Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis
submitted 21. März 2014
accepted after revision 15. Juli 2014
24. Oktober 2014 (online)
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.
- 1 Eriksen J, Sjogren P, Bruera E et al. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 2006; 125: 172-179
- 2 Grunkemeier DM, Cassara JE, Dalton CB et al. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol 2007; 5: 1126-1139 (quiz 1-2)
- 3 LeBlanc JK, DeWitt J, Johnson C et al. A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain. Gastrointest Endosc 2009; 69: 835-842
- 4 LeBlanc JK, Al-Haddad M, McHenry L et al. A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?. Gastrointest Endosc 2011; 74: 1300-1307
- 5 Gress F, Schmitt C, Sherman S et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 2001; 96: 409-416
- 6 Gress F, Schmitt C, Sherman S et al. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999; 94: 900-905
- 7 Adler DG, Lichtenstein D, Baron TH et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 2006; 63: 933-937
- 8 DeWitt J, McGreevy K, LeBlanc J et al. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc 2005; 62: 76-84
- 9 Sahai AV, Zimmerman M, Aabakken L et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 1998; 48: 18-25
- 10 Adler DG, Jacobson BC, Davila RE et al. ASGE guideline: complications of EUS. Gastrointest Endosc 2005; 61: 8-12
- 11 Abdalla EK, Schell SR. Paraplegia following intraoperative celiac plexus injection. J Gastrointest Surg 1999; 3: 668-671
- 12 Sayed I, Elias M. Acute chemical pericarditis following celiac plexus block—a case report. Middle East J Anesthesiol 1997; 14: 201-206
- 13 Fujii L, Clain JE, Morris JM et al. Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis. Endoscopy 2012; 44: E265-E266
- 14 Gimeno-Garcia AZ, Elwassief A, Paquin SC et al. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy 2012; 44: E267
- 15 Iftikhar S, Loftus Jr EV. Gastroparesis after celiac plexus block. Am J Gastroenterol 1998; 93: 2223-2225
- 16 Kumar A, Tripathi SS, Dhar D et al. A case of reversible paraparesis following celiac plexus block. Reg Anesth Pain Med 2001; 26: 75-78
- 17 Lalueza A, Lopez-Medrano F, del Palacio A et al. Cladosporium macrocarpum brain abscess after endoscopic ultrasound-guided celiac plexus block. Endoscopy 2011; 43: E9-E10
- 18 Loeve US, Mortensen MB. Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis. Gastrointest Endosc 2013; 77: 151-152
- 19 Mittal MK, Rabinstein AA, Wijdicks EF. Pearls & oy-sters: acute spinal cord infarction following endoscopic ultrasound-guided celiac plexus neurolysis. Neurology 2012; 78: e57-e59
- 20 Navarro-Martinez J, Montes A, Comps O et al. Retroperitoneal abscess after neurolytic celiac plexus block from the anterior approach. Reg Anesth Pain Med 2003; 28: 528-530
- 21 Pello S, Miller A, Ku T et al. Hemorrhagic gastritis and duodenitis following celiac plexus neurolysis. Pain Physician 2009; 12: 1001-1003
- 22 Shin SK, Kweon TD, Ha SH et al. Ejaculatory failure after unilateral neurolytic celiac plexus block. Korean J Pain 2010; 23: 274-277
- 23 Levy MJ, Topazian MD, Wiersema MJ et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am J Gastroenterol 2008; 103: 98-103
- 24 Sahai AV, Lemelin V, Lam E et al. Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol 2009; 104: 326-329
- 25 Puli SR, Reddy JB, Bechtold ML et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci 2009; 54: 2330-2337