Rai Praveer, Cr Lokesh, Kc Harish
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
Indian J Gastroenterol. 2020 Apr;39(2):171-175. doi: 10.1007/s12664-019-01003-z. Epub 2020 Feb 17.
In gallbladder cancer (GBC), nearly 80% of patients present with pain in the upper abdomen. Narcotic analgesics are usually effective in relieving cancer pain, but induce adverse effects. Celiac plexus neurolysis (CPN) is an effective alternative to reduce pain caused by upper abdominal cancer; however, no published data is available on endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief in GBC.
Patient with unresectable GBC with upper abdominal pain of severity ≥ 3 on visual analogue scale (VAS), not responding to non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol were recruited prospectively over a 2-year period. EUS-CPN was done using the central approach in all the patients. Pain severity was assessed using a VAS, prior to EUS-CPN and at 2, 4, and 8 weeks after CPN.
The technical success was achieved in 19 of 21 patients in whom the procedure was attempted. There was a significant improvement in pain severity as measured by VAS compared with the baseline at 2 and 4 weeks after treatment (p < .001); at 8 weeks, pain severity was less but was not statistically significant. At week 2, nearly 95% of patients had either complete or partial relief of pain. This response declined to 63% and 61% at 4 and 8 weeks, respectively. There was a significant reduction in daily requirement of analgesics in all the patients at 2 and 4 weeks compared with baseline (p < .001); at week 8, there was no significant reduction in analgesic dose.
EUS-CPN has a high technically success in most patients with GBC. It improved pain in about 60% to 70% patients and lowered daily analgesic dose requirement for up to 4 weeks. There was no procedure-related complication.
在胆囊癌（GBC）患者中，近80%的患者存在上腹部疼痛。麻醉性镇痛药通常能有效缓解癌痛，但会引发不良反应。腹腔神经丛阻滞（CPN）是减轻上腹部癌症所致疼痛的一种有效替代方法；然而，关于内镜超声引导下腹腔神经丛阻滞（EUS-CPN）用于缓解GBC疼痛的相关数据尚未见报道。
前瞻性招募了在2年期间内患有不可切除GBC且上腹部疼痛视觉模拟评分（VAS）≥3分、对非甾体抗炎药（NSAIDs）和曲马多无反应的患者。所有患者均采用中心入路进行EUS-CPN。在EUS-CPN前以及CPN后2周、4周和8周，使用VAS评估疼痛严重程度。
在21例尝试进行该操作的患者中，19例获得了技术成功。与治疗前基线相比，治疗后2周和4周时，VAS测量的疼痛严重程度有显著改善（p<0.001）；在8周时，疼痛严重程度有所减轻，但无统计学意义。在第2周时, 近95%的患者疼痛完全或部分缓解。在第4周和第8周时，这一比例分别降至63%和61%。与基线相比，所有患者在第2周和第4周时的每日镇痛药需求量均显著减少（p<0.001）；在第8周时，镇痛药剂量无显著减少。
EUS-CPN在大多数GBC患者中技术成功率较高。它使约60%至70%的患者疼痛得到改善，并在长达4周的时间内降低了每日镇痛药剂量需求。未出现与操作相关的并发症。
