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ABSTRACT
Year : 2017  |  Volume : 6  |  Issue : 7  |  Page : 26

Endoscopic ultrasound-guided celiac plexus neurolysis for pain relief in carcinoma gallbladder


SGPGI, Lucknow, Uttar Pradesh, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.212273

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Background and Objectives: About 80% of patients with gallbladder cancer present with pain. Unlike cancer pancreas, endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief has not been studied in gallbladder cancer. We studied the effect of EUS-CPN in gallbladder cancer and whether it has any effect on decreasing analgesic dose requirement. Methods: Patients with unresectable gallbladder with pain severity = 3 on visual analog scale (VAS) in spite of nonsteroidal anti-inflammatory drugs and/or weak opioids underwent EUS-CPN over 1-year period. They were followed prospectively for 8 weeks; pain severity and analgesic dose requirement were assessed at baseline and weeks 2, 4, and 8. Response was defined as complete, partial, and no response if pain severity on VAS was 0, decreased by = 3, and decreased by <3, respectively, as compared to baseline. Results: CPN was successfully done in 19 out of 21 included in the study. Median pain severity on VAS was 7, 2, 4, and 5 at baseline and weeks 2, 4, and 8. At week 2, 3 (15.8%), 15 (79%), and 1 (5.2%) had complete, partial, and no response, respectively; at week 4, none, 12 (63.2%), and 7 (36.8%) had complete, partial, and no response, respectively; and at week 8, none, 11 (58%), and 8 (42%) had complete, partial, and no response, respectively. Median number of paracetamol + tramadol tablets/day in gallbladder cancer was reduced to 2, 2, and 3 tablets/day on week 2, 4, and 8, respectively, from baseline three tablets/day (P = 0.016). None had any procedure-related adverse events. Conclusion: EUS-CPN provides short-term partial pain relief in about 60-70% of patients.


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