Pancreatic CancerNCT02068677
Evaluation of Injection Techniques in Celiac Plexus Neurolysis
A study testing Sympathetic response and no sympathetic response in people with Pancreatic Cancer and Pain, run by AdventHealth at 1 site in United States.
Trial summary
1. To evaluate the efficacy of EUS-CPN in subjects who experience a sympathetic response during injection when compared with subjects who do not experience sympathetic response during injection. Read more about this study
- Who is it for?
- Ages 19 to 89 years
- Conditions the study is for
- Pancreatic Cancer, Pain
- What is being tested?
- Sympathetic response and no sympathetic response
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 51 participants
- Where
- 1 siteUnited States
- Study dates
- Aug 2013to Nov 2014
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 to 89 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Abdominal pain typical for pancreatic cancer ( pain score ≥ 3/10)
- Abdominal CT consistent with diagnosis of pancreatic cancer
- Pancreatic cancer confirmed by EUS-FNA
- Inoperable pancreatic cancer as determined during EUS or prior CT
Who cannot join
- Age under 19 years
- Unable to safely undergo EUS for any reason
- Coagulopathy (Prothrombin time > 18 secs, platelet count < 80,000/ml)
- Previous CPN or other neurolytic block that could affect pancreatic cancer-related pain or had implanted epidural or intrathecal analgesic therapy
- Another cause for abdominal pain such as pseudocyst, ulcer or other intrabdominal disorder
- Noncompliance such that the patient would not return for subsequent follow-up
Show all 9Show fewer
- Active alcohol or other drug use or significant psychiatric illness
- Unable to consent
- Non-English speaking
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Evaluation of Injection Techniques in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis (EUS-CPN)
- To evaluate the efficacy of EUS-CPN in subjects who experience a sympathetic response during injection when compared with subjects who do not experience sympathetic response during injection.
EUS-CPN when performed in subjects who experience a sympathetic response during injection will have better pain relief when compared to subjects who do not experience a sympathetic response during injection.
Read the detailed description
- All adult patients with radiologically consistent pancreatic carcinoma referred to Florida Hospital to undergo EUS for staging and diagnostic FNA of pancreatic mass lesions will be eligible for study entry. A history and physical examination will be performed to determine the character and quality of the pain and to evaluate for any contraindication for which EUS cannot be performed.
- Written informed consent for study participation will be obtained at the same time as the consent for the procedure as this study is comparing standard of care treatment options in a regular treatment setting. Then, after giving written informed consents and prior to the index procedure, all patients will complete the following written assessments:
- Standardized 11-point continuous visual analog pain scale (12)
- Quality of life instruments: Functional Assessment of Cancer Therapy, Pancreatic Cancer (FACT-PA) (i.e. QLQ-30 and PAN-26) (13)
- Pain medication usage over prior 2 days (converted to equianalgesic doses of morphine)
- EUS will be performed in standard fashion by one of three experienced endoscopists
- Eligible patients will be included if pancreatic carcinoma is confirmed by FNA performed during EUS and if EUS or CT staging shows unresectability of the tumor. Cytology evaluation of FNA is routinely provided during procedure by pathologist into the endoscopy room at our institution. During EUS, included patients will receive CPN in the standard fashion. Whether a sympathetic response occurs or not during CPN, this will be documented. Sympathetic response will be defined as change in heart rate by >10 bpm and change in BP <10mmHg. The technique of EUS-CPN is as follows:
- Using a curvilinear array echoendosocpe, the region of the celiac plexus is visualized from the lesser curvature of the stomach by following the aorta to the origin of the main celiac artery. It is traced, by using counter-clockwise rotation, to its bifurcation into splenic and hepatic arteries, with Doppler US control if needed.
- CPN will be undertaken at the celiac space which is located between the aorta and the celiac artery origin.
- A 20-gauge fenestrated CPN needle is used, its tip is placed slightly anterior and cephalic to the origin of the celiac artery.
- Aspiration is first performed to ensure that vascular puncture has not occurred.
- Bupivacaine is injected first, followed by alcohol.
- Patients will be observed for 2 to 4 hours, with careful monitoring of pulse, blood pressure and temperature.
