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CLINICAL GUIDELINE
Year : 2017  |  Volume : 6  |  Issue : 6  |  Page : 369-375

Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis


1 Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
2 Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
3 Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
4 Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
5 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
6 Surgical Clinical Gastroenterolgy, Hospital of Caldas, University of Caldas, Manizales, Colombia
7 Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
8 Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
9 Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
10 Digestive Endoscopy Unit, Division of Gastroenterology, Copenhagen, Denmark
11 Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
12 Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
13 Department of Internal Medicine, Cairo University, Cairo, Egypt
14 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
15 Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
16 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, USA
17 Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
18 Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
19 Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
20 Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
21 Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL, USA
22 Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
23 Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
24 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
25 Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
26 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
27 Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Bronx, New York, USA
28 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
29 Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
30 Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
31 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
32 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
33 Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
34 Division of Gastroenterology, Center Hospitalier de l'Université de Montréal, Montreal, Canada

Correspondence Address:
Dr. Anand V Sahai
Center Hospitalier de l'Université de Montréal, Montreal
Canada
Dr. Siyu Sun
Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_97_17

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Objectives: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Methods: Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Results: Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. Conclusions: EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.


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