EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review

Abstract

The objective of this study was to evaluate the efficacy of EUS-guided CPN for pain relief in patients with chronic pancreatitis and pancreatic cancer. An initial search identified 1,439 reference articles, of which 130 relevant articles were selected and reviewed. Data was extracted from 8 studies (N = 283) for EUS-guided CPN for pain due to pancreatic cancer and nine studies for chronic pancreatitis (N = 376) which met the inclusion criteria. With EUS-guided CPN, the pooled proportion of patients with pancreatic cancer that showed pain relief was 80.12% (95% CI = 74.47-85.22). In patients with pain due to chronic pancreatitis, EUS-guided CPN provided pain relief in 59.45% (95% CI = 54.51-64.30). In conclusion, EUS-guided CPN offers a safe alternative technique for pain relief in patients with chronic pancreatitis or pancreatic cancer. In patients with pain due to chronic pancreatitis, better techniques or injected materials are needed to improve the response.

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

“…Notably, a large meta-analysis of 8 studies revealed EUS-CPN achieved pain reprieve in 80% of patients, equivocal to standard approaches, with no serious complications. 105 Wyse et al 106 randomized 96 patients with late stage pancreatic adenocarcinoma to early EUS-CPN or standard management. Patients receiving early EUS-CPN reported significant reduction in pain at three months relative to the conventional treatment arm.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…The mean rate of pain alleviation is 72-80%, with a much lower rate of complete pain response [139][140][141]. The post-neurolytic residual pain could be related to non-visceral pain owing to invasion of the muscles or surrounding connective tissue.…”

Endoscopic Management of Pancreatic Cancer: From Diagnosis to Palliative Therapy

“…(Ramesh & Varadarajulu, 2008;Puli et al, 2009;Kaufman et al, 2010) This procedure entails the injection of absolute alcohol under EUS guidance to destroy the sympathetic plexus near the celiac axis. A similar technique involving the injection of triamcinolone is performed in patients with chronic pancreatitis for pain control.…”