- Following EUS, patients will be discharged and called at home by research nurse at 24 hours for evidence of pancreatitis or other complications from the procedure, Clinical research nurse* will also contact the patient at 1, 2, 4 weeks after EUS and then monthly until death or 1 year. Clinical research nurse* will be blinded to the documentation about sympathetic response. Assessment of pain scale, QOL, medication use and side effects will be performed.
- Following CPN, EUS operator will not be actively involved in patient care.
- Medical decisions for each patient will be made by the patient's primary physician and oncologist.
- Patient can be referred for rescue CPN if the patient's primary physician and oncologist feel that this is warranted.
- Conditions
- Pancreatic Cancer, Pain
- Being tested
- Sympathetic response, no sympathetic response
- Medical subject headings
- Pancreatic Neoplasms, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Sympathetic responseOther
Sympathetic response will be defined as change in heart rate by >10 bpm and change in BP <10mmHg.
no sympathetic responseOther
no Sympathetic response will be defined as change in heart rate by <10 bpm and change in BP <10mmHg.
| Study group | Role | What they receive |
|---|---|---|
| sympathetic response | Other | This group will be composed of subjects who experience a heart rate and/or Blood Pressure change during injection. Receives: Other: Sympathetic response |
| no sympathetic response | Other | This group will be made up of subjects that do not experience a vital sign change with injection for CPN. Receives: Other: no sympathetic response |
What is being measured
The primary outcome is the main question the study is designed to answer.
abdominal pain
The primary endpoint of the study is abdominal pain. It will be assessed with a standardized 11-point continuous visual analog pain scale with "0" equaling no pain, "5" moderate pain and "10" worst pain ever. Before the procedure, patient will be instructed in the use of the pain scale by the research nurse. After the procedure, pain scores will be assessed by the clinical research nurse at the predetermined intervals.
A complete response will be defined as an absence of abdominal pain requiring no pain medications. A partial response will be defined as a greater than 50% reduction in abdominal pain as assessed by the numerical 0-10 pain score.
Failure will be defined as a reduction of ≤20% in pain score.
Measured: within the first year post CPN
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2014 (estimated)
- Study startAug 2013
- Primary completionNov 2014
- Study completionNov 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Pancreatic CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 51 participants (actual)
Sponsor and investigators
- Lead sponsor
- AdventHealth
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Shyam Varadarajulu, MD, Principal investigator, AdventHealth
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02068677
- Sponsor's protocol ID
- 456550
- Status last verified
- Apr 2016
- First submitted
- 30 Aug 2013
- Last updated
- 14 Apr 2016
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 14 Apr 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Injection Techniques in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis (EUS-CPN)
- ClinicalTrials.gov ID
- NCT02068677
- Acronym / sponsor ID
- 456550
- Conditions
- Pancreatic Cancer, Pain
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 51 participants (actual)
- Lead sponsor
- AdventHealthUniversity, hospital or other
- Study start
- Aug 2013
- Primary completion
- Nov 2014 (actual)
- Study completion
- Nov 2014 (actual)
- First posted
- 21 Feb 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
- To evaluate the efficacy of EUS-CPN in subjects who experience a sympathetic response during injection when compared with subjects who do not experience sympathetic response during injection.
EUS-CPN when performed in subjects who experience a sympathetic response during injection will have better pain relief when compared to subjects who do not experience a sympathetic response during injection.
Detailed description
- All adult patients with radiologically consistent pancreatic carcinoma referred to Florida Hospital to undergo EUS for staging and diagnostic FNA of pancreatic mass lesions will be eligible for study entry. A history and physical examination will be performed to determine the character and quality of the pain and to evaluate for any contraindication for which EUS cannot be performed.
