A Technical Report on the Performance of Percutaneous Cryoneurolysis of Splanchnic Nerves for the Treatment of Refractory Abdominal Pain in Patients with Pancreatic Cancer: Initial Experience

Author(s):  
D. Filippiadis ◽  
N. Ptohis ◽  
E. Efthymiou ◽  
A. Kelekis
Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 303
Author(s):  
Stavros Grigoriadis ◽  
Maria Tsitskari ◽  
Maria Ioannidi ◽  
Periklis Zavridis ◽  
Ioannis Kotsantis ◽  
...  

The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively (p < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement.


2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.


Pancreas ◽  
2001 ◽  
Vol 22 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Takuji Okusaka ◽  
Shuichi Okada ◽  
Hideki Ueno ◽  
Masafumi Ikeda ◽  
Kazuaki Shimada ◽  
...  

2018 ◽  
pp. 387-398
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick

Pancreatic cancer is the tenth most common cancer in the UK and is most often incurable at diagnosis. Presentation is generally with weight loss, jaundice, and or abdominal pain. Abdominal ultrasound, CT and MRI may be diagnostic. Tissue diagnosis is not usually necessary, but endoscopic ultrasound can obtain fine needle samples. The serum marker CA19-9 may be raised, but is not a screening test. Potentially curable lesions need careful multidisciplinary assessment for resectability, and a thorough assessment of patient fitness. The Whipple procedure is discussed as well as laparoscopic pancreatectomy. Adjuvant chemotherapy and palliative gemcitabine therapy are also covered.


2008 ◽  
Vol 74 (7) ◽  
pp. 602-606 ◽  
Author(s):  
Stephen H. Gray ◽  
Mary T. Hawn ◽  
Meredith L. Kilgore ◽  
Huifeng Yun ◽  
John D. Christein

Early diagnosis and curative resection are significant predictors of survival in patients with pancreatic cancer. We hypothesize that cholecystectomy within 12 months of pancreatic cancer affects 1-year survival. The Surveillance Epidemiology and End Result (SEER) database linked to Medicare data was used to identify patients diagnosed with pancreatic cancer who underwent cholecystectomy 1 to 12 months prior to cancer diagnosis. The SEER database identified 32,569 patients from 1995 to 2002; 415 (1.3%) underwent cholecystectomy prior to cancer diagnosis. Patients who underwent cholecystectomy had a higher proportion of diabetes (40.2% vs 20.5%; P < 0.01), obesity (8.9% vs 3.1%; P < 0.01), jaundice (17.3% vs 0.7%; P < 0.01), cholelithiasis (70.4% vs 4.2%; P < 0.01), choledocholithiasis (0.7% vs 0.0%; P < 0.01), weight loss (17.3% vs 4.7%; P < 0.01), abdominal pain (79.5% vs 22.5%), steatorrhea (0.7% vs 0.0%; P < 0.01), and cholecystitis (32.3% vs 1.7%; P < 0.0001). After controlling for tumor stage, patient demographics, and symptoms, survival at 1 year was significantly lower in patients undergoing cholecystectomy (OR, 0.75; 95% CI, 0.58–0.97). Recent cholecystectomy is associated with decreased 1-year survival among patients with pancreatic cancer. For patients older than 65 years of age, further evaluation prior to cholecystectomy may be necessary to exclude pancreatic cancer, especially patients with jaundice, weight loss, and steatorrhea.


2008 ◽  
Vol 33 (Sup 1) ◽  
pp. e215
Author(s):  
R. Calvo ◽  
J. Arranz ◽  
A. Arteaga ◽  
D. Abejon

2008 ◽  
Vol 33 (Suppl 1) ◽  
pp. e215.2-e215
Author(s):  
R. Calvo ◽  
J. Arranz ◽  
A. Arteaga ◽  
D. Abejon

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