EUS-guided Celiac Plexus Block Research Articles

Safety and efficacy of EUS-guided celiac plexus block in the evaluation of patients with median arcuate ligament syndrome anatomy for possible surgery

Safety and efficacy of EUS-guided celiac plexus block in the evaluation of patients with median arcuate ligament syndrome anatomy for possible surgery

EUS-Guided Celiac Plexus Interventions

AbstractEndoscopic ultrasound (EUS)-guided celiac plexus intervention comprises EUS-guided celiac plexus block (EUS-CPB) and EUS-guided celiac plexus neurolysis (EUS-CPN). EUS-CPB and EUS-CPN are one of the used methods of pain management in patients of pancreatic cancer and chronic pancreatitis, respectively, along with medical therapy. Both the procedures are associated with minimal complications and improves quality of life. The role of EUS-guided celiac plexus intervention is increasing in gall bladder carcinoma for pain control.

Endoscopic Ultrasound-Guided Celiac Plexus Block and Celiac Neurolysis: A Systematic Review of Efficacy, Safety, and Protocols

Introduction: The advent of endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN) has provided immeasurable benefit for patients with pain from chronic pancreatitis and pancreatic malignancies. There are differences in efficacy based on indication and protocol used for CPN and CPB. Here we aim to characterize efficacy, safety, and variations in protocol of both EUS-guided CPB and CPN by performing a systematic review of the literature. Methods: Using predefined keywords a search was performed using the EMBASE, Medline, and Cochrane databases through January 2018. Abstracts that discussed the outcomes of EUS-guided CPN and/or CPB were considered for inclusion. Data was abstracted from all papers, including demographic information, indication for CPN and CPB, protocol used for CPN and CPB, outcomes of intervention, and complication rates of endoscopy. Weighted data was used to calculate the efficacy and complications. Results: Following a database search, 437 abstracts were reviewed. 35 studies were selected for data abstraction of which 8 were randomized trials, 16 prospective, and 11 retrospective. 1290 patients underwent CPN and 714 underwent CPB. In those undergoing CPB and CPN, the main indications were chronic pancreatitis (98%, 698/714) and pancreatic cancer (99%, 1278/1290) respectively. In studies reporting the rate of response, overall initial response was 64% (873/1369). CPN and CPB had an initial response rate of 65% (482/745, range 25-100%) and 63% (391/624, range 0-100%) respectively. When celiac ganglia were targeted, response was 74% (68/92, range 65-94%). Duration of response varied widely across all studies and interpretation was limited by duration of follow-up. No deaths or perforations were reported. There was 1 upper gastrointestinal bleed and 1 peri-pancreatic abscess attributed to the intervention. The most common side effects were transient diarrhea and transient hypotension. In regards to anesthetic agents used, bupivacaine 0.25-0.75%, lidocaine 1.0-2.0%, and xylocaine 1.0% were all used. Triamcinolone was used in doses ranging from 40-160 mg. Finally, alcohol 95-99% was used in doses ranging from <5 ml to 20 ml. One study looked at the efficacy of phenol 7% as a neurolytic agent in those intolerant of alcohol. Conclusion: Overall, CPB and CPN appear to be effective and safe modalities at controlling pain. Due to variations in protocol, clinical guidelines are required to outline best-practice for both EUS-guided CPB and CPN.

A Rare Case of Acute Cholangitis in a Young Male with Tropical Chronic Pancreatitis-Induced Pancreatic Adenocarcinoma with Metastasis to the Liver

