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1
2 Disclosures
3 Objectives
4 CanMED roles
5 Case
6 Case Patient is asking if there are other options besides narcotics for managing his pain Oncologist is considering CyberKnife radiotherapy, and asking if you can assist in placing fiducials
7 CPN Traditional Approach
8 EUS CPN CELIAC GANGLIA Wiersema. GIE 1996
9 EUS CPN in Pancreatic Cancer Pain
10 Efficacy of EUS CPN Puli. Dig Dis Sci 2009
11 Should EUS CPN be done earlier? Double-blinded RCT, N = 48 Decrease in Pain Decrease in Morphine consumption Wyse JM et al. J Clin Oncol 2011
12 Complications of EUS CPN O Toole. Endoscopy 2009 Alvarez Sanchez. Surg Endosc
13 Celiac Ganglia Neurolysis (CGN)
14 CGN vs. CPN Doi. Endoscopy 2013
15 Bilateral vs. Central Injection Sahai. Endoscopy 2009
16 Dose of Alcohol and Anesthetic LeBlanc. Diagn Ther Endosc 2013
17 Type of Needle
18 EUS guided Fiducial Placement
19 EUS guided Fiducial Placement Sanders. GIE Koong. Int J Radiat Oncol Biol Phys 2004 Koong. Int J Radiat Oncol Biol Phys 2005 Didolkar. J Gastrointest Surg 2010 Rwigema. Am J Clin Oncol 2011
20 EUS guided Brachytherapy Authors Therapy N Tumor response (%) Adverse events Sun et al Endoscopy 2006 Iodine seeds implantation 15 Partial (27) Minimal (20) Stable (33) Pancreatitis and pseudocyst (3) Jin et al Endoscopy 2008 Iodine seeds implantation plus chemo 22 Partial (13) Stable (46) Progression (41) Hyperamylasemia Mild fever Seeds translocation Improvement in pain x 1 month No improvement in survival
21 EUS guided delivery of Anti tumor Agents Chang 2000 Study Therapy N Tumor response (%) Cytoimplant (activated allogenic mixed lymphocyte culture) 8 Partial (25), Minimal (12), Stable (37) Farrell 2006 TNFerade (adenovirus vector) 51 Partial (13), Stable (73) Posner 2007 TNFerade 51 Stable (73), Progressive (27) Hecht 2003 ONYX Partial (10), Minor (10), Stable (30), Progression (50) Goldberg 1999 RF ablation 8 N/A Chan 2006 PDT 3 N/A Matthes 2007 OncoGel 3 N/A Sun 2007 Nonogaki 2007 Solid polymer embedded 5 FU Immature dendritic cells 6 N/A 5 Partial (20), Stable (40)
22 Case What are your options?
23 PFC: When to drain Varadarajulu. J Gastrointest Surg Nov;15(11): Bang. Clin Endosc Sep; 47(5): Rana. Ann Gastroenterol. 2014;27(3):
24 PFC: How to drain EUS vs blind EGD vs surgical Varadarajulu. Gastrointest Endosc Dec;68(6): Park. Endoscopy Oct;41(10):842-8 Pananmonta. Eur J Gastroenterol Hepatol 2012; 24: Varadarajulu, Gastroenterology. 2013;145:
25 PFC: How to drain EUS guided PFC drainage Fabbri, World J Gastroenterol 2014 July 14; 20(26):
26 PFC drainage: Technical aspects Van Brunschot, Clin Gastro Hep 2012;10: Siddiqui. Gastrointest Endosc. 2013;78: Shen. Pancreatology Mar Apr;14(2):87 90 Bang. Clin Endosc Sep; 47(5): Bang. Surg Endosc Oct;28(10): Dhir. Gastrointest Endosc Oct;82(4):650 7
27 PFC drainage: Sequence Seewald. Gastrointest Endosc Nov; 64(5):805 8 Talreja, Gastrointest Endosc Dec; 68(6): Vilmann. World J Gastroenterol Nov 7; 21(41): Saftoiu. Endosc Ultrasound Oct Dec; 4(4):
28 EUS guided WOPN treatment Seifert. Gut Sep; 58(9): van Santvoort. N Engl J Med Apr 22;362(16 Varadarajulu. Gastrointest Endosc Jul;74(1 Ross. Gastrointest Endosc Jun; 79(6):929 3 Bang. Clin Endosc Sep; 47(5): Bhutani, Endosc Ultrasound Oct Dec; 4(4)
29 Necrosectomy Seifert. Gut Sep; 58(9): Fabbri, World J Gastroenterol 2014 July 14; 20(26):
30 PFC drainage: Stent removal Arvanitakis. Gastrites Endosc. 2007;65: Dhir. Gastrointest Endosc Oct;82(4):650 7 Bhutani, Endosc Ultrasound Oct Dec; 4(4):
31 When to consider surgery van Santvoort. N Engl J Med Apr 22; 362(16): Seewald. Dig Endosc Jan; 24(1):36 41
32 Case What are your options?
33 EUS guided biliary drainage
34 EUS guided biliary drainage Park. Gastrointest Endosc Dec;74(6): Kahaleh, World J Gastroenterol Mar 7; 19(9): Ogura. World J Gastroenterol Jan 21; 21(3): Kahaleh, World J Gastroenterol Jan 21; 21(3): Bhutani, Endosc Ultrasound Oct Dec; 4(4):
35 EUS BD versus PTBD Park. Gastrointest Endosc Dec;74(6): Bhutani, Endosc Ultrasound Oct Dec; 4(4): Lee. Clin Gastroenterol and Hepatol Dec; epub
36 Efficacy and safety Park. Gastrointest Endosc Dec;74(6): Kahaleh, World J Gastroenterol Jan 21; 21(3): Bhutani, Endosc Ultrasound Oct Dec; 4(4):
37 Technical tips Sarkaria. Gut Liver Mar; 7(2): Ogura. World J Gastroenterol Jan 21; 21(3): Prachayakul, World J Gastroenterol Jan 16; 7(1):37 44
38 Limitations to EUS BD Ogura. World J Gastroenterol Jan 21; 21(3): Lee. Clin Gastroenterol and Hepatol Dec; epub
39 Dedicated Lumen Apposing Stents: Uses
Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009
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