Echoendoscopic ethanol ablation of tumor combined to celiac plexus neurolysis improved pain control in a patient with pancreatic adenocarcinoma

A 75-year-old man suffering from opioid-refractory due to an advanced pancreatic adenocarcinoma was treated with endoscopic ultrasound (EUS)-guided celiac plexus neurolysis (CPN) combined to EUS-guided tumor ablation. No major complications were recorded during the procedure. In the days following the procedure, mild diarrhea and fever were the only minor complications experienced by the patient. Complete tumor devascularization was assessed by means of computed tomography (CT) 48 h after the procedure. The patient remained pain-free without need of opioid, and was treated only with paracetamol for 20 weeks. Our results were optimal in terms of pain relief and immediate tumor response (assessed by means of CT and tumor marker levels). The present case demonstrates that the combined approach (EUS-guided ethanol ablation and CPN) may be a valuable option in patients with pancreatic cancer. Randomized-controlled trials are needed to confirm this result.