Symptoms and General Pathology

All Conditions

Digestive System Diseases

Nutritional and Metabolic Diseases

Nervous System Diseases

Cancer Pain

Pain

Celiac Disease

Neurologic Manifestations

Central Nervous System Depressants

All Drugs and Chemicals

Anti-Infective Agents

Bupivacaine

Ethanol

Endoscopic Ultrasound Guided Coeliac Plexus Block

Endoscopic Ultrasound Guided Coeliac Plexus Radiofrequency Ablation

Chemical ablation is performed by injection of 10 mL of 0.25% bupivacaine, followed by 10 mL of 98% dehydrated alcohol using a 22G FNA needle (Cook and Olympus)

Alcohol injection

coeliac plexus is identified and punctured with 19G EUSRA RFA needle with 10W-30W of energy for 10-50s bilaterally or unilaterally depends on individual anatomical characteristics.

Radiofrequency Ablation

Wan Yee Chiu, BISC

Ka Wing Ma, MBBS, MS

Many cancer patients suffer from intractable pain and which is often suboptimally controlled by even strong opioid analgesics. Coeliac plexus neurolysis (CPN) is procedure which intended to permanently destroy the nociceptive pathway that transmits the pain caused by the tumour. It can be with different approaches, such as percutaneously guided by fluoroscopy, echo-endoscopically or surgically with endoscopic approach being the more popular one in many centers equipped with echo-endoscopic services. The effect of CPN has been well established by some retrospective series. The overall response rate to CPN ranges from 70-90%, however, the analgesic effect is limited and up to roughly around 3 months. It is believed that the short-lasting analgesic effect is related to incomplete neurolysis by absolute alcohol injection.

Recently, radiofrequency ablation (RFA) of coeliac plexus has been introduced as another mode of CPN. So far, only one small single center randomized controlled trial (RCT) suggesting superior performance in favour to CPN using RFA. This result has to be validated and by a RCT with larger sample size. In addition, data concerning the quality of life (QOL) improvement and cost-effectiveness need to be further elucidated. Therefore, the aim of this study is to perform a RCT to look into these issues.

The aim of this study is to compare the efficacy of EUS-CPN by chemical ablation using alcohol injection versus by radiofrequency ablation in patients with cancer pain related to intra-abdominal malignancy. This is a randomised controlled trial to assess the clinical outcomes and cost-effectiveness of this new treatment approach.

Endoscopic Ultrasound Guided Coeliac Plexus Neurolysis for Cancer Pain

Endoscopic Ultrasound-Guided Coeliac Plexus Neurolysis for Cancer Pain: Chemical Versus Radiofrequency Ablation

change of pain score at 4th week after the procedure (by VAS score)

change of pain score (Visual Analog Score) after the procedure

decrease in pain level by 30% from the pre-procedural baseline

time from injection of pre-medication to procedure last observation recording at the procedure suite

The University of Hong Kong

Clinical Assistant Professor

Pharmaceutical Solutions

Coeliac plexus neurolysis (CPN) will be performed bilaterally. Neurolytic solution will be injected around the coeliac plexus (a network of nerves located in the abdomen).

Splanchnic nerve neurolysis (SNN) will be performed bilaterally. Neurolytic solution will be injected around the splanchnic nerves (a nerve located at thoracic trunk).

Coeliac plexus neurolysis

Splanchnic nerve neurolysis

Timmy CW Chan, MBBS

Chi Wing Chan, MBBS

Pain is prevalent among patients with gastrointestinal cancers. Standard procedures such as coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases. Meanwhile, splanchnic nerve neurolysis (SNN) as an alternative to CPN is more effective for cancer pain relief.

Although previous studies investigating the role of CPN/SNN mainly focus on pancreatic cancer cases, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

Pain is prevalent among patients with gastrointestinal cancers. There is abundant evidence that coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases while the evidence for other upper abdominal cancer pain is less robust but emerging. Meanwhile, there is an increasing interest in utilising splanchnic nerve neurolysis (SNN) as an alternative to CPN for cancer pain relief.

Although previous studies investigating the role of CPN/SNN involved heterogenous types of intra-abdominal malignancies, majority of cases were pancreatic cancer. Therefore, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

The randomization sequence will be generated by Microsoft Excel software. Blocked randomization will be done with an allocation ratio of 1:1. This will be prepared by a statistician unaware of the nature of the clinical study. The sequence will be concealed in opaque envelopes and opened by an investigator just before the procedure. The patients and independent investigators collecting outcome data will be blinded

The patients and independent investigators collecting outcome data will be blinded.

Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis

Comparing the Effects of Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis for Non-pancreatic Upper Intra-abdominal Cancer Pain: a Prospective Randomized Study

Pain intensity using numerical rating scale from 0 to 10 where 0 is no pain and 10 is the worst pain.

Honorary Clinical Associate Professor

Neoplasms

Gland and Hormone Related Diseases

Rare Diseases

Pancreatic Neoplasms

Pain, Intractable

Gastrointestinal Diseases

Gastrointestinal Neoplasms

Digestive System Neoplasms

Endocrine Gland Neoplasms

Pancreatic Diseases

Endocrine System Diseases

Pancreatic Cancer

Anti-Infective Agents, Local

Radiofrequency ablation of the coeliac plexus

* coeliac plexus is identified and punctured
* Injection of 10 mL of .25% bupivacaine, followed by 10 mL of 98% dehydrated alcohol.

98% dehydrated alcohol

* 10W-30W RFA will be applied unilaterally or bilaterally depends on individual anatomical characteristics for 10-50s
* Complete ablation of coeliac plexus nervous tissue is confirmed by appearance of air-bubble ultrasound scan

19G EUSRA needle, Taewoong Medical, Korea

The aim of this study is to compare the efficacy of EUS-guided CPN versus radiofrequency ablation in patients with pain related to pancreatic cancer. By performing a randomized controlled trial, the clinical outcomes and cost-effectiveness of this new RFA treatment approach can be evaluated.

EUS-Coeliac Plexus Block Versus Radiofrequency Ablation in Pain Relief of Patients With Malignancy

Endoscopic Ultrasound Guided Coeliac Plexus Block Versus Radiofrequency Ablation in Pain Relief of Patients With Intractable Pain Due to Malignancy A Randomized Controlled Study

Pain score at 4 weeks after procedure (by VAS score)

Decrease of pain level by 30% from pre-procedural baseline

Time from injection of pre-medication to procedure last observation recording at the procedure suite

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Endoscopic Ultrasound Guided Coeliac Plexus Neurolysis for Cancer Pain	NCT04801082	Malignancy Pain Management	Alcohol injecti... Radiofrequency ...	18 Years -	The University of Hong Kong
Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis	NCT05541211	Cancer Pain	Coeliac plexus ... Splanchnic nerv...	18 Years -	The University of Hong Kong
EUS-Coeliac Plexus Block Versus Radiofrequency Ablation in Pain Relief of Patients With Malignancy	NCT04809935	Cancer of Pancr... Pancreatic Neop... Pain Cancer-Associat... Pain Management	98% dehydrated ... 19G EUSRA needl...	18 Years -	The University of Hong Kong
EUS-Coeliac Plexus Block Versus Radiofrequency Ablation in Pain Relief of Patients With Malignancy	NCT04809935	Cancer of Pancr... Pancreatic Neop... Pain Cancer-Associat... Pain Management	98% dehydrated ... 19G EUSRA needl...	18 Years -	The University of Hong Kong

Spots Global Cancer Trial Database for coeliac plexus neurolysis