Tropical chronic pancreatitis (TCP) is a rare and poorly understood variant of chronic pancreatitis. It is typically diagnosed in young, nonalcoholic patients in tropical regions such as southern Asia, often presenting with abdominal pain, and leading to several complications, including diabetes, malnutrition, and pancreatic adenocarcinoma. Though the link between chronic pancreatitis and cancer is established, the risk for malignancy is highest in those with rare causes of chronic pancreatitis. We present a case of TCP-induced pancreatic adenocarcinoma complicated by acute cholangitis. A 34 year-old Bangladeshi male with TCP complicated by diabetes and stage IV pancreatic adenocarcinoma with liver metastasis, s/p whipple procedure, and 3 cycles of adjuvant Gemcitabine and Abraxane presented with acute worsening of chronic abdominal pain. Labs were remarkable for elevated liver enzymes and a marked increase in CA 19-9. CT Abdomen/Pelvis revealed progression of metastatic disease in the liver and upper abdomen, including the peritoneum and anterior abdominal wall. His pain persisted despite EUS-guided celiac plexus block, but became acutely worse on hospital day 15 when he became febrile, jaundiced, and with blood cultures growing E. Coli, Klebsiella, and Aeromonas. Due to concern for acute cholangitis secondary to stenosis of hepaticojejunostomy, he was taken for ERCP. The biliary system was not successfully identified, so he then underwent IR-guided placement of a biliary drain via percutaneous transhepatic cholangiography, which showed central biliary stenosis and severe bilateral ductal dilation. He was subsequently placed in hospice due to his poor prognosis. The etiology of TCP is multifactorial, but also associated with a mutation of the SPINK1 gene, which causes parenchymal damage by lowering the threshold for trypsin activation. Characteristic radiographic findings include a dilated pancreatic duct with large intra-ductal calculi, pancreatic calcifications, and pancreatic atrophy. Data suggests that only 5% of patients with a 20-year history of chronic pancreatitis develop cancer, but 17% of patients with TCP develop malignancy, which is significantly higher than the near 0% risk of malignancy in those with chronic alcoholic pancreatitis. TCP is a rare disease that potentiates many long-term complications that can significantly increase mortality in an otherwise young and healthy population.1273_A.tif Figure 1: Marked dilation of pancreatic duct measuring up to 18 mm (blue arrow) that terminates at the pancreatic head due to a large calcification (red arrow).1273_B.tif Figure 2: Fine needle aspiration of mass at pancreatic head (blue arrow) and dilated CBD measuring up to 13mm (red arrow).1273_C.tif Figure 3: Multiple hepatic metastatic lesions (blue arrows) and invasion of the pancreatic head mass into the anterior abdominal wall (red arrow).

Endoscopic Ultrasound-Guided Management of Pain in Chronic Pancreatitis and Pancreatic Cancer: an Update.

PURPOSE OF REVIEW: Unrelenting pain from chronic pancreatitis (CP) and pancreatic cancer (PC) remain clinical challenges for the physician and a significant cause of decreased quality of life for the patient. Endoscopic ultrasound (EUS)-guided therapy for each condition is distinct and builds on the endosonographer's straightforward access to the celiac axis. Over the past 20years, generally small studies of modest methodology have surfaced for both EUS-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN). Our review aims to synthesize, analyze, and update the latest literature on the technique, efficacy, and safety of these procedures. EUS-CPB's role in treating CP pain is likely still relevant for a subset of patients and studies have shown efficacy and safety. However, a dramatic drop in research publications on the topic will make optimizing its role (including technique, injectate, and patient selection) increasingly difficult. However, EUS-CPN for PC pain is actively being refined with new information, data, and even guidelines. New EUS-guided strategies to treat PC pain besides conventional neurolysis are also likely to evolve in coming years.

Endoscopic Ultrasound Guided Intervention

Endoscopic ultrasound (EUS) has recently become widely used for the diagnosis and treatment of gastrointestinal disease. With applications of linear EUS and EUS-guided fine needle aspiration, many EUS-guided interventions are now emerging as feasible treatment options for patients with pancreatobiliary disease. EUS-guided drainage from pseudocyst, bile duct, pancreatic duct, and the gallbladder are becoming routine procedure. EUS-guided celiac plexus neurolysis and block can relieve intractable pancreatic pain. Moreover, EUS-guided local tumor therapy (ethanol ablation and radiofrequency ablation) may be feasible in selected patients. Safe EUS-guided intervention requires a good deal of experience but is becoming widely used to treat pancreatobiliary disease. (Korean J Med 2015,89:507-514)

Endoscopic therapy in chronic pancreatitis: current perspectives.

