Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

Michael J. Levy, Ferga C. Gleeson, Mark Topazian, Larissa L. Fujii-Lau, Felicity T Enders, Joseph J. Larson, Kristin Mara, Barham K. Abu Dayyeh, Steven Robert Alberts, Christopher L. Hallemeier, Prasad G Iyer, Michael L. Kendrick, William D. Mauck, Randall K. Pearson, Bret Thomas Petersen, Elizabeth Rajan, Naoki Takahashi, Santhi Swaroop Vege, Kenneth Ke Ning Wang, Suresh T Chari

Research output: Contribution to journalArticle

Abstract

Background & Aims: Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. Methods: We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Results: Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P =.84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02–2.19; P =.042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95% CI, 1.61–5.45; P <.001). Rates of survival at 12 months were 42% for patients who underwent CPN vs 26% for patients who underwent CGN. The number of adverse events did not differ between techniques. Conclusion: In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.

Original languageEnglish (US)
Pages (from-to)728-738.e9
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number4
DOIs
StatePublished - Mar 1 2019

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Celiac Plexus
Sympathetic Ganglia
Survival
Pain
Quality of Life
Abdominal Pain
Adenocarcinoma
Pancreatic Neoplasms
Morphine
Opioid Analgesics
Survival Rate

Keywords

  • EUS
  • Management
  • PDAC
  • Treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone. / Levy, Michael J.; Gleeson, Ferga C.; Topazian, Mark; Fujii-Lau, Larissa L.; Enders, Felicity T; Larson, Joseph J.; Mara, Kristin; Abu Dayyeh, Barham K.; Alberts, Steven Robert; Hallemeier, Christopher L.; Iyer, Prasad G; Kendrick, Michael L.; Mauck, William D.; Pearson, Randall K.; Petersen, Bret Thomas; Rajan, Elizabeth; Takahashi, Naoki; Vege, Santhi Swaroop; Wang, Kenneth Ke Ning; Chari, Suresh T.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 4, 01.03.2019, p. 728-738.e9.

Research output: Contribution to journalArticle

Levy, MJ, Gleeson, FC, Topazian, M, Fujii-Lau, LL, Enders, FT, Larson, JJ, Mara, K, Abu Dayyeh, BK, Alberts, SR, Hallemeier, CL, Iyer, PG, Kendrick, ML, Mauck, WD, Pearson, RK, Petersen, BT, Rajan, E, Takahashi, N, Vege, SS, Wang, KKN & Chari, ST 2019, 'Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone', Clinical Gastroenterology and Hepatology, vol. 17, no. 4, pp. 728-738.e9. https://doi.org/10.1016/j.cgh.2018.08.040
Levy, Michael J. ; Gleeson, Ferga C. ; Topazian, Mark ; Fujii-Lau, Larissa L. ; Enders, Felicity T ; Larson, Joseph J. ; Mara, Kristin ; Abu Dayyeh, Barham K. ; Alberts, Steven Robert ; Hallemeier, Christopher L. ; Iyer, Prasad G ; Kendrick, Michael L. ; Mauck, William D. ; Pearson, Randall K. ; Petersen, Bret Thomas ; Rajan, Elizabeth ; Takahashi, Naoki ; Vege, Santhi Swaroop ; Wang, Kenneth Ke Ning ; Chari, Suresh T. / Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 4. pp. 728-738.e9.
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abstract = "Background & Aims: Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. Methods: We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66{\%}) received CPN and 50 patients (age 66.8±10.0 years; male 56{\%}) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Results: Rates of pain response at 12 weeks were 46.2{\%} for CGN and 40.4{\%} for CPN (P =.84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95{\%} CI, 1.02–2.19; P =.042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95{\%} CI, 1.61–5.45; P <.001). Rates of survival at 12 months were 42{\%} for patients who underwent CPN vs 26{\%} for patients who underwent CGN. The number of adverse events did not differ between techniques. Conclusion: In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.",
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TY - JOUR

T1 - Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

AU - Levy, Michael J.

AU - Gleeson, Ferga C.

AU - Topazian, Mark

AU - Fujii-Lau, Larissa L.

AU - Enders, Felicity T

AU - Larson, Joseph J.

AU - Mara, Kristin

AU - Abu Dayyeh, Barham K.

AU - Alberts, Steven Robert

AU - Hallemeier, Christopher L.

AU - Iyer, Prasad G

AU - Kendrick, Michael L.

AU - Mauck, William D.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Rajan, Elizabeth

AU - Takahashi, Naoki

AU - Vege, Santhi Swaroop

AU - Wang, Kenneth Ke Ning

AU - Chari, Suresh T

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background & Aims: Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. Methods: We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Results: Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P =.84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02–2.19; P =.042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95% CI, 1.61–5.45; P <.001). Rates of survival at 12 months were 42% for patients who underwent CPN vs 26% for patients who underwent CGN. The number of adverse events did not differ between techniques. Conclusion: In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.

AB - Background & Aims: Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival. Methods: We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events. Results: Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P =.84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02–2.19; P =.042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95% CI, 1.61–5.45; P <.001). Rates of survival at 12 months were 42% for patients who underwent CPN vs 26% for patients who underwent CGN. The number of adverse events did not differ between techniques. Conclusion: In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.

KW - EUS

KW - Management

KW - PDAC

KW - Treatment

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