Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Abstract

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.

Ganglion blocks as a treatment of pain: current perspectives

“… 40 Recently, endoscopic ultrasound (EUS) has become a preferred approach since it defines the plexus and adjacent structures in detail. 41 …”

Major Laparoscopic Intraperitoneal Surgery Performed With Combined Bilateral Subcostal Transversus Abdominal Plane Block and Celiac Plexus Block, Intravenous Sedation Without Tracheal Intubation

“…4,10 Endoscopic techniques have more recently been reported. 11 As stated by Mercadante and Nicosia, 4 the anterior approach might theoretically reduce the risk of neurologic injury, but available data are limited. In 1988, Montero Matamala et al 12 described a new computed tomography-guided approach of the celiac plexus, opening the door of the anterior approaches, and in 1989, the same authors reported the use of ultrasound guidance instead of computed tomography guidance.…”

Current status and future perspectives of interventional endoscopic ultrasonography in Japan

“…The real‐time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief compared with other modalities, such as computed tomography and fluoroscopy. Moreover, a new technique, EUS‐guided direct ganglia neurolysis, was recently developed and provided greater pain relief than the conventional EUS‐CPN . However, such EUS‐guided celiac plexus interventions are not widely applied, probably due to their limited long‐term analgesic effects and development of better opioid analgesics.…”

“…Moreover, a new technique, EUSguided direct ganglia neurolysis, was recently developed and provided greater pain relief than the conventional EUS-CPN. 9 However, such EUS-guided celiac plexus interventions are not widely applied, probably due to their limited long-term analgesic effects and development of better opioid analgesics.…”