Endoscopic therapy in chronic pancreatitis (CP) aims to provide pain relief and to treat local complications, by using the decompression of the pancreatic duct and the drainage of pseudocysts and biliary strictures, respectively. This is the reason for using it as first-line therapy for painful uncomplicated CP. The clinical response has to be evaluated at 6–8 weeks, when surgery may be chosen. This article reviews the main possibilities of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) therapies. Endotherapy for pancreatic ductal stones uses ultrasound wave lithotripsy and sometimes additional stone extractions. The treatment of pancreatic duct strictures consists of a single large stenting for 1 year. If the stricture persists, simultaneous multiple stents are applied. In case of unsuccessful ERCP, the EUS-guided drainage of the main pancreatic duct (MPD) or a rendezvous technique can solve the ductal strictures. EUS-guided celiac plexus block has limited efficiency in CP. The drainage of symptomatic or complicated pancreatic pseudocysts can be performed transpapillarily or transgastrically/transduodenally, preferably by EUS guidance. When the biliary stricture is symptomatic or progressive, multiple plastic stents are indicated. In conclusion, as in many fields of symptomatic treatment, endoscopy remains the first choice, either by using ERCP or EUS-guided procedures, after consideration of a multidisciplinary team with endoscopists, surgeons, and radiologists. However, what is crucial is establishing the right timing for surgery.

Retroperitoneal Abscess Following EUS-Guided Celiac Plexus Block

Introduction: A 75-year-old diabetic man underwent EUS-guided celiac plexus block for refractory abdominal pain secondary to sclerosing mesenteritis. A total of 20 mL of 0.25% bupivacaine and 20 mg of triamcinolone (40 mg/mL) were injected into the celiac plexus. He was treated with ciprofloxacin 250 mg twice a day for 3 days after the procedure. He reported symptomatic improvement for several weeks. A follow-up CT scan at 6 weeks showed multiple new heterogeneous peripherally-enhancing solid soft tissue nodules in the supra celiac region (Figure 1). He denied fevers and abdominal pain was under good control at the time. These findings were suspected to be reactive changes to the injected medications. Four weeks later, he developed malaise, recurrent abdominal pain, and a leukocytosis of 13.9. A CT scan demonstrated interval development of a large air and fluid collection along the right diaphragmatic crus, suspicious for abscess (Figure 2). He underwent IR-guided drainage of the fluid collection and culture of the aspirate grew multidrug-resistant E. coli. He had rapid clinic improvement following antibiotics and drainage and was discharged to complete a course of ertepenam. Retroperitoneal abscess has been described as a rare complication of both EUS-guided celiac plexus block (CPB) and neurolysis (CPN). Reported abscesses occurred within a week and up to 4 weeks following the procedure. This report adds to literature demonstrating the rare but serious complication of abscess formation following CPB/CPN, and demonstrates that there may be significant delay between the procedure and presentation of abscess.Figure 1Figure 2

736 A Randomize, Double-Blinded, Multi-Center, Sham-Controlled Trial of EUS-Guided Celiac Plexus Block for Pain Due to Chronic Pancreatitis

736 A Randomize, Double-Blinded, Multi-Center, Sham-Controlled Trial of EUS-Guided Celiac Plexus Block for Pain Due to Chronic Pancreatitis

Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review.

The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field.

Interventional endoscopic ultrasonography: an overview of safety and complications

