RECRUITINGINTERVENTIONAL

Upfront EUS CGN/CPN vs Conventional Step up Approach for Inoperable Painful Pancreatic Cancer

Upfront Endoscopic Ultrasound-guided Celiac Ganglion Neurolysis Versus Conventional Step-up Approach for Patients With Painful, Inoperable Pancreatic Cancer

About This Trial

Patients with unresectable pancreatic cancer are often demoralized by intractable, persistent and incapacitating pain. It must be managed aggressively and strong opioids are recommended as the mainstay of treatment. However, patients develop opioid-related adverse effects. EUS-guided celiac plexus neurolysis (CPN) and celiac ganglion neurolysis (CGN) has been shown to provide high efficacy for pain control. The optimal timing, however, is in debate.

Who May Be Eligible (Plain English)

Who May Qualify: 1. Age \>= 18 years old 2. Diagnosed to have inoperable pancreatic cancer 3. Presence of tumor pain (centrally located, constant, with no other obvious cause) with a VAS \>= 3 4. Karnofsky performance status \>= 60 5. Planned for EUS examination and/or biopsy of the pancreatic tumor Who Should NOT Join This Trial: 1. Allergy to bupivacaine, or alcohol 2. Potentially operable after neoadjuvant therapy 3. Expected survival of less than 3 months 4. Patient who is already on opioids for pain control 5. Previous percutaneous or EUS-guided CGN/ CPN 6. Recurrent pancreatic tumors after operation 7. Uncorrectable coagulopathy 8. Inability or unwillingness to provide willing to sign a consent form Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: 1. Age \>= 18 years old 2. Diagnosed to have inoperable pancreatic cancer 3. Presence of tumor pain (centrally located, constant, with no other obvious cause) with a VAS \>= 3 4. Karnofsky performance status \>= 60 5. Planned for EUS examination and/or biopsy of the pancreatic tumor Exclusion Criteria: 1. Allergy to bupivacaine, or alcohol 2. Potentially operable after neoadjuvant therapy 3. Expected survival of less than 3 months 4. Patient who is already on opioids for pain control 5. Previous percutaneous or EUS-guided CGN/ CPN 6. Recurrent pancreatic tumors after operation 7. Uncorrectable coagulopathy 8. Inability or unwillingness to provide informed consent

Treatments Being Tested

PROCEDURE

EUS-guided coeliac ganglion neurolysis / celiac plexus neurolysis

The EUS scope was first inserted into the stomach, and the coeliac trunk was visualized by scanning from the lesser curve of the gastric body. After visualization, the scope was rotated clockwise, enabling visualization and identification of the left adrenal gland. The coeliac ganglia are often seen to the left of the coeliac artery, between the aorta and the left adrenal gland, at the level between the coeliac artery and the left adrenal artery. They are also visualized cephalad to the coeliac artery in some cases. Hypoechoic nodular structures linked by hypoechoic threads residing in the periphery of this region were defined as the coeliac ganglia . A 19G or 22G needle was used for puncture of the CGN. After confirming the lack of backflow of blood with aspiration, a mixture of 5ml of 0.25-0.5% bupivacaine and 5ml absolute alcohol was injected. For cases in which celiac ganglia could not be visualized, EUS-guided coeliac plexus neurolysis (CPN) will be performed.

Locations (1)

Prince of Wales Hospital

Hong Kong, Hong Kong