Endoscopic Ultrasound-Guided Celiac Plexus Block (EUS-CPB) and Neurolysis (EUS-CPN)

Abstract

Purpose: EUS-CPB and EUS-CPN has been increasingly used for pain control in patients with chronic pancreatitis and unresectable pancreatic cancer respectively. Significant reported complications include hemoperitoneum, perforation, peripancreatic abscess and sepsis. We have prospectively evaluated our complications using this technique. Methods: Between December 2001 and March 2006, patients undergoing CPB and CPN were evaluated prospectively. A total of 78 patients underwent 123 procedures. All cases were performed by three dedicated pancreatico-biliary endoscopists (VMS, PY and MK) using the Olympus linear echoendoscope (GFUCT140, 130, or GFUCP140) and a 22 or 19 gauge needle. Prophylactic antibiotics were not administered. All cases were done using a single injection technique once the celiac axis was identified. The CPBs were performed by administering 18cc of 0.25% bupivacaine and 2cc of triamcinolone. The CPNs were performed injecting 5 cc of 0.25% bupivacaine and 20cc of dehydrated absolute alcohol. Results: A total of 78 patients (47 males) with a median age of 51 ± 13 years were enrolled. Thirty four patients underwent CPB for chronic pancreatitis, and 44 patients underwent CPN for pancreatic cancer. The CPB group had a mean of 2.4 (range of 1–8) procedures performed per patient. Two had major complications; one with a periesophageal abscess requiring thoracotomy, and one with peritonitis treated conservatively with antibiotics. No major complications were noted in the CPN group. Conclusions: EUS-CPB and EUS-CPN provide pain control in patients with chronic pancreatitis and pancreatic cancer. Although the procedure is relatively safe, severe complications may occur in the CPB group. Since chronic pancreatitis patients seem to require multiple CPB sessions for pain control, further studies identifying patients who respond the best to this treatment are required.