Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis

Abstract

Background and study aims: 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. Patients and 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.

Ganglion blocks as a treatment of pain: current perspectives

“…Older age at first injection and relief after the first procedure were significantly associated with pain relief after subsequent blocks. 60 …”

EUS-Guided Celiac Plexus Interventions

“…For CPB in chronic pancreatitis, the average length of pain relief was around 3 months, hence it was recommended that CPB was considered as temporizing measure in pain relief in chronic pancreatitis. Some studies 15 have shown that repeated CPB can be safe choice and response to first CPB is a predictor of responses to subsequent sessions of blocks.…”

Advances in endotherapy in chronic pancreatitis

“…Most patients underwent a median of three procedures and lack of response after the first procedure was predictive of failure in subsequent sessions. 41 In a meta-analysis that included 6 studies and 221 patients with CP, EUS-CPB was effective in 51.46% of patients. EUS-CPN is effective in patients with pancreatic cancer [42][43][44] and it has been used in patients with CP as well, achieving acceptable pain-relief shortly after the procedure, although the long-term effects are still uncertain.…”