Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): A large single center experience

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.