Predictors of pain response after endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain caused by pancreatic malignancy

BACKGROUND Endoscopic ultrasound-guided celiac plexus neurolysis(EUS-CPN)has gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain.However,response to treatment is variable.AIM To identify the efficacy of EUS-CPN and explore determinants of pain response in EUS-CPN for pancreatic cancer-associated pain.METHODS A retrospective study of 58 patients with abdominal pain due to inoperable pancreatic cancer who underwent EUS-CPN were included.The efficacy for palliation of pain was evaluated based on the visual analog scale pain score at 1 wk and 4 wk after EUS-CPN.Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response.RESULTS A good pain response was obtained in 74.1%and 67.2%of patients at 1 wk and 4 wk,respectively.Tumors located in the body/tail of the pancreas and patients receiving bilateral treatment were weakly associated with a good outcome.Multivariate analysis revealed patients with invisible ganglia and metastatic disease were significant factors for a negative response to EUS-CPN at 1 wk and 4 wk,respectively,particularly for invasion of the celiac plexus(odds ratio(OR)=13.20,P=0.003 for 1 wk and OR=15.11,P=0.001 for 4 wk).No severe adverse events were reported.CONCLUSION EUS-CPN is a safe and effective form of treatment for intractable pancreatic cancer-associated pain.Invisible ganglia,distant metastasis,and invasion of the celiac plexus were predictors of less effective response in EUS-CPN for pancreatic cancer-related pain.For these patients,efficacy warrants attention.