Department of Pancreatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Medicine (Baltimore). 2021 Oct 15;100(41):e27103. doi: 10.1097/MD.0000000000027103.
Comparison between endosonographic ultrasonography (EUS)-guided celiac ganglia neurolysis (CGN) and EUS-guided celiac plexus neurolysis (CPN) in pain management for pancreatic cancer has engendered controversy. To analyze the effectiveness and safety of EUS-CGN and figure out whether EUS-CGN is better than EUS-CPN, a qualitative systematic review was conducted.
Studies were searched from Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE up to April 2020. We only included studies with full-text and in English and assessed study quality with Newcastle-Ottawa Scale or Cochrane risk-of-bias tool. We recorded details of study design, participants, procedure performed, protocol of follow-up, pain response, quality of life, survival, and adverse events. The study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009.
Five studies involving 319 patients were included. Short-term pain response rates ranged from 65.0% to 88.46% in EUS-CGN group and most studies reported its superiority over EUS-CPN. As for adverse events, the incidence of transient hypotension and gastrointestinal symptoms seemed comparable, while results of initial pain exacerbation varied among studies. Besides, EUS-CGN might provide a shorter survival.
EUS-CGN can be safely performed while it may shorten survival. In terms of short-term pain response, EUS-CGN is better than EUS-CPN while no conclusion of long-term pain control can be drawn.
超声内镜引导腹腔神经丛松解术（EUS-CGN）与超声内镜引导腹腔神经丛化学消融术（EUS-CPN）在胰腺癌疼痛管理中的比较存在争议。为分析 EUS-CGN 的有效性和安全性，明确 EUS-CGN 是否优于 EUS-CPN，我们进行了定性系统评价。
检索 Cochrane 对照试验中心注册库、MEDLINE 和 EMBASE 中截至 2020 年 4 月的研究。我们仅纳入有全文且为英文的研究，并使用纽卡斯尔-渥太华量表或 Cochrane 偏倚风险工具评估研究质量。我们记录了研究设计、参与者、实施的程序、随访方案、疼痛反应、生活质量、生存和不良事件的详细信息。本研究根据系统评价和荟萃分析的首选报告项目 2009 进行。
纳入 5 项研究，共 319 例患者。EUS-CGN 组的短期疼痛缓解率为 65.0%至 88.46%，大多数研究报告其优于 EUS-CPN。至于不良事件，短暂性低血压和胃肠道症状的发生率似乎相似，而初始疼痛加重的结果在不同研究中有所不同。此外，EUS-CGN 可能会缩短生存时间。
EUS-CGN 可安全实施，但其可能会缩短生存时间。在短期疼痛反应方面，EUS-CGN 优于 EUS-CPN，但不能得出长期疼痛控制的结论。
