ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand) | September 2022-5_DeWitt

5_DeWitt_Celiac Plexus block and neurolysis

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This document discusses the use of celiac plexus blocks (CPB) and neurolysis for the treatment of pain in chronic pancreatitis and pancreatic cancer. CPB is a procedure in which a nerve block is performed to alleviate pain, while neurolysis involves the destruction of nerve tissue. The document presents various choices and factors to consider when performing CPB or neurolysis, such as the type of needle, the number of injections, the use of steroids or alcohol, and the involvement of ganglia.<br /><br />A clinical trial compared fluoroscopy-guided percutaneous technique to endoscopic ultrasound (EUS) guided technique for CPB. Both approaches showed similar results in terms of pain relief. Another study evaluated the effectiveness of one versus two injections during EUS-guided CPB for chronic pancreatitis pain, with no significant difference in pain relief between the two groups.<br /><br />A meta-analysis of studies on EUS-guided CPB for chronic pancreatitis reported a median pain relief duration of 11.3-37 days. The presence of ganglia was detected in about 80% of patients undergoing EUS. The document also discusses the safety and adverse events associated with CPB and neurolysis procedures, including rare but serious complications.<br /><br />Overall, the document concludes that EUS CPB shows comparable or greater pain relief compared to percutaneous techniques for chronic pancreatitis. The necessity of steroids in CPB for chronic pancreatitis is still debated. In pancreatic cancer, EUS CP/GN has response rates of 70-75% initially, which decrease over time. Bilateral or broad plexus injections may increase the response rate. Different volumes of ethanol can be used during the neurolysis procedure.

Keywords

celiac plexus blocks

neurolysis

pain relief

chronic pancreatitis

pancreatic cancer

fluoroscopy-guided percutaneous technique

endoscopic ultrasound guided technique

injections

ganglia

response rates