Endoscopic Ultrasound-Guided Celiac Plexus Block (EUS-CPB) and Neurolysis (EUS-CPN): Evaluation of Complications: A Prospective Single Center

Introduction: EUS-CPB and CPN have been increasingly used for pain control in patients with chronic pancreatitis and unresectable pancreatic cancer. Significant reported complications include hemoperitoneum, perforation, abscess and sepsis. We have prospectively evaluated our complications using this technique.

Methods: Between December 2001 and March 2006, patients undergoing EUS-CPB and EUS-CPN were evaluated prospectively. All cases were performed by 3 endoscopists (VMS, PY and MK) using the Olympus linear echoendoscope (GFUCT140 or GFUC140P) and a 22 or 19 gauge needle. Prophylactic antibiotics were not administered. All cases were done using a single injection technique once the celiac axis was identified. The EUS-CPBs were performed by administering 18cc of 0.25% bupivacaine and 2cc (80mg) of triamcinolone. The EUS-CPNs were performed by injecting 5cc of 0.25% bupivacaine and 20cc of dehydrated absolute alcohol.

Results: A total of 78 patients (47 males) with a median age of 51 +/- 13 years underwent 123 procedures (79 EUS-CPB, 44 EUS-CPN). Thirty-four patients underwent EUS-CPB for chronic pancreatitis, and 44 patients had EUS-CPN for pancreatic cancer. The EUS-CPB group underwent a mean of 2.3 (range of 1–8) procedures per patient. Two (2.5%) had major complications; one with a periesophageal abscess requiring thoracotomy, and one with peritonitis treated with antibiotics. One minor complication (2.3%) of transient bradycardia was noted in the EUS-CPN group.

Conclusion: EUS-CPB and EUS-CPN provide pain control in patients with chronic pancreatitis and pancreatic cancer. Although the procedure is relatively safe, major complications may occur in the EUS-CPB group. Since patients with chronic pancreatitis seem to require multiple EUS-CPB sessions for pain control, further studies identifying which subgroup of these patients respond best to this treatment are required.