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Review
Endoscopic ultrasound-guided neurolysis in advanced pancreatic cancer: current status
  1. Katy Hickman1,
  2. Edmund Godfrey1 and
  3. Thankamma Ajithkumar2
  1. 1 Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Katy Hickman, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; katharine.hickman{at}gmail.com

Abstract

Pancreatic cancer has a very poor prognosis with patients often presenting with locally advanced, inoperable or metastatic disease. A significant proportion of patients have visceral pain due to perineural infiltration or coeliac plexus involvement by the tumour. This pain is difficult to control and may become refractory to conventional pain management. Therefore, coeliac plexus neurolysis (CPN) has been proposed to ablate the neuronal transmission pathway of pain permanently. CPN is recommended for those who have uncontrolled pain, are experiencing unacceptable opioid adverse effects or are receiving escalating doses of analgesics. It is not known whether CPN performed at diagnosis as the first-line treatment (‘early’) would impact short-term and long-term pain control and quality of life. NICE has recommended (2018) a randomised trial comparing early endoscopic ultrasound-guided coeliac plexus neurolysis (EUS-CPN) with on-demand EUS-CPN in pancreatic cancer. In this context, we will review the current evidence on its clinical benefits.

  • pancreatic
  • pain
  • quality of life
  • symptoms and symptom management

https://doi.org/10.1136/bmjspcare-2021-002905

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    Footnotes

    • Contributors Conception, planning and design of the work; final approval of the version to be published; and guarantor for the overal content: TA; drafting and critical revision of the article: KH, EG and TA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.