RecruitingNot ApplicableNCT06160323

Upfront EUS CGN/CPN vs Conventional Step up Approach for Inoperable Painful Pancreatic Cancer

Upfront Endoscopic Ultrasound-guided Celiac Ganglion Neurolysis Versus Conventional Step-up Approach for Patients With Painful, Inoperable Pancreatic Cancer


Sponsor

Chinese University of Hong Kong

Enrollment

94 participants

Start Date

Nov 10, 2023

Study Type

INTERVENTIONAL

Conditions

Summary

Patients with unresectable pancreatic cancer are often demoralized by intractable, persistent and incapacitating pain. It must be managed aggressively and strong opioids are recommended as the mainstay of treatment. However, patients develop opioid-related adverse effects. EUS-guided celiac plexus neurolysis (CPN) and celiac ganglion neurolysis (CGN) has been shown to provide high efficacy for pain control. The optimal timing, however, is in debate.


Eligibility

Min Age: 18 Years

Plain Language Summary

Simplified for easier understanding

This study is comparing two approaches for managing pain in patients with inoperable pancreatic cancer: an early nerve block procedure (celiac plexus neurolysis/ganglion impar neurolysis) done via endoscopic ultrasound (EUS) versus the standard step-up approach where pain medication is tried first and the nerve block is only used later. The goal is to see if performing the nerve block earlier leads to better pain control. **You may be eligible if...** - You are 18 years or older - You have been diagnosed with inoperable pancreatic cancer - You are experiencing tumor-related pain (centrally located, constant) rated at 3 or higher on a pain scale - You are scheduled for an endoscopic ultrasound procedure - Your general functional status is reasonable **You may NOT be eligible if...** - You are not experiencing significant tumor pain - Your pancreatic cancer is operable - You are not suitable for an endoscopic ultrasound procedure - Your functional status or general health does not meet the requirements Talk to your doctor to see if this trial is right for you.

This summary was AI-generated to explain the trial in plain language. It is not medical advice. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

PROCEDUREEUS-guided coeliac ganglion neurolysis / celiac plexus neurolysis

The EUS scope was first inserted into the stomach, and the coeliac trunk was visualized by scanning from the lesser curve of the gastric body. After visualization, the scope was rotated clockwise, enabling visualization and identification of the left adrenal gland. The coeliac ganglia are often seen to the left of the coeliac artery, between the aorta and the left adrenal gland, at the level between the coeliac artery and the left adrenal artery. They are also visualized cephalad to the coeliac artery in some cases. Hypoechoic nodular structures linked by hypoechoic threads residing in the periphery of this region were defined as the coeliac ganglia . A 19G or 22G needle was used for puncture of the CGN. After confirming the lack of backflow of blood with aspiration, a mixture of 5ml of 0.25-0.5% bupivacaine and 5ml absolute alcohol was injected. For cases in which celiac ganglia could not be visualized, EUS-guided coeliac plexus neurolysis (CPN) will be performed.


Locations(1)

Prince of Wales Hospital

Hong Kong, Hong Kong

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NCT06160323


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