title: Effectiveness and safety of serial endoscopic ultrasound-guided celiac plexus block for chronic pancreatitis.
abstract: OBJECTIVE
  Endoscopic ultrasound - guided celiac plexus block (EUS-CPB) is an established treatment for pain in patients with chronic pancreatitis (CP), but the effectiveness and safety of repeated procedures are unknown. Our objective is to report our experience of repeated EUS-CPB procedures within a single patient.
  
  
  METHODS
  A prospectively maintained EUS database was retrospectively analyzed to identify patients who had undergone more than one EUS-CPB procedure over a 17-year period. The main outcome measures included number of EUS-CPB procedures for each patient, self-reported pain relief, duration of pain relief, and procedure-related adverse events.
  
  
  RESULTS
  A total of 248 patients underwent more than one EUS-CPB procedure and were included in our study. Patients with known or suspected CP (N = 248) underwent a mean (SD) of 3.1 (1.6) EUS-CPB procedures. In 76 % of the patients with CP, the median (range) duration of the response to the first EUS-CPB procedure was 10 (1 - 54) weeks. Lack of pain relief after the initial EUS-CPB was associated with failure of the next EUS-CPB (OR 0.17, 95 %CI 0.06 - 0.54). Older age at first EUS-CPB and pain relief after the first EUS-CPB were significantly associated with pain relief after subsequent blocks (P = 0.026 and P = 0.002, respectively). Adverse events included peri-procedural hypoxia (n = 2) and hypotension (n = 1) and post-procedural orthostasis (n = 2) and diarrhea (n = 4). No major adverse events occurred.
  
  
  CONCLUSIONS
  Repeated EUS-CPB procedures in a single patient appear to be safe. Response to the first EUS-CPB is associated with response to subsequent blocks.
authors.affiliation: Department of Gastroenterology and Hepatology, Western University, London, Ontario, Canada.
authors.forename: Michael S L
authors.initials: MS
authors.lastname: Sey
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Schmaltz
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Al-Haddad
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.affiliation: Department of Biostatistics, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Cynthia S J
authors.initials: CS
authors.lastname: Calley
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Juan
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Femi
authors.initials: F
authors.lastname: Lasisi
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA ; Regenstrief Institute, Indianapolis, Indiana, USA ; Center of Innovation, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: LeBlanc