Top

Published in:

01-11-2009 | Review

EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review

Authors: Srinivas R. Puli, Jyotsna B. K. Reddy, Matthew L. Bechtold, Mainor R. Antillon, William R. Brugge

Published in: Digestive Diseases and Sciences | Issue 11/2009

Abstract

The objective of this study was to evaluate the efficacy of EUS-guided CPN for pain relief in patients with chronic pancreatitis and pancreatic cancer. An initial search identified 1,439 reference articles, of which 130 relevant articles were selected and reviewed. Data was extracted from 8 studies (N = 283) for EUS-guided CPN for pain due to pancreatic cancer and nine studies for chronic pancreatitis (N = 376) which met the inclusion criteria. With EUS-guided CPN, the pooled proportion of patients with pancreatic cancer that showed pain relief was 80.12% (95% CI = 74.47–85.22). In patients with pain due to chronic pancreatitis, EUS-guided CPN provided pain relief in 59.45% (95% CI = 54.51–64.30). In conclusion, EUS-guided CPN offers a safe alternative technique for pain relief in patients with chronic pancreatitis or pancreatic cancer. In patients with pain due to chronic pancreatitis, better techniques or injected materials are needed to improve the response.

Ammann RW, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology. 1999;116(5):1132–1140. doi:10.1016/S0016-5085(99)70016-8.CrossRefPubMed

Bornman PC, Marks IN, Girdwood AW, Berberat PO, Gulbinas A, Büchler MW. Pathogenesis of pain in chronic pancreatitis: ongoing enigma. World J Surg. 2003;27(11):1175–1182. doi:10.1007/s00268-003-7235-x.CrossRefPubMed

Ebbehøj N, Svendsen LB, Madsen P. Pancreatic tissue pressure: techniques and pathophysiological aspects. Scand J Gastroenterol. 1984;19(8):1066–1068.PubMed

Ebbehøj N, Borly L, Bülow J, Henriksen JH, Heyeraas KJ, Rasmussen SG. Evaluation of pancreatic tissue fluid pressure measurements intraoperatively and by sonographically guided fine-needle puncture. Scand J Gastroenterol. 1990;25(11):1097–1102. doi:10.3109/00365529008998540.CrossRefPubMed

Keith RG, Keshavjee SH, Kerenyi NR. Neuropathology of chronic pancreatitis in humans. Can J Surg. 1985;28(3):207–211.PubMed

Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988;94(6):1459–1469.PubMed

Pace MC, Mazzariello L, Passavanti MB, Sansone P, Barbarisi M, Aurilio C. Neurobiology of pain. J Cell Physiol. 2006;209(1):8–12. doi:10.1002/jcp.20693.CrossRefPubMed

Warshaw AL, Banks PA, Fernández-Del Castillo C. AGA technical review: treatment of pain in chronic pancreatitis. Gastroenterology. 1998;115(3):765–776. doi:10.1016/S0016-5085(98)70157-X.CrossRefPubMed

Andrén-Sandberg A, Hoem D, Gislason H. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol. 2002;14(9):957–970. doi:10.1097/00042737-200209000-00006.CrossRefPubMed

10.

Wilder-Smith CH, Hill L, Osler W, O’Keefe S. Effect of tramadol and morphine on pain and gastrointestinal motor function in patients with chronic pancreatitis. Dig Dis Sci. 1999;44(6):1107–1116. doi:10.1023/A:1026607703352.CrossRefPubMed

11.

Halgreen H, Pedersen NT, Worning H. Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroenterol. 1986;21(1):104–108. doi:10.3109/00365528609034631.CrossRefPubMed

12.

Malesci A, Gaia E, Fioretta A, et al. No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Scand J Gastroenterol. 1995;30(4):392–398. doi:10.3109/00365529509093296.CrossRefPubMed

13.

Uden S, Bilton D, Nathan L, Hunt LP, Main C, Braganza JM. Antioxidant therapy for recurrent pancreatitis: placebo-controlled trial. Aliment Pharmacol Ther. 1990;4(4):357–371.PubMedCrossRef

14.

