Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kaufman
Marina
M
Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA. Marina_s_kaufman@yahoo.com
Singh
Gurpreet
G
Das
Sourish
S
Concha-Parra
Ronald
R
Erber
Jonathan
J
Micames
Carlos
C
Gress
Frank
F
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D001340:Autonomic Nerve Block / Q000379:methods*; D002447:Celiac Plexus; D002986:Clinical Trials as Topic; D019160:Endosonography / Q000379:methods; D006801:Humans; D010190:Pancreatic Neoplasms / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000503:physiopathology; D012597:Sclerosing Solutions / Q000378:metabolism / Q000627:therapeutic use
D012597:Sclerosing Solutions