Predictive factors for pain relief after EUS-guided neurolysis in patients suffering from upper abdominal cancer pain

Introduction and Aims: EUS-guided celiac plexus neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, two alternative techniques, EUS-guided celiac ganglia neurolysis (CGN) and EUS-guided broad plexus neurolysis (BPN) for abdominal pain management have been reported. The aim of this study to determine the predictive factors for response to EUS-guided neurolysis. Methods: Outcomes of EUS-guided neurolysis in 134 patients suffering from upper abdominal cancer pain were retrospectively analyzed. The efficacy in pain relief was evaluated on the basis of the visual analogue pain score (VAS) at day 7 after the procedure, and negative predictive factors for the efficacy in pain relief were analyzed.Results: Pain relief was obtained in 108 patients (81%). Narcotic consumption dose (>60 mg/day), tumor size (>30 mm), and neurolytic spread area (>3 areas) were significant factors for a negative response to EUS-guided neurolysis, while VAS score before the procedure and location of the tumor did not affect the efficacy. The efficacy of combination treatments with two techniques (CPN+CGN or BPN+CGN) was superior to treatments with a single technique (CPN, CGN or BPN alone). Conclusion: EUS-guided neurolysis for the management of cancer pain should be considered at an earlier stage and combination treatments for wider range of neurolytic spread would be more effective.