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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(04): 203-210
DOI: 10.1055/s-0043-1777737
Research article

Endoscopic Ultrasound-Guided Celiac Plexus Block Can Be a Useful Procedure for Pain Relief in Chronic Pancreatitis When Used Selectively

Nikhil Sonthalia
1   Institute of Gastrosciences and Liver Disease, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
,
Vikram Patil
1   Institute of Gastrosciences and Liver Disease, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
,
Awanish Tewari
1   Institute of Gastrosciences and Liver Disease, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
,
Akash Roy 
1   Institute of Gastrosciences and Liver Disease, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
,
Mahesh Kumar Goenka
1   Institute of Gastrosciences and Liver Disease, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
› Author Affiliations Funding All the authors have no financial disclosers to declare.
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Abstract

Background and Objectives: Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) for pain relief in chronic pancreatitis (CP) has wide variation in results as reported in the literature. The objective was to find out the efficacy of EUS-CPB in painful CP from our region where phenotype of CP is different from West and to find out factors favoring response to EUS-CPB.

Methods and Results: Patients with known CP who underwent EUS-CPB were assessed for response to CPB. Response to EUS-CPB was recorded as more than 50% reduction in visual analogue scale (VAS) score for pain severity at 1 week, 4 weeks, 12 weeks and 24 weeks after procedure. Factors between responders and nonresponders were analyzed. Among 29 patients who underwent EUS-CPB during the study period, response was seen in 72.4% patients after the procedure. The mean time to response to EUS-CPB was 1.22 (± 0.43) days. Mean duration of response was 8 months (± 4.73). Short duration of painful CP (≤2 years) was seen in 15 patients (51.72%) and long duration (>2 years) was seen in 14 (48.27%). Among responders (21/29), those patients who had short duration of disease had significantly lower median VAS score at 12 weeks, (1 versus 3, p-value= 0.026) and at 24 weeks, (1.5 versus 2.5, p-value= 0.049), as compared to those with longer duration of disease. Overall, 83.3% males responded as compared to 54.54% females (p = 0.04). Significant proportion of subjects who responded either stopped or used analgesics occasionally (p < 0.0001). There was no statistically significant difference in response to EUS-CPB with respect to age, prior history of endoscopic retrograde cholangiopancreatography (ERCP), etiology of CP, prior history of surgery, or whether only EUS-CBP was done (p > 0.05 for all).

Conclusion: EUS-CPB can be effective when used in select group of painful CP patient who are not immediate candidates for surgery especially in early course of disease. It can be offered to patients with persistent pain despite optimum medical therapy. When effective, it can reduce need for analgesic medication at least in short to medium term.

Keywords

endoscopic ultrasound-guided celiac plexus block/neurolysis - management of pain in chronic pancreatitis - celiac ganglion - celiac plexus neurolysis - endotherapy in chronic pancreatitis

Ethical Approval

Institutional review board approval was taken for this study.


Authors' Contributions

Nikhil Sonthalia did the procedures, designed research, and statistical analysis and wrote the manuscript; Vikram Patil did the statistical analysis and contributed in writing the manuscript; Awanish Tewary contributed in writing manuscript and data collection; Aakash Roy did critical review of manuscript and contributed in statistical analysis; MK Goenka contributed in designing research, did the critical review, and contributed in statistical analysis. All authors have read and approved the final manuscript.




Publication History

Article published online:
28 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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