"...Pancreatic cancer and chronic pancreatitis commonly
cause pain that is difficult to control[1-3]. Opioids are frequently
used in an attempt to mitigate pain, however, tolerance,
nausea, constipation and other side effects develop[
4,5]. Non-pharmacologic therapies are often employed
to improve pain control and quality of life while reducing
drug-related side effects.
Celiac plexus blockade (CPB) using
steroids or celiac plexus neurolysis (CPN) using alcohol has been utilized and considered safe.
Endoscopic ultrasound
(EUS)-guided CPB and CPN have demonstrated
safety and efficacy through real-time imaging and anterior
access to the celiac plexus from the posterior gastric wall,
thereby avoiding complications related to the puncture of
spinal nerves, arteries and the diaphragm.
Unfortunately, EUS-guided CPN and CPB provide
limited benefit in terms of degree and duration of pain
relief[3]. While benefit duration of EUS CPN diminishes
after 8-12 wk, the etiology remains unknown[6,7]. One theory
is that the neurolytic or blockade agent washes away
from the celiac plexus injection site due to its liquid freeflowing
form and does not remain in the ideal anatomical
location. Thus, if a neurolytic or blockade agent could be
delivered in an alternate phase (solid or gel), it could offer
the potential for enhanced efficacy and safety[8]..."
World J Gastroenterol 2010 February 14; 16(6): 728-731
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