Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness.
OBJECTIVE
Endoscopic ultrasound (EUS)-guided celiac plexus block/neurolysis (CPB/N) can be performed by injecting at the base (central) or on either side (bilateral) of the celiac axis. Central CPB/N is easier and possibly safer. Bilateral CPB/N is more difficult but may be more effective as it reaches more ganglia. The aim of this study was to compare the short-term safety and efficacy of central and bilateral CPB/N.


METHODS
Consecutive patients referred for CPB/N to a quaternary EUS center were eligible for this study. Central CPB/N was used in the first half of the study period and bilateral CPB/N in the last half. The primary outcome was the percent reduction in visual analog pain scores at day 7.


RESULTS
A total of 184 patients were eligible. Out of them, 24 (13%) were excluded for incomplete data. A total of 160 were left (71 central, 89 bilateral). The groups were similar for all cogent variables. Bilateral CPB/N was more effective than central CPB/N (mean percent pain reduction 70.4% (61.0-80.0) vs. 45.9% (32.7-57.4); P=0.0016). The only predictor of a >50% pain reduction was bilateral CPB/N (odds ratio 3.55, 1.72-7.34). Only one complication was noted: self-limited bleeding because of laceration of the adrenal artery following bilateral celiac plexus (CP) block in an anticoagulated patient.


CONCLUSIONS
(i) Bilateral CPB/N is more effective than central CPB/N; (ii) bilateral CPB/N is safe, but on rare occasions can cause trauma to the left adrenal artery; it should therefore be avoided in patients with a bleeding diathesis.
Sahai
Anand V
AV
Gastroenterology, CHUM, Montreal, Quebec, Canada. anand.sahai@sympatico.ca
Lemelin
Valéry
V
Lam
Eric
E
Paquin
Sarto C
SC
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000777:Anesthetics / Q000008:administration & dosage*; D001340:Autonomic Nerve Block / Q000379:methods*; D002447:Celiac Plexus; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications; D012997:Solvents / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000777:Anesthetics; D012997:Solvents; D000431:Ethanol