Endoscopic ultrasound-guided celiac plexus block and neurolysis.
Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real-time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS-CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS-guided direct celiac ganglia neurolysis (EUS-CGN) was introduced recently. Pain relief is achieved by EUS-CPN in 70-80% of patients with pancreatic cancer and in 50-60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS-CGN may provide greater pain relief than conventional EUS-CPN. Procedure-related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur.
Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
Ichiro
http://orcid.org/0000-0002-6888-0310
I
Yasuda
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Hsiu-Po
HP
Wang
D001340:Autonomic Nerve Block / Q000379:methods*; D002447:Celiac Plexus; D019160:Endosonography; D006801:Humans
celiac ganglia; celiac plexus; celiac plexus neurolysis; endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN)