Endoscopic Ultrasound-Guided Celiac Plexus Block and Celiac Plexus Neurolysis

Abstract

Celiac plexus neurolysis (CPN) and celiac plexus block (CPB) have been described as alternatives to increasing narcotic usage for patients with chronic abdominal pain due to pancreatic cancer and chronic pancreatitis. Endoscopic ultrasound (EUS) allows for direct and easy visualization of the celiac plexus region, and more recently, direct endosonographic views of the ganglia and interconnecting fibers have been described. This technique provides a safer, more reliable and possibly cost-effective means of performing the procedure when compared with the percutaneous approach. Although there are no strong randomized controlled trials or quality of life studies, there is some convincing evidence of the efficacy of EUS CPN and EUS CPB for the treatment of abdominal pain related to pancreatic cancer or chronic pancreatitis. Several small to medium-sized retrospective and prospective studies have reported significant data that supports the use of EUS-guided CPN and CPB procedures to provide safe delivery of pain relief.