RT Generic T1 Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update A1 Perez-Aguado, Guillermo A1 de la Mata, Diego Martinez-Acitores A1 Valenciano, Carlos Marra-Lopez A1 Sainz, Ignacio Fernandez-Urien K1 Pancreatic cancer K1 Endosonography K1 Celiac plexus neurolysis K1 Opioids K1 Echoendoscopy K1 Spinal-cord infarction K1 Ganglia neurolysis K1 Pain management K1 Efficacy K1 Complication K1 Ischemia K1 Relief K1 Block AB Pancreatic cancer produces disabling abdominal pain, and the pain medical management for pancreatic cancer is often challenging because it mainly relies on the use of narcotics (major opioids). However, opioids often provide suboptimal pain relief, and the use of opioids can lead to patient tolerance and several side effects that considerably reduce the quality of life of pancreatic cancer patients. Endosonography-guided celiac plexus neurolysis (EUS-CPN) is an alternative for pain control in patients with nonsurgical pancreatic cancer; EUS-CPN consists of the injection of alcohol and a local anesthetic into the area of the celiac plexus to achieve chemical ablation of the nerve tissue. EUS-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous approach. We have reviewed most of the studies that evaluate the efficacy of EUS-CPN and that have compared the different approaches that have been performed by endosonographers. The efficacy of EUS-CPN varies from 50% to 94% in the different studies, and EUS-CPN has a pain relief duration of 4-8 wk. Several factors are involved in its efficacy, such as the onset of pain, previous use of chemotherapy, presence of metastatic disease, EUS-CPN technique, type of needle or neurolytic agent used, etc. According to this review, injection into the ganglia may be the best technique, and a good visualization of the ganglia is the best predictor for a good EUS-CPN response, although more studies are needed. However, any of the 4 different techniques could be used to perform EUS-CPN effectively with no differences in terms of complications between the techniques, but more studies are needed. The effect of EUS-CPN on pain improvement, patient survival and patient quality of life should be evaluated in well-designed randomized clinical trials. Further research also needs to be performed to clarify the best time frame in performing a EUS-CPN. PB Baishideng publishing group inc SN 1948-5190 YR 2021 FD 2021-10-16 LK https://hdl.handle.net/10668/26752 UL https://hdl.handle.net/10668/26752 LA en DS RISalud RD Apr 17, 2025