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DOI: 10.1055/s-0034-1377919
Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis
Publication History
submitted 21 March 2014
accepted after revision 15 July 2014
Publication Date:
24 October 2014 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201501/lookinside/thumbnails/10.1055-s-0034-1377919-1.jpg)
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.
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References
- 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