EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study

Background Celiac plexus neurolysis for the palliative reduction of pain in unresectable pancreatic carcinoma (PC) is safe but provides limited relief. In a previous study, we found that EUS-guided implantation of iodine-125 (125 I) around the celiac ganglia is a safe procedure and can induce apoptosis of local neurons in a porcine model. Objective To evaluate the safety and efficacy of direct celiac ganglion irradiation with125 I seeds for the relief of moderate to severe pain secondary to unresectable PC. Design Prospective study. Setting Single, tertiary care referral center. Patients This study enrolled consecutive patients who had moderate to severe pain resulting from biopsy-proven unresectable PC. Intervention All patients underwent EUS-guided direct celiac ganglion irradiation with125 I seeds. Follow-up was conducted at least once weekly until death. Main Outcome Measurements Blood parameters, Visual Analog Scale (VAS) score, mean analgesic (MS Contin [morphine sulfate]) consumption, and complications were evaluated during follow-up. Results Twenty-three patients with unresectable PC underwent the procedure. The mean number of seeds implanted in the celiac ganglion per patient was 4 (range 2-6). Immediately after the procedure, pain relief and analgesic consumption showed no significant changes compared with preoperative values. Six patients (26%) reported pain exacerbation. Two weeks later, the VAS score and mean analgesic consumption were significantly less than preoperative values. No procedure-related deaths or major complications occurred. Limitations Uncontrolled study. Conclusions EUS-guided direct celiac ganglion irradiation with125 I seeds can reduce the VAS score and analgesic drug consumption in patients with unresectable PC.