Endoscopic ultrasound-guided CPN effective for abdominal pain in pancreatic cancer

Endoscopic ultrasound-guided celiac plexus neurolysis added to medical management (EUS-CPN+MM) provides beneficial effects for abdominal pain in patients with unresectable pancreatic cancer at 4 and 12 weeks, reports a recent study.

A team of investigators searched the databases of PubMed, Web of Science, and Cochrane for randomized controlled trials (RCTs) comparing EUS-CPN+MM with MM, percutaneous CPN (P-CPN)+MM, or intraoperative CPN (I-CPN)+MM for abdominal pain associated with unresectable pancreatic cancer. They then performed a network meta-analysis using a frequentist weighted least-squares approach.

A random-effects model was used to synthesize the primary outcome, defined as the mean difference between treatment groups in standardized pain intensity scores at 4 and 12 weeks.

Ten RCTs including a total of 662 individuals met the eligibility criteria. The estimated mean difference between the EUS-CPN+MM and MM groups at week 4 was ‒1.30 (95 percent confidence interval [CI], ‒2.19 to ‒0.41), in favour of the combination therapy, while that between the EUS-CPN+MM and P-CPN+MM groups was ‒0.88 (95 percent CI, ‒1.82 to 0.06).

At week 12, the estimated mean difference between the EUS-CPN+MM and MM groups was ‒2.58 (95 percent CI, ‒3.68 to ‒1.48) and that between the EUS-CPN+MM and P-CPN+MM groups was −2.44 (95 percent CI, ‒4.03 to ‒0.84), both in favour of EUS-CPN+MM.

“The combination of EUS-CPN+MM was effective at 4 and 12 weeks, although the risk of bias in synthesized studies was generally high, necessitating careful interpretation,” the investigators said.