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Celiac plexus neurolysis for the palliative reduction of pain in unresectable pancreatic carcinoma is safe but provides limited relief. Dr Kai-Xuan Wang and colleagues from China previously reported that the EUS-guided implantation of iodine-125 (125I) around the celiac ganglia is a safe procedure, and can induce apoptosis of local neurons in a porcine model. The research team evaluate the safety and efficacy of direct celiac ganglion irradiation with 125I seeds for the relief of moderate to severe pain secondary to unresectable pancreatic carcinoma. The researchers enrolled consecutive patients who had moderate to severe pain resulting from biopsy-proven unresectable pancreatic carcinoma.  | | 26% reported pain exacerbation | | Gastrointestinal Endoscopy |
All patients underwent EUS-guided direct celiac ganglion irradiation with 125I seeds. Follow-up was conducted at least once weekly until death. The team's main outcomes included blood parameters, Visual Analog Scale score, mean analgesic consumption, and complications were evaluated during follow-up. The research team found that 23 patients with unresectable pancreatic carcinoma underwent the procedure. The mean number of seeds implanted in the celiac ganglion per patient was 4. Immediately after the procedure, pain relief and analgesic consumption showed no significant changes compared with preoperative values. The researchers found that 26% reported pain exacerbation. The team noted that 2 weeks later, the Visual Analog Scale score and mean analgesic consumption were significantly less than preoperative values. The research team observed no procedure-related deaths or major complications. Dr Wang's team commented, "EUS-guided direct celiac ganglion irradiation with 125I seeds can reduce the Visual Analog Scale score and analgesic drug consumption in patients with unresectable pancreatic carcinoma."
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