INTRODUCTION: EUS guided fine needle aspiration (FNA) has allowed for development of new interventions for managing GI disease. EUS guided CB has been reported with some success in pts with pain due to malignancy This randomized prospective trial was designed to assess the role of EUS guided CB for the treatment of pain due to CP. METHODS: All pts with intractable abdominal pain due to CP were eligible for this study. Pts enrolled were randomly assigned to either EUS guided CB or CT guided CB. Pain scores using a visual analog scale (0-10) were determined pre and post CB for both techniques and follow up was performed by a nurse at 2, 7, 14, 28, and 42 days and monthly thereafter. Pts were also questioned about their overall experience with each of these procedures. If any pts in this study required another CB they were crossed over to the other technique. CT guided CB was performed by radiology EUS guided CB was performed under the guidance of the linear array echoendoscope (FG32UA, Pentax Corp., Orangeburg, NY) using a 22-gauge FNA needle (GIF, Mediglobe Inc, Tempe, AZ) via a transgastric approach The aorta was traced to the celiac artery and confirmed with color flow Doppler, then the FNA needle was inserted into this region and bupivacaine 0.25% (10 cc) followed by triamcinolone 40 mg (3 cc) was injected on both sides of the celiac area. RESULTS: 22 pts (10 m/12 f) with mean age of 45 yrs (range 17-76 yrs) were enrolled in this study between 7/1/95 and 12/1/95. EUS CB was performed in 14 pts and CT in 8 pts. All pts had documented CP by ERCP, EUS and in some EUS FNA cytology. Overall significant pain improvement occurred in 36% (8/22 pts). For EUS CB 6/14 pts (43%) were pain free with a mean post procedure follow up of 6 wks (range 2 to 22 wks). The mean pain score decreased from 7 to 1 post EUS CB at 8 wks follow up with 25% of pts having persistent benefit. At 12 wks 15% of pts still had persistent benefit. Only 2/8 pts (25%) had relief with CT CB with a mean follow up of 4 wks (range 2-6 wks). Mean pain score decreased from 7 to 3 at 4 wks. No CT CB pts had persistent relief beyond 4 wks and all had recurrent pain by 6 wks. One pt had both CT and EUS CB without improvement in symptoms. One pt with severe CP and s/p distal pancreatectomy experienced persistent diarrhea post EUS CB however, it is unclear whether the diarrhea was due to the CB or his disease. There were no serious pt complications during this study. SUMMARY: A cost comparison between EUS CB and CT CB at our institution showed EUS to be less costly ($1100) than CT ($1500). EUS CB appeared to have a more persistent effect then CT CB for pain control in CP.and was the preferred CB technique primarily due to the use of conscious sedation and lack of back pain associated with the CT technique. CONCLUSIONS: EUS guided CB appears to be a safe, effective and cost saving method for controlling pain in CP and perhaps other benign diseases.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging