Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP)

A large single center experience

F. Gress, D. Ciaccia, J. Kiel, Stuart Sherman, Glen Lehman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

We previously reported our data from a small prospective trial suggesting a role for EUS guided CB in the treatment of pain associated with CP. AIM: To present our prospective experience with EUS guided CB for the management of CP including follow up on response rates and complications. METHODS: All subjects had documented CP by ERCP, EUS +/- FNA cytology and chronic abdominal pain unresponsive to prior treatment options. All patients underwent EUS guided steroid CB Global daily pain scores using a visual analog scale (0-10) were determined pre and post CB with telephone follow up by a nurse at 2, 7, 14 days and monthly thereafter. EUS guided CB was performed under the guidance of linear array endosonography (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 by Doppler, the needle was then inserted into the celiac ganglion area followed by injection of bupivacaine 0.25% (20 cc) and triamcinolone 80 mg (6 cc). RESULTS: EUS guided CB was performed in 80 patients (35M/45F) with mean age of 45 yrs (range 17 - 76 yrs) between 7/1/95 and 12/1/96. Two pts had ethanol injection after they failed to improve with steroid EUS CB. A significant improvement in pain occurred in 55% (44/80 pts) manifest by at least a 50% decrease in global pain score at 7 days. In 25% of pts there was persistent benefit beyond 12 wks and 10% still had persistent benefit at 24 weeks, including patient who was pain-free for 48 weeks. Three pts experienced greater than 10 stools/day after CB that resolved in 7-10 days. One patient experienced a brief episode of orthostatic hypotension that resolved with fluids. There were two major complications (2.5%): 1) a peripancreatic abscess five days post procedure in a patient taking omeprazole. We hypothesized that add suppression may have contributed to this event by allowing bacterial colonization of the stomach. 2) a retroperitoneal bleed 18 days after the procedure due to ethanol CB induced pseudoaneurysm. She had previously had three steroid CB. A vascular patch graft was required. Similar complications have been reported after CT guided CB. CONCLUSION: EUS guided steroid CB gives good short term pain relief in approximately 1/2 of CP patients. Prophylactic antibiotics should be given if acid suppressing drugs have been given.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997

Fingerprint

Celiac Plexus
Chronic Pancreatitis
Pain Management
Pain
Steroids
Needles
Ethanol
Celiac Artery
Triamcinolone
Endosonography
Sympathetic Ganglia
Orthostatic Hypotension
Injections
Omeprazole
Endoscopic Retrograde Cholangiopancreatography
Bupivacaine
False Aneurysm
Visual Analog Scale
Telephone
Chronic Pain

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{04d5098cf74846b08fe11e21f6d84526,
title = "Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): A large single center experience",
abstract = "We previously reported our data from a small prospective trial suggesting a role for EUS guided CB in the treatment of pain associated with CP. AIM: To present our prospective experience with EUS guided CB for the management of CP including follow up on response rates and complications. METHODS: All subjects had documented CP by ERCP, EUS +/- FNA cytology and chronic abdominal pain unresponsive to prior treatment options. All patients underwent EUS guided steroid CB Global daily pain scores using a visual analog scale (0-10) were determined pre and post CB with telephone follow up by a nurse at 2, 7, 14 days and monthly thereafter. EUS guided CB was performed under the guidance of linear array endosonography (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 by Doppler, the needle was then inserted into the celiac ganglion area followed by injection of bupivacaine 0.25{\%} (20 cc) and triamcinolone 80 mg (6 cc). RESULTS: EUS guided CB was performed in 80 patients (35M/45F) with mean age of 45 yrs (range 17 - 76 yrs) between 7/1/95 and 12/1/96. Two pts had ethanol injection after they failed to improve with steroid EUS CB. A significant improvement in pain occurred in 55{\%} (44/80 pts) manifest by at least a 50{\%} decrease in global pain score at 7 days. In 25{\%} of pts there was persistent benefit beyond 12 wks and 10{\%} still had persistent benefit at 24 weeks, including patient who was pain-free for 48 weeks. Three pts experienced greater than 10 stools/day after CB that resolved in 7-10 days. One patient experienced a brief episode of orthostatic hypotension that resolved with fluids. There were two major complications (2.5{\%}): 1) a peripancreatic abscess five days post procedure in a patient taking omeprazole. We hypothesized that add suppression may have contributed to this event by allowing bacterial colonization of the stomach. 2) a retroperitoneal bleed 18 days after the procedure due to ethanol CB induced pseudoaneurysm. She had previously had three steroid CB. A vascular patch graft was required. Similar complications have been reported after CT guided CB. CONCLUSION: EUS guided steroid CB gives good short term pain relief in approximately 1/2 of CP patients. Prophylactic antibiotics should be given if acid suppressing drugs have been given.",
author = "F. Gress and D. Ciaccia and J. Kiel and Stuart Sherman and Glen Lehman",
year = "1997",
language = "English",
volume = "45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP)

T2 - A large single center experience

AU - Gress, F.

AU - Ciaccia, D.

AU - Kiel, J.

AU - Sherman, Stuart

AU - Lehman, Glen

PY - 1997

Y1 - 1997

N2 - We previously reported our data from a small prospective trial suggesting a role for EUS guided CB in the treatment of pain associated with CP. AIM: To present our prospective experience with EUS guided CB for the management of CP including follow up on response rates and complications. METHODS: All subjects had documented CP by ERCP, EUS +/- FNA cytology and chronic abdominal pain unresponsive to prior treatment options. All patients underwent EUS guided steroid CB Global daily pain scores using a visual analog scale (0-10) were determined pre and post CB with telephone follow up by a nurse at 2, 7, 14 days and monthly thereafter. EUS guided CB was performed under the guidance of linear array endosonography (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 by Doppler, the needle was then inserted into the celiac ganglion area followed by injection of bupivacaine 0.25% (20 cc) and triamcinolone 80 mg (6 cc). RESULTS: EUS guided CB was performed in 80 patients (35M/45F) with mean age of 45 yrs (range 17 - 76 yrs) between 7/1/95 and 12/1/96. Two pts had ethanol injection after they failed to improve with steroid EUS CB. A significant improvement in pain occurred in 55% (44/80 pts) manifest by at least a 50% decrease in global pain score at 7 days. In 25% of pts there was persistent benefit beyond 12 wks and 10% still had persistent benefit at 24 weeks, including patient who was pain-free for 48 weeks. Three pts experienced greater than 10 stools/day after CB that resolved in 7-10 days. One patient experienced a brief episode of orthostatic hypotension that resolved with fluids. There were two major complications (2.5%): 1) a peripancreatic abscess five days post procedure in a patient taking omeprazole. We hypothesized that add suppression may have contributed to this event by allowing bacterial colonization of the stomach. 2) a retroperitoneal bleed 18 days after the procedure due to ethanol CB induced pseudoaneurysm. She had previously had three steroid CB. A vascular patch graft was required. Similar complications have been reported after CT guided CB. CONCLUSION: EUS guided steroid CB gives good short term pain relief in approximately 1/2 of CP patients. Prophylactic antibiotics should be given if acid suppressing drugs have been given.

AB - We previously reported our data from a small prospective trial suggesting a role for EUS guided CB in the treatment of pain associated with CP. AIM: To present our prospective experience with EUS guided CB for the management of CP including follow up on response rates and complications. METHODS: All subjects had documented CP by ERCP, EUS +/- FNA cytology and chronic abdominal pain unresponsive to prior treatment options. All patients underwent EUS guided steroid CB Global daily pain scores using a visual analog scale (0-10) were determined pre and post CB with telephone follow up by a nurse at 2, 7, 14 days and monthly thereafter. EUS guided CB was performed under the guidance of linear array endosonography (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 by Doppler, the needle was then inserted into the celiac ganglion area followed by injection of bupivacaine 0.25% (20 cc) and triamcinolone 80 mg (6 cc). RESULTS: EUS guided CB was performed in 80 patients (35M/45F) with mean age of 45 yrs (range 17 - 76 yrs) between 7/1/95 and 12/1/96. Two pts had ethanol injection after they failed to improve with steroid EUS CB. A significant improvement in pain occurred in 55% (44/80 pts) manifest by at least a 50% decrease in global pain score at 7 days. In 25% of pts there was persistent benefit beyond 12 wks and 10% still had persistent benefit at 24 weeks, including patient who was pain-free for 48 weeks. Three pts experienced greater than 10 stools/day after CB that resolved in 7-10 days. One patient experienced a brief episode of orthostatic hypotension that resolved with fluids. There were two major complications (2.5%): 1) a peripancreatic abscess five days post procedure in a patient taking omeprazole. We hypothesized that add suppression may have contributed to this event by allowing bacterial colonization of the stomach. 2) a retroperitoneal bleed 18 days after the procedure due to ethanol CB induced pseudoaneurysm. She had previously had three steroid CB. A vascular patch graft was required. Similar complications have been reported after CT guided CB. CONCLUSION: EUS guided steroid CB gives good short term pain relief in approximately 1/2 of CP patients. Prophylactic antibiotics should be given if acid suppressing drugs have been given.

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M3 - Article

VL - 45

JO - Gastrointestinal Endoscopy

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