Minaga Kosuke, Kitano Masayuki, Sakamoto Hiroki, Miyata Takeshi, Imai Hajime, Yamao Kentaro, Kamata Ken, Omoto Shunsuke, Kadosaka Kumpei, Sakurai Toshiharu, Nishida Naoshi, Chiba Yasutaka, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan.
Therap Adv Gastroenterol. 2016 Jul;9(4):483-94. doi: 10.1177/1756283X16644248. Epub 2016 Apr 19.
Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain.
This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications.
A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications.
EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment.
介入性内镜超声（EUS）引导下的手术，如EUS引导下腹腔神经节松解术（EUS-CGN）和EUS引导下广泛神经丛松解术（EUS-BPN），旨在治疗腹部癌症相关疼痛；然而，这些手术并非总是有效。本研究的目的是探索EUS引导下神经松解术治疗胰腺癌相关疼痛时疼痛反应的预测因素。
这是一项对在我们机构连续接受EUS-BPN的112例患者的前瞻性收集数据进行的回顾性分析。在可见腹腔神经节的病例中加用EUS-CGN。神经溶解扩散区域分为六个部分，并通过术后计算机断层扫描进行评估。使用视觉模拟量表（VAS）评估疼痛强度，神经松解术后VAS评分降低≥3分被认为是良好的疼痛反应。进行单变量和多变量逻辑回归分析，以探索1周和4周时疼痛反应的预测因素以及并发症。
分别有77.7%和67.9%的患者在1周和4周时获得了良好的疼痛反应。在对这些患者的多变量分析中，联合方法（EUS-BPN加CGN）在1周时（比值比=3.69，p=0.017）和4周时（比值比=6.37，p=0.043）是一个显著的阳性预测因素。联合方法和单一方法治疗的患者中，神经溶解/造影剂扩散区域的数量（平均值±标准差）分别为4.98±1.08和4.15±1.12（p<0.001）。没有并发症的显著预测因素。
EUS-BPN联合EUS-CGN是EUS引导下神经松解术治疗胰腺癌相关疼痛时良好疼痛反应的预测因素。接受联合治疗的患者中，神经溶解/造影剂扩散区域数量较多可能会带来更好的结果。