In recent years, endoscopic ultrasonography (EUS)-guided techniques have been developed as alternatives to surgical, radiologic, or conventional endoscopic approaches for the treatment or palliation of several digestive diseases. The use of EUS guidance allows the therapeutic area to be targeting more precisely, with a possible clinical benefit and less morbidity. Nevertheless, the risks persist and must be taken into consideration. This review gives an overview of the complications observed with the most established procedures of therapeutic EUS. The PubMed and Embase databases were used to search English language articles on interventional EUS. The studies considered for inclusion were those reporting on complications of EUS-guided celiac plexus block (EUS-CPB), EUS-guided celiac plexus neurolysis (EUS-CPN), drainage of fluid pancreatic and pelvic collections, and EUS-guided biliary and pancreatic drainage (EUS-BD and EUS-PD). Variations in methodology and design in most studies made a thorough statistical analysis difficult. Instead, a frequency analysis of complications and a critical discussion were performed. Although EUS-guided celiac plexus injection causes mainly mild and transient complications, growing experience shows that EUS-CPN is not as benign a procedure as previously thought. Most of the major complications have been observed in patients with chronic pancreatitis. The findings show that EUS-guided drainage of fluid collections is a safe procedure. Complications occur more often after the drainage of pancreatic abscesses and necrosis. Although the heterogeneity of studies dealing with pancreatobiliary drainage makes the evaluation of risks after these procedures difficult, complications after EUS-BD and EUS-PD are relatively frequent and can be severe. The technical complexity and the lack of specifically designed devices may account for their complication rates. Clinicians can consider EUS-guided celiac injection and EUS-guided drainage of fluid collections to be safe alternatives to surgical and radiologic interventions. Well-designed prospective trials are needed to assess the risks of EUS-BD and EUS-PD accurately before they are broadly advocated after a failed endoscopic retrograde cholangiopancreatography (ERCP).

Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis

A 57-year-old woman with a diagnosis of idiopathic recurrent pancreatitis and progressive epigastric pain radiating to her back was admitted to the hospital. Abdominal computed tomography (CT) showed a suspicious 3-cm pancreatic head mass involving the superior mesenteric artery (SMA) and vein. Endoscopic ultrasound (EUS) showed the suspicious pancreatic head mass with bile duct and main pancreatic duct dilatation and changes compatible with chronic pancreatitis. However, EUS-guided fine needle aspiration cytology was negative on three occasions. EUS-guided celiac plexus neurolysis (EUSCPN) was carried out using a 19-gauge needle. Absolute alcohol (10cc) and bupivacaine 0.5% (5cc) were injected on each side of the celiac takeoff. Color Doppler imaging after the procedure revealed the permeability of the SMA and celiac takeoff. After the procedure, the patient experienced stabbing pain radiating to the back, with nausea, hypotension, and fever. CT demonstrated complete thrombosis of the celiac takeoff, as well as wall thickening and bubble-like pneumatosis of the stomach, duodenum, jejunum, ileum loops, and ascending colon. Signs of hepatic infarction of segments I and III, and near-total right-kidney and splenic infarction were discovered. Conservative management was carried out and the patient died 8 days later. Major complications have rarely been reported using EUS-CPN or EUS-guided celiac plexus block (● Tab.1) [1–7]. The present case is the first to document a fatal outcome. The sclerosing effect of absolute ethanol, arterial embolisms after injection, and vasospasm could explain the necrosis of organs distant to the celiac takeoff [8]. All cases of major complications due to CPN, except one, were reported in the setting of chronic pancreatitis (● Tab.1). The issue of using CPN in patients with chronic pancreatitis is still a matter of debate [9]. In conclusion, major complications of CPN can include death. It may be preferable to limit EUS-guided CPN to patients with histologically proven cancers.

First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis

Intractable abdominal pain is common in carcinoma of the pancreas.1,2 EUS-guided celiac plexus block (CPB) and neurolysis (CPN) have been performed successfully to reduce chronic abdominal pain in patients with pancreatic cancer or chronic pancreatitis.3,4 We present the first case of effective pain relief after CPB for intractable abdominal pain related to peripancreatic colon cancer metastasis.

