Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): A large single center experience

Gress, Frank G.; Ciaccia, D.; Kiel, John; Sherman, Stuart; Lehman, G.

doi:10.1016/s0016-5107(97)80593-7

Cited by 25 publications

(18 citation statements)

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“…Procedure-related transient abdominal pain was noted in 9% of subjects who did not have direct injection of celiac ganglia [14]. There have been 2 reports of major complications occurring after EUS-CPB using steroids for chronic pancreatitis including death after an arterial pseudoaneurysm hemorrhage [32], and a peripancreatic abscess developed 5 days after EUS-CPB treated with intravenous antibiotics [33]. A recent report of acute spinal cord infarction following EUS-CPN was attributed to 24 mL of a 1 : 5 mixture of bupivacaine 0.25% with epinephrine and alcohol (5 mL into a celiac ganglia, and 19 mL into the celiac trunk area) [13].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol

Leblanc

Rawl

Juan

et al. 2013

Diagnostic and Therapeutic Endoscopy

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Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20 mL alcohol versus 10 mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain. Methods. 20 patients were selected to receive 10 mL or 20 mL of alcohol during EUS-CPN. Followup was done at baseline, 24 hours, and weekly. Health-related quality of life (HRQoL) was assessed at baseline, week 2, week 4, and every 4 weeks thereafter until pain returned. Results. There were no major complications in both groups. Minor self-limited adverse effects were seen in 6 (30%) subjects and included lightheadedness in 1 (5%), transient diarrhea in 2 (10%), and transient nausea and vomiting in 3. Pain relief was similar in both groups: 80% in the 10 mL group and 100% in the 20 mL group (P = 0.21). The mean (± SD) duration of pain relief in the 10 mL and 20 mL groups was 7.9 ± 10.8 and 8.4 ± 9.2 weeks, respectively. 30% of patients in each group had complete pain relief. Conclusions. EUS-CPN using 20 mL of alcohol is safe. Similar clinical outcomes were seen in both groups. Further investigations to confirm these findings are warranted.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol

Leblanc

Rawl

Juan

et al. 2013

Diagnostic and Therapeutic Endoscopy

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“…Transient pain has been reported, but in the Gunaratnam et al [20] study only 9% of patients experienced an increase in the pain, which lasted 48 h. Gastroparesis has also been reported as a rare complication of CPB [69] . The anterior approach utilized by EUS reduces the risk of major complications such as paraplegia, but other serious complications such as retroperitoneal hemorrhage and peripancreatic abscess formation have been reported [70] . The risk of abscess formation has led to the recommendations of antibiotic coverage prior to EUS CPB, but its use remains operator dependent.…”

Section: Eus Benefits and Complicationsmentioning

confidence: 99%

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Michaels

Draganov²

2007

WJG

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Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported, but larger studies are needed to confirm this finding. At this time, the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

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“…Transient hypotension is minimized by infusion of normal saline while the patient is recovering from conscious sedation. Transient pain has been reported, but in some studies researchers found a transient increase in pain which lasted up to 48 h. Gastroparesis has also been reported as a rare complication of celiac plexus neurolysis and block (Gress et al 1997). The anterior approach utilized by EUS reduces the risk of major complications, such as paraplegia and pneumothorax.…”

Section: Techniques For Performing Eus-guided Cpn and Cpbmentioning

confidence: 99%

Diagnostic and Therapeutic Procedures in Gastroenterology

Wu¹,

Sridhar²

2011

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Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): A large single center experience

Cited by 25 publications

References 0 publications

Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol

Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Diagnostic and Therapeutic Procedures in Gastroenterology

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