Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20？mL alcohol versus 10？mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain. Methods. 20 patients were selected to receive 10？mL or 20？mL of alcohol during EUS-CPN. Followup was done at baseline, 24 hours, and weekly. Health-related quality of life (HRQoL) was assessed at baseline, week 2, week 4, and every 4 weeks thereafter until pain returned. Results. There were no major complications in both groups. Minor self-limited adverse effects were seen in 6 (30%) subjects and included lightheadedness in 1 (5%), transient diarrhea in 2 (10%), and transient nausea and vomiting in 3. Pain relief was similar in both groups: 80% in the 10？mL group and 100% in the 20？mL group ( ). The mean (±？SD) duration of pain relief in the 10？mL and 20？mL groups was and weeks, respectively. 30% of patients in each group had complete pain relief. Conclusions. EUS-CPN using 20？mL of alcohol is safe. Similar clinical outcomes were seen in both groups. Further investigations to confirm these findings are warranted. 1. Introduction One of the main concerns of patients with pancreatic cancer is pain [1]. For patients with pancreatic cancer, pain has a negative impact on quality of life (HRQoL) [2]. Pain will be present in a third of patients at the time of diagnosis, 30% to 50% undergoing treatment, and up to 90% with advanced disease [3–10]. After surgery for pancreatic cancer from 60% to 84% of patients reported moderate-to-severe pain [11]. While opioids are commonly used to relieve pain, their adverse side effects such as sedation, constipation, nausea, and vomiting have a negative impact on quality of life [3]. Celiac plexus neurolysis is not associated with these adverse effects and may improve survival among unresectable pancreatic cancer patients [5]. Although endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) does not have the side effects of opioids, it is not free of risks [12, 13]. Acute spinal cord infarction has been reported after EUS-CPN [13]. The amount of alcohol used in EUS-CPN ranges from 2 to 20？mL of alcohol [14–18]. There are no randomized studies that compare the safety of varying amounts of alcohol in celiac plexus neurolysis. We hypothesized that 20？mL of alcohol was safe in EUS-CPN. Onset of HRQoL and survival were also examined. 2. Methods This study was approved by the Institutional Review Board at Indiana University Medical Center. Consecutive patients with known or suspected unresectable pancreatic cancer
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