Advances in Diagnosis and Treatment of Biliopancreatic Diseases

Management of biliopancreatic diseases has seen great progress in recent years. Innovations in endoscopy have allowed gastroenterologists to assist in the care of many conditions of the biliary tree and pancreas, which were previously only managed surgically. Outcomes for many of these endoscopic interventions are comparable to their surgical counterpart. However, endoscopists taking care of these patients should be well aware of the limitations of their procedures and the advantages of surgery for certain patients. This special issue will address some of the main challenges faced today by physicians taking care of patients with pancreatic and biliary diseases. Endosonography, or endoscopic ultrasound (EUS), which previously was only considered a diagnostic tool, has now emerged as a useful therapeutic technique. In contrast, endoscopic retrograde cholangiopancreatography, or ERCP, has now become mainly a therapeutic tool. Some ERCP techniques have been adopted by endosonographers and allowed interventions for draining bile ducts and peripancreatic fluid collections, previously considered outside the realm of endoscopy. Despite the advances in outcomes and minimal invasiveness of EUS and ERCP-guided interventions, several risks and complications still remain. Pancreatitis is a well-recognized complication of ERCP with a significant incidence that has not been reduced greatly throughout recent years. Numerous studies have looked at ways of decreasing the risk of this dreadful complication. This special issue will discuss and review the problem of post-ERCP pancreatitis, a topic that raises a high level of concern for many who do this procedure, and ways to reduce its risk, especially in patients considered at high risk for developing this complication. Incidental pancreatic cysts continue to pose a diagnostic dilemma for gastroenterologists and surgeons alike. Despite the ability of safely obtaining a tissue sample during EUS examination, the utility of cytopathology in determining the exact nature of these lesions remains limited. More recently, DNA analysis of fluid obtained during aspiration has shown promise in improving the diagnostic accuracy of EUS-FNA. However, the effect of these newer tests in terms of deciding when to observe versus surgically resect in many of these incidental cysts remains to be proven. Pancreatologists agree that a reliable method for determining the nature and prognosis of pancreatic cystic neoplasms is required for improving the management strategy in asymptomatic patients. Abdominal pain is a cardinal symptom of chronic pancreatitis. The effectiveness of medical therapy, in the form of pancreatic enzyme supplementation or octreotide injections, is dismal. Pain relief can certainly be obtained with the use of narcotic medications, but at the cost of significant side effects, such as constipation, sedation, and drug dependence. Endoscopic alternatives for improving pain in chronic pancreatitis include those guided by ERCP, such as intraductal stone removal, stricture dilation, or drainage procedures, and EUS-guided celiac plexus block. This special issue will review the ERCP-guided interventions and discuss the efficacy of EUS-guided celiac plexus neurolysis for the treatment of pain in patients with pancreatic cancer. As advances in endoscopy and surgical innovations are introduced into the field of biliary and pancreatic diseases, many diseases previously requiring complicated surgeries with prolonged recovery are now being managed by minimally invasive techniques. Many of these procedures have a reduced risk when compared to their surgical alternative. However, long-term efficacy and patient risk factors need close consideration when deciding between different management alternatives. Many, if not all, biliary and pancreatic disorders require a close interaction between gastroenterologist and surgeon. The phrase “No man is an island” by John Donne (1572–1631) emphasizes the importance of consensus between specialists and should always be in the minds of those managing patients with biliopancreatic diseases. Fauze Maluf-Filho Jose G. de la Mora Levy Carlos G. Micames

Interventional Endoscopic Ultrasonography: Present and Future

The technical advances in endoscopic ultrasonograpy (EUS) and accessories have enabled performing EUS-guided intervention in the pancreas and biliary tract. Many research centers have been performing or investigating EUS-guided drainage, EUS-guided celiac plexus neurolysis and block, EUS-guided anastomosis that includes choledocho-enterostomy and choledocho-gastrostomy, EUS-guided ablation and injection therapy mainly for pancreatic neoplasm, EUS-guided photodynamic therapy and EUS-guided brachytherapy. Some of these are currently clinical applications and others are under investigations in clinical studies or animal models. Further detailed randomized controlled clinical trials and the development of materials will bring us into a new era of therapeutic EUS.

