Asif Abuzar A, Walayat Saqib K, Bechtold Matthew L, Revanur Vakya, Puli Srinivas R
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
J Community Hosp Intern Med Perspect. 2021 Jun 21;11(4):536-542. doi: 10.1080/20009666.2021.1929049.
: Endoscopic ultrasound guided celiac plexus neurolysis (EUS- CPN) has been reported to be an effective way to help with pain in pancreatic cancer patient. The aim of our updated meta-analysis is to assess the efficacy of pain relief in patients with pancreatic cancer who underwent EUS guided neurolysis. : Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test based upon inverse variance weights. : Initial search identified 176 reference articles, of which 34 were selected and reviewed in detail. Sixteen studies that met the inclusion criteria were included in this analysis. The mean age of patients undergoing neurolysis was 56.31 ± 19.72 years. Number of males, = 563 (57.4%), was higher than the number of females, = 417 (42.5%). The pooled proportion of patients who showed pain relief with EUS-guided neurolysis was 71% (95% CI = 68-74). Bias calculated using Begg-Mazumdar was not significant ( = 0.8). In a subgroup analysis, when comparing the central and bilateral techniques, the pooled proportion of patients with pain relief was 66% (95% CI = 61-71) and 57% (95% CI = 48-67), respectively. : Our results show that EUS guided CPN could provide relief in as much as 70% of patients with central neurolysis technique having some edge over peripheral neurolysis. Further larger scale randomized controlled trials may further help to elaborate the efficacy of central vs peripheral neurolysis.
据报道，内镜超声引导下腹腔神经丛毁损术（EUS-CPN）是缓解胰腺癌患者疼痛的有效方法。我们更新的荟萃分析的目的是评估接受EUS引导下神经毁损术的胰腺癌患者的疼痛缓解疗效。使用Mantel-Haenszel法（固定效应模型）和DerSimonian Laird法（随机效应模型）计算合并比例。基于逆方差权重，使用Cochran's Q检验对研究间的异质性进行检验。初步检索确定了176篇参考文献，其中34篇被选中并进行详细审查。本分析纳入了16项符合纳入标准的研究。接受神经毁损术患者的平均年龄为56.31±19.72岁。男性患者数量为563例（57.4%），高于女性患者数量417例（42.5%）。EUS引导下神经毁损术显示疼痛缓解的患者合并比例为71%（95%CI=68-74）。使用Begg-Mazumdar计算的偏倚不显著（P=0.8）。在亚组分析中，比较中央和双侧技术时，疼痛缓解患者的合并比例分别为66%（95%CI=61-71）和57%（95%CI=48-67）。我们的结果表明，EUS引导下的CPN可为多达70%的患者提供缓解，中央神经毁损术比外周神经毁损术更具优势。进一步大规模的随机对照试验可能有助于进一步阐明中央与外周神经毁损术的疗效。
