ASGE Therapeutic EUS for Advanced Endosonographers (Live and Virtual) | September 2022-5_DeWitt

5_DeWitt_Celiac Plexus block and neurolysis

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This document discusses the use of celiac plexus block (CPB) and neurolysis for the treatment of pain in chronic pancreatitis. It includes information about the different techniques and choices involved in performing these procedures. <br /><br />A clinical trial compared fluoroscopy-guided percutaneous technique vs. endoscopic ultrasound-guided technique of CPB for pain treatment in chronic pancreatitis. The study found no difference among the groups for BMI, age, smoking, ASA class, EtOH use, sedative or narcotic use. Pain scores were assessed at various time points, and positive response was defined as a decrease in Visual Analog Scale (VAS) score of 3 or more. The study concluded that both techniques provided pain relief, with greater pain relief observed with the endoscopic ultrasound-guided technique.<br /><br />Another study compared the effect of one vs. two injections during EUS-guided CPB for chronic pancreatitis pain. The study found no significant difference in pain relief or reduction in pain medication between the one injection and two injections groups.<br /><br />Meta-analysis of studies evaluating the efficacy of EUS-CPB and CPN (celiac plexus neurolysis) for abdominal pain from chronic pancreatitis and pancreatic cancer showed varying durations of pain relief, ranging from 11.3-37 days and up to 48 weeks.<br /><br />The document also discusses the use of steroids in CPB for chronic pancreatitis and highlights conflicting results from studies on whether steroids are necessary for CPB.<br /><br />The use of neurolysis, specifically celiac ganglia neurolysis (CGN), is also explored. A randomized multicenter trial compared EUS-guided CGN vs. CPN and found no significant difference in pain response at 12 weeks, but CPN was associated with a longer median overall survival time. Adverse events following CPN were also reported, including lethal necrosis, perforation, hepatic and splenic infarction, and bowel ischemia.<br /><br />Overall, the document suggests that EUS-guided CPB and neurolysis can provide pain relief in chronic pancreatitis and pancreatic cancer, with varying response rates and durations of pain relief. The choice of technique and number of injections may depend on individual patient characteristics.

Keywords

celiac plexus block

neurolysis

pain treatment

chronic pancreatitis

endoscopic ultrasound-guided technique

EUS-guided CPB

Meta-analysis

abdominal pain

steroids

celiac ganglia neurolysis