Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
Gastrointest Endosc. 2017 Oct;86(4):655-663. doi: 10.1016/j.gie.2017.01.041. Epub 2017 Feb 7.
There is little evidence that structures targeted during EUS-guided celiac ganglia neurolysis (EUS-CGN) are celiac ganglia and that selective ethanol injection into ganglia is feasible. We aimed to visualize celiac ganglia, confirm that these structures are ganglia, and visualize ethanol spread after EUS-CGN and EUS-guided celiac plexus neurolysis (EUS-CPN).
First, celiac ganglia were sought during 97 consecutive EUS procedures. Second, ganglia were identified in a prosected human cadaver by placing a linear echoendoscope next to the celiac trunk and removing the underlying tissue for histology. Finally, various EUS-CGN and EUS-CPN techniques were performed in human cadavers; EUS-CGN was performed with 1 mL ethanol in 1 ganglion, 1 mL per ganglion (both low volume), and 4 mL per ganglion (high volume). EUS-CPN was performed with a central (20 mL) and a bilateral (2*10 mL) approach. Transverse sections (75 μm) were obtained and photographed to allow visualization of the spread of ethanol.
A total of 204 ganglia were detected in 83 patients. Mean (± standard deviation) size of the long axis was 8.1 mm (± 7.4 mm). Histology of the removed region in the cadaver showed only nerve cell bodies. After low-volume EUS-CGN in cadavers, ethanol spread well beyond the targeted ganglion. After high-volume EUS-CGN in cadavers, a larger ethanol spread was seen, which also reached unidentified ganglia; the spread was comparable to the spread after EUS-CPN.
Specific EUS-CGN is not feasible because ethanol spreads well beyond the targeted ganglion. Unidentified celiac ganglia are better reached with high-volume EUS-CGN, and this would likely result in a more thorough neurolysis. High-volume EUS-CGN should be preferred to low-volume EUS-CGN.
几乎没有证据表明 EUS 引导的腹腔神经丛神经松解术（EUS-CGN）中靶向的结构是腹腔神经节，并且向神经节内注射乙醇是可行的。我们旨在可视化腹腔神经节，确认这些结构是神经节，并在 EUS-CGN 和 EUS 引导的腹腔神经丛神经松解术（EUS-CPN）后可视化乙醇的扩散。
首先，在 97 例连续的 EUS 操作中寻找腹腔神经节。其次，在人体解剖标本中，通过将线性回声内镜放置在腹腔干旁边并切除下方的组织进行组织学检查来识别神经节。最后，在人体解剖标本中进行各种 EUS-CGN 和 EUS-CPN 技术；EUS-CGN 中在 1 个神经节中注射 1 毫升乙醇，每个神经节注射 1 毫升（低容量）和每个神经节注射 4 毫升（高容量）。EUS-CPN 采用中央（20 毫升）和双侧（2*10 毫升）方法进行。获得横向切片（75μm）并拍照，以允许可视化乙醇的扩散。
在 83 例患者中总共检测到 204 个神经节。长轴的平均（±标准差）大小为 8.1mm（±7.4mm）。解剖标本中切除区域的组织学显示只有神经细胞体。在尸体的低容量 EUS-CGN 后，乙醇很好地扩散到靶向神经节之外。在尸体的高容量 EUS-CGN 后，观察到更大的乙醇扩散，也到达了未识别的神经节；扩散与 EUS-CPN 后的扩散相当。
特定的 EUS-CGN 是不可行的，因为乙醇很好地扩散到靶向神经节之外。用高容量 EUS-CGN 可以更好地到达未识别的腹腔神经节，并且这可能会导致更彻底的神经松解。应该优先选择高容量 EUS-CGN 而不是低容量 EUS-CGN。
