Endoscopic ultrasound guided celiac plexus block

Background: Celiac plexus block is used to treat pain caused by pancreatic diseases. Most commonly, celiac plexus block is performed percutaneously under US, CT or fluoroscopic guidance, but can also be performed with EUS. The aim of this study was to prospectively assess the efficacy of EUS celiac plexus block in the management of pancreatic pain.

Method: EUS-guided celiac plexus block was performed under the guidance of linear array endosonography (FG 32UA, Pentax), utilizing a sterile 22-gauge FNA needle system (“Vilman” type, GIP). The technique we used, including the location of the needle during injection, has been described previously. 20 cc of bupivacaine (0. 5%) and 1 a Diprophos was injected to the celiac area.

Results: We performed EUS-guided celiac block in 12 patients (4 men, 8 women). A significant improvement in pain scores with reduction in pain medication usage occurred in 92% (11 of 12) of patients having the EUS block. The mean post procedure follow-up was 10 weeks (range: 2–18 wk). Persistent benefit was experienced by 40% of patients at 6 wk and by 30% at 18 wk. There were no complications.

Conclusions: EUS-guided celiac block appears to be a safe, effective, and less costly method for controlling the pancreatic pain.

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Gress F., Ikenberry S. and Sherman S. et al. (1999) A prospective randomized comparison of endoscopic ultrasound-guided and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 94: 895–899.