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20.11.2010, 22:21
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"...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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