Wang, K.X., Jin, Z.D., Du, Y.Q., Zhan, X.B., Zou, D.W., Liu, Y., . . . Li, Z.S. (2012). EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: A prospective pilot study. Gastrointestinal Endoscopy, 76, 945–952.

To determine the feasibility, safety, and effects of endoscopic ultrasound (EUS)-guided direct celiac ganglion irradiation with iodine-125 seeds in patients with pain secondary to unresectable pancreatic cancer

Patients were prehydrated and given intravenous ciproflosacin during the procedures and postoperatively for three days. After identification of celiac ganglion, two to four seeds were inserted via the biopsy channel of the endoscope. Computed tomography scans and abdominal radiography were done the day after surgery to ensure correct placement. Postoperative drug therapy was done following World Health Organization guidelines. None of the patients received radiotherapy. Patients were followed weekly until death.

• The study reported on a sample of 23 patients.
• Median patient age was 64 years, with a range of 38–77 years.
• The sample was 61% male and 39% female.
• All patients had unresectable pancreatic cancer.
• Half (50%) of the patients were within two months of diagnosis, and 50% had not had any previous antitumor treatment.

• Single site
• Multiple settings
• China

• Patients were receiving palliative care.
• The study has clinical applicability for late effects and survivorship.

An observational, prospective study design was used.

Pain visual analog scale (VAS)

Average duration of follow-up was 79 weeks (range 43–156 weeks). Patients received morphine sulfate for pain. Baseline VAS mean score was 5.78 (range 4–8), and average morphine sulfate conception was 68.26 (range 40–90). Initial pain score and opioid consumption increased over the first two weeks. By week 3, pain and opioid consumption declined, and by week 7 VAS mean score was 2.91 (range 1–6) and morphine sulfate consumption was 40.45 (range 20–80). These values continued to decline weekly.  By five months, only two patients remained: pain score was 1.5 and opioid consumption with morphine sulfate was 20. None of the patients achieved complete relief of pain. No procedure complications were reported.

The EUS-guided celiac ganglion irradiation with iodine-125 seeds as done here was effective in reducing pain in these patients with pain due to unresectable pancreatic cancer.

• The study has a small sample size, with less than 30 patients.
• The study has risk of bias due to no control group, no blinding, and no random assignment.
• Validity and reliability of measurement is questionable.
• Findings are not generalizable.
• The exact timing and method of VAS scoring is not described.
• Findings are only applicable to patients with unresectable pancreatic cancer.

Control of pain secondary to pancreatic cancer is a challenge, and many of these patients had severe intractable pain. The procedure tested here showed a positive effect for pain control. As such, this procedure may provide another option for pain management in these patients as an adjunct to other pain control approaches. Further well-designed research in this area is warranted, and studies comparing various pain-control methods in this group of patients would be helpful to identify the most beneficial approaches.