy clinics of North America, 2018Co-Authors: Amit H. Sachdev, Frank G GressAbstract:Pain is often associated with chronic pancreatitis and pancreatic cancer. Often times opioids are used to treat pain; however, the use of opioids is frequently difficult. Endoscopic ultrasound-guided celiac plexus block and celiac plexus nuerolysis are safe and effective modalities used to alleviate pain. Celiac plexus block is a transient interruption of the plexus by local anesthetic, while celiac plexus Neurolysis is prolonged interruption of the transmission of pain from the celiac plexus using chemical ablation. Celiac plexus block is generally performed in the unilateral position, while celiac plexus Neurolysis is performed in the unilateral or bilateral position.
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Endoscopic Ultrasound-Guided Celiac Plexus Block and Celiac Plexus Neurolysis
Clinical Gastroenterology, 2010Co-Authors: Alejandra Castillo-roth, Frank G GressAbstract:Endoscopic ultrasound-guided celiac plexus block and celiac plexus Neurolysis are two techniques used to control pain associated with chronic pancreatitis and pancreatic cancer, respectively. These procedures are safe, have few absolute contraindications, and are relatively well tolerated. Celiac plexus block and celiac plexus Neurolysis use bupivacaine followed by triamcinolone or ethyl alcohol, respectively. On average, the long-term effect of celiac plexus block is 3 months, and repeat blocks can be administered. Direct celiac plexus ganglia Neurolysis is gaining acceptance in clinical practice, and further research is needed to evaluate the effectiveness of this technique.
Hiroki Sakamoto - One of the best experts on this subject based on the ideXlab platform.
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Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis.
Cancers, 2018Co-Authors: Kosuke Minaga, Mamoru Takenaka, Ken Kamata, Tomoe Yoshikawa, Atsushi Nakai, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Hiroki SakamotoAbstract:The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus Neurolysis, in which the celiac plexus is chemically ablated. This procedure was performed percutaneously or intraoperatively until 1996, when endoscopic ultrasound (EUS)-guided celiac plexus Neurolysis was first described. In this transgastric anterior approach, a neurolytic agent is injected around the celiac trunk under EUS guidance. The procedure gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. We focus on two relatively new techniques of EUS-guided Neurolysis: EUS-guided celiac ganglia Neurolysis and EUS-guided broad plexus Neurolysis, which have been developed to improve efficacy. Although the techniques are safe and effective in general, some serious adverse events including ischemic and infectious complications have been reported as the procedure has gained widespread popularity. We summarize reported clinical outcomes of EUS-guided Neurolysis in pancreatic cancer (from the PubMed and Embase databases) with a goal of providing information useful in developing strategies for pancreatic cancer-associated pain alleviation.
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Endoscopic Ultrasound-Guided Neurolysis in Pancreatic Cancer
Pancreatology, 2011Co-Authors: Hiroki Sakamoto, Ken Kamata, Hajime Imai, Masayuki Kitano, Takamitsu Komaki, Masatoshi KudoAbstract:Abdominal pain in patients with pancreatic cancer is a common symptom that is often difficult to manage. Opioids are frequently used in an attempt to mitigate pain; however, side effects may develop. Celiac plexus Neurolysis (CPN) affords effective pain control in patients with pancreatic cancer and is not associated with opioid side effects. Endoscopic ultrasound (EUS)-guided CPN has demonstrated safety and efficacy due to real-time imaging and anterior access to the celiac plexus from the posterior gastric wall, thereby avoiding complications related to the puncture of spinal nerves, arteries and the diaphragm, and is now practiced widely. Furthermore, two new techniques of EUS-guided Neurolysis for abdominal pain management in pancreatic cancer patients have recently been developed. The first technique is EUS-guided celiac ganglia Neurolysis (EUS-CGN) in which EUS facilitates CGN by enabling direct injection into the individual celiac ganglion, and the second technique is EUS-guided broad plexus Neurolysis (EUS-BPN) which extends over the superior mesenteric artery. This review provides evidence for the efficacy of EUS-CPN. Particular attention is paid to the two new techniques of EUS-guided Neurolysis, EUS-CGN and EUS-BPN.