Efficacy of Endoscopic Ultrasound-guided Celiac Plexus Block and Celiac Plexus Neurolysis for Managing Abdominal Pain Associated With Chronic Pancreatitis and Pancreatic Cancer

Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN) have become important interventions in the management of pain due to chronic pancreatitis and pancreatic cancer. However, only a few well-structured studies have been performed to evaluate their efficacy. Given limited data, their use remains controversial. Herein, we evaluate the efficacy of EUS-guided CPB and CPN in alleviating chronic abdominal pain due to chronic pancreatitis and pancreatic cancer respectively. Using Medline, Pubmed, and Embase databases from January 1966 through December 2007, a thorough search of the English literature for studies evaluating the efficacy of EUS-guided CPB and CPN for the management of chronic abdominal pain due to chronic pancreatitis and pancreatic cancer was conducted, along with a hand search of reference lists. Studies that involved less than 10 patients were excluded. Data on pain relief was extracted, pooled, and analyzed. A total of 9 studies were included in the final analysis. For chronic pancreatitis, 6 relevant studies were identified, comprising a total of 221 patients. EUS-guided CPB was effective in alleviating abdominal pain in 51.46% of patients. For pancreatic cancer, 5 relevant studies were identified with a total of 119 patients. EUS-guided CPN was effective in alleviating abdominal pain in 72.54% of patients. EUS-guided CPB was 51.46% effective in managing chronic abdominal pain in patients with chronic pancreatitis, but warrants improvement in patient selection and refinement of technique, whereas EUS-guided CPN was 72.54% effective in managing pain due to pancreatic cancer and is a reasonable option for patients with tolerance to narcotic analgesics.

EUS 2008 Working Group document: evaluation of EUS-guided celiac plexus neurolysis/block (with video)

Celiac plexus neurolysis (CPN) has been performed for almost 100 years as a means of alleviating pain of pancreatic or retroperitoneal origin, and a variety of techniques, routes, and chemical agents have been used to maximize efficacy and minimize complications. 1-3 Until recently, CPN has been most commonly performed under fluoroscopic or CT guidance by using either a bilateral posterior or an anterior approach, and numerous studies confirmed the efficacy of the procedure and highlighted potential advantages over opioid therapy. 4,5 In the last 10 years, EUS-guided CPN (EUS-CPN)/EUS-guided celiac plexus block (EUS-CPB) has been described as an alternative approach and is now widely practiced. 6,7 This section of the EUS 2008 Working Group Proceedings evaluates the current evidence and potential for future research in this area.

EUS-guided celiac plexus neurolysis vs. block: assessing interference with pancreatic surgery and adhesions in a pig survival model

Background/Purpose: Celiac plexus neurolysis (CPN) is used for pain management in pancreatic cancer. It involves the injection of alcohol to destroy the celiac neural structures, aimed at achieving longer-lasting analgesia than a steroid/anesthetic block alone (CPB). However, one concern in chronic pancreatitis is that subsequent surgery may prove difficult due to adhesions. The aim of the study was to determine the degree of interference and the adhesion burden from CPN vs. CPB in a blinded pig survival model.

A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain

The efficacy of 1-injection versus a 2-injections method of EUS-guided celiac plexus block (EUS-CPB) in patients with chronic pancreatitis is not known. To compare the clinical effectiveness and safety of EUS-CPB by using 1 versus 2 injections in patients with chronic pancreatitis and pain. The secondary aim is to identify factors that predict responsiveness. A prospective randomized study. EUS-CPB was performed by using bupivacaine and triamcinolone injected into 1 or 2 sites at the level of the celiac trunk during a single EUS-CPB procedure. Duration of pain relief, onset of pain relief, and complications. Fifty [corrected] subjects were enrolled (23 received 1 injection, 27 [corrected] received 2 injections). The median duration of pain relief in the 31 responders was 28 days (range 1-673 days). [corrected] Fifteen [corrected] of 23 (65%) [corrected] subjects who received 1 injection [corrected] had relief from pain compared with 16 of 27 (59%) [corrected] subjects who received 2 injections [corrected] (P = .67). [corrected] The median times to onset in the 1-injection and 2-injections groups were 21 and 14 days, respectively (P = .99). No correlation existed between duration of pain relief and time to onset of pain relief or onset within 24 hours. Age, sex, race, prior EUS-CPB, and smoking or alcohol history did not predict duration of pain relief. Telephone interviewers were not blinded. There was no difference in duration of pain relief or onset of pain relief in subjects with chronic pancreatitis and pain when the same total amount of medication was delivered in 1 or 2 injections during a single EUS-CPB procedure. Both methods were safe.

A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain

A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain