Accepted Article
1
EUS-guided celiac ganglion radiofrequency ablation for pain control in pancreatic carcinoma1
Zhen Dong JIN [email protected] Changhai Hospital, Second Military Medical University Department of Gastroenterology Shanghai China Lei Wang [email protected] http://orcid.org/0000-0001-6604-3175
Shanghai Changhai Hospital Gastroenterology 168 Changhai Road Shanghai Shanghai Shanghai China 200433
Zhaoshen Li [email protected] Shanghai Changhai Hospital Gastroenterology Shanghai Shanghai China
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/den.12398 This article is protected by copyright. All rights reserved.
Accepted Article
2
A 57-year-old male was diagnosised pancreatic cancer with liver metastasis by Computed tomography (Figure 1A). Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed a pathology diagnosis of pancreatic cancer (Figure 1B). The patient had undergone EUS-guided radiofrequency ablation (RFA) two months prior to presentation (Figure 1C). However, the patient had a visual analog scale (VAS) score of 8 and received 40 mg oral opioid analgesics every 2 hours. For pain control, EUS-guided celiac ganglion RFA was performed. Firstly, an EUS-guided puncture of the celiac ganglion was performed using a 19-gauge EUS needle. Secondly, a RF probe, The Habib™
RF DUO 13, was advanced into the needle to the center of the celiac ganglion, then the needle was withdrawn to the border in order to disengage contact with the active part of the probe. With the application of RFA, the center of the celiac ganglion gradually became hyperechoic (Figure 1, D-F; video). Ablation parameters were set as follows: fixed RF power (heating) was 10 W for 120 s and 15 W for 120 s. Three days after the procedure, the patient’s VAS score decreased to 2, thereby eliminating the need for opioid analgesics. Two weeks after the procedure, the VAS score stabilized at 4, and opioid analgesics were still unneeded. However, three months after the procedure, the patient died from dyscrasia. Pancreatic carcinoma often causes refractory abdominal pain as a chief symptom. Although the World Health Organization Cancer Pain Relief Program recommends celiac plexus neurolysis for pain relief1, the effect is often short-lived2. In comparison, RFA induces irreparable cellular damage and coagulation necrosis3. In this article, we report a new method for celiac ganglion ablation and the VAS score for the treated patient decreased substantially. Therefore, we propose that EUS-guided celiac ganglion RFA is a feasible, effective, and safe procedure.
This article is protected by copyright. All rights reserved.
Accepted Article
3
REFERENCES 1.
Teixeira MJ, Neto ER, da Nobrega JC, et al. Celiac plexus neurolysis for the treatment of upper
abdominal cancer pain. Neuropsychiatr Dis Treat. 2013; 9: 1209-12. 2.
Vranken JH, Zuurmond WW, Van Kemenade FJ, Dzoljic M. Neurohistopathologic findings after a
neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain. Acta Anaesthesiol Scand. 2002; 46: 827-30. 3.
Rossi S, Fornari F, Pathies C, Buscarini L. Thermal lesions induced by 480 KHz localized current
field in guinea pig and pig liver. Tumori. 1990; 76: 54-7.
This article is protected by copyright. All rights reserved.
Accepted Article
4
Figure Legends Figure 1. A) Contrasted CT showsing the pancreatic tail mass. B) The malignancy is detected in a slide of a EUS-FNA sample slide showing the malignancy. – staining was performed. C) EUS-guided RFA. – images obtained bD) Before (D), during (E), and after (F) EUS-guided RFA in the celiac ganglion E) EUS-guided RFA in the celiac ganglion.F)After EUS-guided RFA in the celiac ganglion. Video Legend EUS-guided celiac ganglion radiofrequency ablation with RF using a convex linear -array echoendoscope. The probe was insertedplaced directly into the center of the celiac ganglion through the needle using real-time endosonographic guidance. The needle was withdrawn to the border of the celiac ganglion when the probe had reachedwas push into the center of the celiac ganglion. Following radiofrequency ablation, tThe center of the celiac ganglion becaome hyperechoic with RF ablation.
This article is protected by copyright. All rights reserved.
Accepted Article
5
DEN_12398_Figure
This article is protected by copyright. All rights reserved.
1
EUS-guided celiac ganglion radiofrequency ablation for pain control in pancreatic carcinoma1
Zhen Dong JIN [email protected] Changhai Hospital, Second Military Medical University Department of Gastroenterology Shanghai China Lei Wang [email protected] http://orcid.org/0000-0001-6604-3175
Shanghai Changhai Hospital Gastroenterology 168 Changhai Road Shanghai Shanghai Shanghai China 200433
Zhaoshen Li [email protected] Shanghai Changhai Hospital Gastroenterology Shanghai Shanghai China
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/den.12398 This article is protected by copyright. All rights reserved.
Accepted Article
2
A 57-year-old male was diagnosised pancreatic cancer with liver metastasis by Computed tomography (Figure 1A). Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed a pathology diagnosis of pancreatic cancer (Figure 1B). The patient had undergone EUS-guided radiofrequency ablation (RFA) two months prior to presentation (Figure 1C). However, the patient had a visual analog scale (VAS) score of 8 and received 40 mg oral opioid analgesics every 2 hours. For pain control, EUS-guided celiac ganglion RFA was performed. Firstly, an EUS-guided puncture of the celiac ganglion was performed using a 19-gauge EUS needle. Secondly, a RF probe, The Habib™
RF DUO 13, was advanced into the needle to the center of the celiac ganglion, then the needle was withdrawn to the border in order to disengage contact with the active part of the probe. With the application of RFA, the center of the celiac ganglion gradually became hyperechoic (Figure 1, D-F; video). Ablation parameters were set as follows: fixed RF power (heating) was 10 W for 120 s and 15 W for 120 s. Three days after the procedure, the patient’s VAS score decreased to 2, thereby eliminating the need for opioid analgesics. Two weeks after the procedure, the VAS score stabilized at 4, and opioid analgesics were still unneeded. However, three months after the procedure, the patient died from dyscrasia. Pancreatic carcinoma often causes refractory abdominal pain as a chief symptom. Although the World Health Organization Cancer Pain Relief Program recommends celiac plexus neurolysis for pain relief1, the effect is often short-lived2. In comparison, RFA induces irreparable cellular damage and coagulation necrosis3. In this article, we report a new method for celiac ganglion ablation and the VAS score for the treated patient decreased substantially. Therefore, we propose that EUS-guided celiac ganglion RFA is a feasible, effective, and safe procedure.
This article is protected by copyright. All rights reserved.
Accepted Article
3
REFERENCES 1.
Teixeira MJ, Neto ER, da Nobrega JC, et al. Celiac plexus neurolysis for the treatment of upper
abdominal cancer pain. Neuropsychiatr Dis Treat. 2013; 9: 1209-12. 2.
Vranken JH, Zuurmond WW, Van Kemenade FJ, Dzoljic M. Neurohistopathologic findings after a
neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain. Acta Anaesthesiol Scand. 2002; 46: 827-30. 3.
Rossi S, Fornari F, Pathies C, Buscarini L. Thermal lesions induced by 480 KHz localized current
field in guinea pig and pig liver. Tumori. 1990; 76: 54-7.
This article is protected by copyright. All rights reserved.
Accepted Article
4
Figure Legends Figure 1. A) Contrasted CT showsing the pancreatic tail mass. B) The malignancy is detected in a slide of a EUS-FNA sample slide showing the malignancy. – staining was performed. C) EUS-guided RFA. – images obtained bD) Before (D), during (E), and after (F) EUS-guided RFA in the celiac ganglion E) EUS-guided RFA in the celiac ganglion.F)After EUS-guided RFA in the celiac ganglion. Video Legend EUS-guided celiac ganglion radiofrequency ablation with RF using a convex linear -array echoendoscope. The probe was insertedplaced directly into the center of the celiac ganglion through the needle using real-time endosonographic guidance. The needle was withdrawn to the border of the celiac ganglion when the probe had reachedwas push into the center of the celiac ganglion. Following radiofrequency ablation, tThe center of the celiac ganglion becaome hyperechoic with RF ablation.
This article is protected by copyright. All rights reserved.
Accepted Article
5
DEN_12398_Figure
This article is protected by copyright. All rights reserved.
