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 prov...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 EUSCPN 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.展开更多
Choledochal cyst is defined as a cystic dilatation of the distal common bile duct protruding into the duo- denum. It is considered as the rarest congenital cyst of the biliary tract by 1.4%. We report a 46 years old w...Choledochal cyst is defined as a cystic dilatation of the distal common bile duct protruding into the duo- denum. It is considered as the rarest congenital cyst of the biliary tract by 1.4%. We report a 46 years old woman who presented with recurrent jaundice associated with abdominal pain of 07 years duration. The liver function tests showed cholestasis. The abdominal scan and Biliary MRI revealed a dilatation of intrahepatic, pancreatic ducts and a dilatation of the common bile duct with a stenosis in its the lower part. The diagnosis of a common bile duct cholangiocarinoma was mentioned. The gastroscopy revealed a stenosed duodenal bulb not allowing us to perform an echo endoscopy and ERCP. An intraoperative cholangiography illustrating a cystic dilatation of the papillary region in which exist a separate protrusion of the choledochal and wirsung ducts. Therefore, we didn’t accomplish the cephalic duodeno-pancreatectomy and we decided to realize a partial resection of the papilla. The histolological examination proved the absence of any tumoral lesion and the presence of biliary mucosa layered the internal surface of the cyst. The patient is still asymptomatic after one year of the surgery.展开更多
文摘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 EUSCPN 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.
文摘Choledochal cyst is defined as a cystic dilatation of the distal common bile duct protruding into the duo- denum. It is considered as the rarest congenital cyst of the biliary tract by 1.4%. We report a 46 years old woman who presented with recurrent jaundice associated with abdominal pain of 07 years duration. The liver function tests showed cholestasis. The abdominal scan and Biliary MRI revealed a dilatation of intrahepatic, pancreatic ducts and a dilatation of the common bile duct with a stenosis in its the lower part. The diagnosis of a common bile duct cholangiocarinoma was mentioned. The gastroscopy revealed a stenosed duodenal bulb not allowing us to perform an echo endoscopy and ERCP. An intraoperative cholangiography illustrating a cystic dilatation of the papillary region in which exist a separate protrusion of the choledochal and wirsung ducts. Therefore, we didn’t accomplish the cephalic duodeno-pancreatectomy and we decided to realize a partial resection of the papilla. The histolological examination proved the absence of any tumoral lesion and the presence of biliary mucosa layered the internal surface of the cyst. The patient is still asymptomatic after one year of the surgery.
