Is there a role for celiac plexus block for chronic pancreatitis?

Abstract

License terms Editorial E60 THIEME Endoscopic ultrasound-celiac plexus block (EUS-CPB) and endoscopic ultrasound-celiac plexus neurolysis (EUS-CPN) have been reported to provide pain relief and reduce narcotics use in patients with chronic pancreatitis [1]. The techniques of EUS-CPB and EUS-CPN are identical; the differences are in the substances injected and in the indications. Neurolysis, in which bupiva-caine and ethanol are injected, has been used in patients who have pancreatic cancer or chronic pancreatitis. On the other hand, block, in which bupivacaine with or without triamcinolone is injected , has been used mainly in patients who have chronic pancreatitis [2]. The injection of ethanol, bupivacaine, and triam-cinolone into the celiac plexus disrupts signal transmission to the spinal cord and central nervous system, theoretically interfering with the perception of pain. The effects of ethanol are much less reversible than the effects of bupiva-caine and triamcinolone, and albeit rare, more severe adverse effects have been reported with EUS-CPN than with EUS-CPB [3-5]. Moreover, meta-analysis of EUS-CPN showed results in patients with pain due to chronic pancreatitis (pain relief in 59 % of 376 patients in 9 studies) that were inferior to results in patients with pancreat-ic cancer (pain relief in 80 % of 283 patients in 8 studies) [6]. For these reasons, EUS-CPN is the technique of choice for patients with pancreatic cancer, whereas EUS-CPB is preferred for patients affected with a benign condition, such as chronic pancreatitis. Because of the anatomical location of the celiac plexus around the origin of the celiac trunk and superior mesenteric artery, the EUS-guided technique provides near-field and real-time visualiza-tion, resulting in a safer approach than is possible with percutaneous techniques [7]. A randomized, controlled trial, in which EUS-guided and fluoro-scopy-guided percutaneous CPB with bupivacaine and triamcinolone were compared in patients who had chronic pancreatitis, demonstrated improvement in pain scores (visual analogue scale) in 70 % of patients in the EUS group versus 30 % of those in the percutaneous group (P = 0.044) [8].