EUS (ENDOSCOPIC ULTRASOUND) – GUIDED CELIAC PLEXUS BLOCK (CPB) FOR PANCREATO-BILLIARY PAIN

Aims:

The efficacy of EUS-CPB in the pain management of pancreatic cancer and chronic pancreatitis is 72% and 51% respectively. The efficacy of EUS-CPB in pancreato-biliary pain but with normal investigations has not yet been reported. We report the results of a single centre retrospective observational study on the efficacy and safety of EUS-CPB in the above condition.

Methods:

All adult patients who had EUSS- CPB block between January 2013 and December 2016 were collected through Electronic patient records. Investigations including LFT, Ultrasonography, MRCP, EUS and HIDA scans were reviewed. They were included only if the above investigations were normal. Structured telephone interview was conducted and medication records were reviewed to assess response for treatment. Complete response was defined as resolution of symptoms and not requiring further procedures. Partial response was defined as resolution of symptoms but requiring further procedures.

Results:

Seventy patients had CPB for chronic pancreato-biliary pain; predominantly females 58/70 (83%) with median age 52 (25 – 86). There were no abnormalities on investigations to explain the symptoms in 91.4% (CBD and PD diameter is normal, CBD dilated in 8.5% -6/70 with median diameter 13.3 mm). The procedure was technically successful in all patients. The median number of CPB blocks required was 3 (range 1 – 18). Pain free period between the procedures is 3 months (range 2 – 41). There was Complete response in 17/65 (26%), partial response in 27/65 (41%) and No response to treatment in 21/65 (32%). There were no complications in this study (bleeding, perforation and diarrhoea).

Conclusions:

EUS-CPB is technically successful, safe and has a reasonable cumulative efficacy of 67% in the management of Pancreato-biliary pain with normal investigations.

Randomised control trial is needed to determine the efficacy of EUS-CPB in this particular group of patients.