EUS for Pain Control in Chronic Pancreatitis and Pancreatic Cancer

Abstract

Chronic abdominal pain is often associated with chronic pancreatitis and pancreatic malignancy, and it is a major cause of patient morbidity and healthcare cost. Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are viable options for treatment of chronic abdominal pain in these clinical situations and have advantages over analgesic medications and/or percutaneous CPB/CPN. Technique for EUS-guided CPB/CPN varies from center to center, but all facilitate delivery of medication to the area of the celiac plexus in a safe, controlled manner via a transgastric anterior approach. Published reports demonstrate that EUS-guided CPN for pancreatic cancer pain is beneficial in selected patients and is at least as effective as percutaneous CPN. Comparatively, studies have shown that for chronic pancreatitis pain, CPB provides a lower degree of analgesia and a shorter duration of effect, whether by EUS or percutaneous approach. Serious complications from EUS-guided CPB/CPN are rare. Recently, direct targeting of the celiac plexus ganglia for block or neurolysis has been investigated and may provide greater analgesic effect than traditional CPB/CPN. Other areas of research include variations in injection technique and use of brachytherapy.