Endoscopic ultrasound-guided celiac plexus neurolysis for treatment of hepatocellular carcinoma-related abdominal pain

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Abstract

Background
Overall, 20–50% of patients with hepatocellular carcinoma (HCC) present at advanced stage where palliative treatment is the only reasonable management. Pain in HCC is a significant factor of morbidity, and celiac plexus neurolysis demonstrated good results in relief of pain as a result of pancreatic cancer; however, there are no studies concerning its use in management of HCC.
Patients and methods
A total of 30 patients with advanced stage HCC complaining of moderate to severe abdominal pain, requiring opioid analgesics to control, scored their abdominal pain according to the Numeric Rating Scale-11 before the procedure and were re-assessed every 2 weeks for 2 months.
Results
This study included 30 patients, comprising 24 men and six women, with a mean age of 61.73±7.9 years. A significant correlation between older age and better BCLC staging and pain reduction was found (=0.045 and 0.08, respectively), whereas there is no significant correlation between pain reduction and clinical manifestations and medical history. There is a significant reduction in pain score after the procedure. Median pain score was significantly lower than pre-endoscopic median pain score, with a value less than 0.001.
Conclusion
Endoscopic ultrasound-celiac plexus neurolysis should be a potential choice in patients with moderate to severe abdominal pain in patients with HCC who are not considered for therapeutic intervention.

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