Eus-guided therapy for pancreatic pain: easy, effective and safe. why isn´t the first therapeutic approach?

Abstract

Visceral pain is often a disabling symptom that appears in many chronic digestive diseases. In the case of pancreatic disease it´s especially important, being most of the times the main symptom and interfering with nutrition, emotional state and life quality of these patients. The etiology of pancreatic pain is multifactorial, having neuropathic paths a main role. The current management of pancreatic pain follows the World Health Organization three-step ladder for pain control, but this classic model seems sometimes insufficient in pancreatic disease. Lately, therapeutic endoscopic ultrasound (EUS) has emerged as an effective alternative in pancreatic pain treatment, since the first descriptions of EUS-guided celiac plexus block and plexus neurolysis. Several studies confirm the effectiveness of these techniques, showing better results compared with those performed under fluoroscopy guidance, with less adverse effects and complications. In addition, they are easy and safe interventions, which can be performed by any endoscopist trained in basic therapeutic EUS. Both celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are performed using a lineal therapeutic echoendoscope, injecting different substances in order to reduce the effects of celiac plexus activity. CPB is mainly recommended in pain due to chronic pancreatitis a well as CPN is preferred in pancreatic cancer, being more effective than CPB even with only one session. In this review we pretend to summarize the state-of-art in EUS-guided therapy, focusing in treatment of chronic pancreatic pain, neoplastic and benign, reviewing the main studies of effectiveness and comparing with other invasive techniques. In addition, we would like to evaluate the effectiveness of combined treatment, according to recent publications.