- Written informed consent for study participation will be obtained at the same time as the consent for the procedure as this study is comparing standard of care treatment options in a regular treatment setting. Then, after giving written informed consents and prior to the index procedure, all patients will complete the following written assessments:
- Standardized 11-point continuous visual analog pain scale (12)
- Quality of life instruments: Functional Assessment of Cancer Therapy, Pancreatic Cancer (FACT-PA) (i.e. QLQ-30 and PAN-26) (13)
- Pain medication usage over prior 2 days (converted to equianalgesic doses of morphine)
- EUS will be performed in standard fashion by one of three experienced endoscopists
- Eligible patients will be included if pancreatic carcinoma is confirmed by FNA performed during EUS and if EUS or CT staging shows unresectability of the tumor. Cytology evaluation of FNA is routinely provided during procedure by pathologist into the endoscopy room at our institution. During EUS, included patients will receive CPN in the standard fashion. Whether a sympathetic response occurs or not during CPN, this will be documented. Sympathetic response will be defined as change in heart rate by >10 bpm and change in BP <10mmHg. The technique of EUS-CPN is as follows:
- Using a curvilinear array echoendosocpe, the region of the celiac plexus is visualized from the lesser curvature of the stomach by following the aorta to the origin of the main celiac artery. It is traced, by using counter-clockwise rotation, to its bifurcation into splenic and hepatic arteries, with Doppler US control if needed.
- CPN will be undertaken at the celiac space which is located between the aorta and the celiac artery origin.
- A 20-gauge fenestrated CPN needle is used, its tip is placed slightly anterior and cephalic to the origin of the celiac artery.
- Aspiration is first performed to ensure that vascular puncture has not occurred.
- Bupivacaine is injected first, followed by alcohol.
- Patients will be observed for 2 to 4 hours, with careful monitoring of pulse, blood pressure and temperature.
- Following EUS, patients will be discharged and called at home by research nurse at 24 hours for evidence of pancreatitis or other complications from the procedure, Clinical research nurse* will also contact the patient at 1, 2, 4 weeks after EUS and then monthly until death or 1 year. Clinical research nurse* will be blinded to the documentation about sympathetic response. Assessment of pain scale, QOL, medication use and side effects will be performed.
- Following CPN, EUS operator will not be actively involved in patient care.
- Medical decisions for each patient will be made by the patient's primary physician and oncologist.
- Patient can be referred for rescue CPN if the patient's primary physician and oncologist feel that this is warranted.
Study design
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| sympathetic response | Other | Other: Sympathetic responseThis group will be composed of subjects who experience a heart rate and/or Blood Pressure change during injection. |
| no sympathetic response | Other | Other: no sympathetic responseThis group will be made up of subjects that do not experience a vital sign change with injection for CPN. |
Who may qualify
- Ages
- 19 to 89 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Abdominal pain typical for pancreatic cancer ( pain score ≥ 3/10)
- Abdominal CT consistent with diagnosis of pancreatic cancer
- Pancreatic cancer confirmed by EUS-FNA
- Inoperable pancreatic cancer as determined during EUS or prior CT
Key exclusion criteria (9 listed)
- Age under 19 years
- Unable to safely undergo EUS for any reason
- Coagulopathy (Prothrombin time > 18 secs, platelet count < 80,000/ml)
- Previous CPN or other neurolytic block that could affect pancreatic cancer-related pain or had implanted epidural or intrathecal analgesic therapy
- Another cause for abdominal pain such as pseudocyst, ulcer or other intrabdominal disorder
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Sympathetic responseSympathetic response will be defined as change in heart rate by >10 bpm and change in BP <10mmHg. | Other | sympathetic response |
| no sympathetic responseno Sympathetic response will be defined as change in heart rate by <10 bpm and change in BP <10mmHg. | Other | no sympathetic response |
Primary outcome
abdominal pain
Time frame: within the first year post CPN
The primary endpoint of the study is abdominal pain. It will be assessed with a standardized 11-point continuous visual analog pain scale with "0" equaling no pain, "5" moderate pain and "10" worst pain ever. Before the procedure, patient will be instructed in the use of the pain scale by the research nurse. After the procedure, pain scores will be assessed by the clinical research nurse at the predetermined intervals. A complete response will be defined as an absence of abdominal pain requiring no pain medications. A partial response will be defined as a greater than 50% reduction in abdominal pain as assessed by the numerical 0-10 pain score. Failure will be defined as a reduction of ≤20% in pain score.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Apr 2016.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Shyam Varadarajulu, MD principal investigator
AdventHealth
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Sympathetic response and no sympathetic response in people with Pancreatic Cancer and Pain, run by AdventHealth at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 14 Apr 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
abdominal pain (time frame: within the first year post CPN). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Apr 2016.