REGULAR CONTENT
Final ID
639
Type
Educational Exhibit-Poster Only
Authors
S Pietrini1, J Stavas1, J List1, A Csordas1
Institutions
1Creighton University School of Medicine, Omaha, NE
Purpose
1. Discuss the growing role of IR in palliative cancer care.2. Describe our institution's method for CT-guided, contrast-assisted celiac ganglion neurolysis (CGN) using step-by-step imaging correlates.3. Discuss other non-CT-Guided CGN techniques.
Materials & Methods
CGN is a procedure often performed by interventional radiologists that relieves intractable abdominal pain secondary to infiltrating cancers of the upper abdomen and retroperitoneum, particularly pancreatic cancer. Developing competence in this procedure can enhance existing pain management programs and complements ongoing growth in multidisciplinary palliative care services.
Results
The risks of CT-guided CGN include vascular injury, hypotension and ileus due to loss of sympathetic tone, and persistent/worsening abdominal pain up to 72 hours post-procedure secondary to alcohol-induced neuritis. A 21-gauge Chiba needle is advanced to the right and/or left margin of the celiac artery takeoff under intermittent CT fluoroscopic guidance from an anterior or retroperitoneal approach. 5-10 ml of dilute iodinated contrast is injected through the needle to opacify the anterocural space surrounding the celiac artery and confirm correct positioning of the needle tip. 2 ml betamethasone mixed with 8-10 ml 0.5% bupivacaine is slowly injected to counter inflammation in the celiac ganglion and deliver local anesthesia prior to injection of 10-20 ml dehydrated alcohol. A follow-up limited CT is performed to visualize mixed fluid changes in the anterocrural space. The needle is then removed with simultaneous injection of Xylocaine to prevent irritation of the liver and peritoneum by residual alcohol. If there is no spread of contrast to the opposite margin of the celiac artery, a second puncture can be performed.
Conclusions
Our method for CT-guided CGN is easily reproducible, precise, and well-tolerated by patients. Our method is more accurate and less prone to vascular and neurologic complications than fluoroscopically and anatomically guided techniques utilizing a posterior approach. Unlike EUS-guided techniques, our method allows for direct visualization of the injected solutions, and it is better tolerated by poor anesthesia candidates.
Final ID
639
Type
Educational Exhibit-Poster Only
Authors
S Pietrini1, J Stavas1, J List1, A Csordas1
Institutions
1Creighton University School of Medicine, Omaha, NE
Purpose
1. Discuss the growing role of IR in palliative cancer care.2. Describe our institution's method for CT-guided, contrast-assisted celiac ganglion neurolysis (CGN) using step-by-step imaging correlates.3. Discuss other non-CT-Guided CGN techniques.
Materials & Methods
CGN is a procedure often performed by interventional radiologists that relieves intractable abdominal pain secondary to infiltrating cancers of the upper abdomen and retroperitoneum, particularly pancreatic cancer. Developing competence in this procedure can enhance existing pain management programs and complements ongoing growth in multidisciplinary palliative care services.
Results
The risks of CT-guided CGN include vascular injury, hypotension and ileus due to loss of sympathetic tone, and persistent/worsening abdominal pain up to 72 hours post-procedure secondary to alcohol-induced neuritis. A 21-gauge Chiba needle is advanced to the right and/or left margin of the celiac artery takeoff under intermittent CT fluoroscopic guidance from an anterior or retroperitoneal approach. 5-10 ml of dilute iodinated contrast is injected through the needle to opacify the anterocural space surrounding the celiac artery and confirm correct positioning of the needle tip. 2 ml betamethasone mixed with 8-10 ml 0.5% bupivacaine is slowly injected to counter inflammation in the celiac ganglion and deliver local anesthesia prior to injection of 10-20 ml dehydrated alcohol. A follow-up limited CT is performed to visualize mixed fluid changes in the anterocrural space. The needle is then removed with simultaneous injection of Xylocaine to prevent irritation of the liver and peritoneum by residual alcohol. If there is no spread of contrast to the opposite margin of the celiac artery, a second puncture can be performed.
Conclusions
Our method for CT-guided CGN is easily reproducible, precise, and well-tolerated by patients. Our method is more accurate and less prone to vascular and neurologic complications than fluoroscopically and anatomically guided techniques utilizing a posterior approach. Unlike EUS-guided techniques, our method allows for direct visualization of the injected solutions, and it is better tolerated by poor anesthesia candidates.