• S Doi, I Yasuda, H Kawakami, T Hayashi, H Hisai, A Irisawa, T Mukai, A Katanuma, K Kubota, T Ohnishi, S Ryozawa, K Hara, T Itoi, K Hanada, and K Yamao.
• First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan.
• Endoscopy. 2013 Jan 1;45(5):362-9.

Background And Study AimsNo 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 MethodsPatients 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.ResultsA 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.ConclusionsEUS - CGN is significantly superior to conventional EUS - CPN in cancer pain relief.Clinical Trial Registrationhttp://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536).© Georg Thieme Verlag KG Stuttgart · New York.

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