Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial

Background and study aims: No prospective comparison of endoscopic ultrasonography-guided direct celiac ganglia neurolysis (EUS-CGN) vs. EUS-guided celiac plexus neurolysis (EUS-CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS-CGN and EUS-CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial. Patients and methods: Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS-CGN or EUS-CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to <= 3 were considered to have a positive response, and those experiencing a decrease in pain to <= 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS-CGN and EUS-CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects. Results: A total of 34 patients were assigned to each group. Visualization of ganglia was possible in 30 cases (88%) in the EUS-CGN group. The positive response rate was significantly higher in the EUS-CGN group (73.5%) than in the EUS-CPN group (45.5%; P=0.026). The complete response rate was also significantly higher in the EUS-CGN group (50.0%) than in the EUS-CPN group (18.2%; P=0.010). There was no difference in adverse events or duration of pain relief between the two groups. Conclusions: EUS-CGN is significantly superior to conventional EUS-CPN in cancer pain relief. Clinical trial registration: http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536)