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EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

  • 주제(키워드) pancreatic cancer , pain , celiac neurolysis , endoscopic ultrasound
  • 주제(기타) Medicine, General & Internal
  • 설명문(일반) [Yoon, Won Jae] Ewha Womans Univ, Coll Med, Dept Internal Med, Seoul 07804, South Korea; [Oh, Yul; Suh, Jeong-Hun; Choi, Seong-Soo] Univ Ulsan, Asan Med Ctr, Dept Anesthesiol & Pain Med, Coll Med, Seoul 05505, South Korea; [Yoo, Changhoon] Univ Ulsan, Asan Med Ctr, Dept Oncol, Coll Med, Seoul 05505, South Korea; [Jang, Sunguk] Cleveland Clin, Dept Gastroenterol & Hepatol, Cleveland, OH 44195 USA; [Cho, Seong-Sik] Dong A Univ, Dept Occupat & Environm Med, Coll Med, Busan 49201, South Korea; [Park, Do Hyun] Univ Ulsan, Asan Med Ctr, Dept Internal Med, Div Gastroenterol,Coll Med, Seoul 05505, South Korea; [Oh, Yul] Namyangju Baek Hosp, Namyangju Si, South Korea; [Suh, Jeong-Hun] Seoulnanum Pain Clin, Jeju Si, South Korea
  • 등재 SCIE, SCOPUS
  • OA유형 Green Published, gold
  • 발행기관 MDPI
  • 발행년도 2020
  • 총서유형 Journal
  • URI http://www.dcollection.net/handler/ewha/000000172397
  • 본문언어 영어
  • Published As https://dx.doi.org/10.3390/jcm9061666
  • PubMed https://pubmed.ncbi.nlm.nih.gov/32492883

초록/요약

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n= 30) or PCN (n= 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease >= 50% or >= 3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): -0.8 to 4.2) and 1.7 (95% CI: -0.3 to 2.1); back pain: 1.3 (95% CI: -0.9 to 3.4) and 2.5 (95% CI: -0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were -0.5 (p= 0.46) and -1.4 (p= 0.11) for abdominal pain and 0.1 (p= 0.85) and -0.9 (p= 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

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