Rösch T, Daniel S, Scholz M, et al. European Society of Gastrointestinal Endoscopy Research Group. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy. 2002;34(10):765–771. doi:10.1055/s-2002-34256.CrossRefPubMed

15.

Wilcox CM, Varadarajulu S. Endoscopic therapy for chronic pancreatitis: an evidence-based review. Curr Gastroenterol Rep. 2006;8(2):104–110. doi:10.1007/s11894-006-0005-9.CrossRefPubMed

16.

Tham TC, Lichtenstein DR, Vandervoort J, et al. Pancreatic duct stents for “obstructive type” pain in pancreatic malignancy. Am J Gastroenterol. 2000;95(4):956–960.PubMed

17.

Guda NM, Partington S, Freeman ML. Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis. JOP. 2005;6(1):6–12.PubMed

18.

Ohara H, Hoshino M, Hayakawa T, et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol. 1996;91(7):1388–1394.PubMed

19.

Dumonceau JM, Costamagna G, Tringali A, et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut. 2007;56(4):545–552. doi:10.1136/gut.2006.096883.CrossRefPubMed

20.

Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg. 1958;76(6):898–907.PubMed

21.

Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg. 1960;152:1037–1043.CrossRefPubMed

22.

Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery. 1985;97(4):467–473.PubMed

23.

Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2(6):701–707. doi:10.1097/00006676-198711000-00014.CrossRefPubMed

24.

Büchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 1995;169(1):65–69. doi:10.1016/S0002-9610(99)80111-1.CrossRefPubMed

25.

Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE. Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg. 1998;228(6):771–779. doi:10.1097/00000658-199812000-00008.CrossRefPubMed

26.

Bradley EL 3rd, Bem J. Nerve blocks and neuroablative surgery for chronic pancreatitis. World J Surg. 2003;27(11):1241–1248. doi:10.1007/s00268-003-7244-9.CrossRefPubMed

27.

Lillemoe KD, Cameron JL, Kaufman HS, Yeo CJ, Pitt HA, Sauter PK. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann Surg. 1993;217(5):447–455. doi:10.1097/00000658-199305010-00004.CrossRefPubMed

28.

Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA. 2004;291(9):1092–1099. doi:10.1001/jama.291.9.1092.CrossRefPubMed

29.

Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet. 1999;354:1896–1900. doi:10.1016/S0140-6736(99)04149-5.CrossRefPubMed

30.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology. A proposal for reporting. JAMA. 2002;283:2008–2012. doi:10.1001/jama.283.15.2008.CrossRef

31.

Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304:1491–1494.CrossRefPubMed

32.

Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12. doi:10.1016/0197-2456(95)00134-4.CrossRefPubMed

33.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012. doi:10.1001/jama.283.15.2008.CrossRefPubMed

34.

Stuart A, Ord JK. Kendall’s Advanced Theory of Statistics. 6th ed. London: Edward Arnold; 1994.

35.

DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188. doi:10.1016/0197-2456(86)90046-2.CrossRefPubMed

36.

Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care. Meta-Analysis in Context. London: BMJ Books; 2001.

37.

Harbord RM, Egger M, Sterne JAC. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2005;25(20):3443–3457. doi:10.1002/sim.2380.CrossRef

38.

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–1101. doi:10.2307/2533446.CrossRefPubMed

39.

Sterne JAC, Egger M, Davey-Smith G. Investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323:101–105. doi:10.1136/bmj.323.7304.101.CrossRefPubMed

40.

Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–1055. doi:10.1016/S0895-4356(01)00377-8.CrossRefPubMed

41.

Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44(6):656–662. doi:10.1016/S0016-5107(96)70047-0.CrossRefPubMed

42.

Tran QN, Urayama S, Meyers FJ. Endoscopic ultrasound-guided celiac plexus neurolysis for pancreatic cancer pain: a single-institution experience and review of the literature. J Support Oncol. 2006;4(9):460–462.PubMed

43.

Usatii M, Paquin SC, Dagenais M, et al. Preliminary results of a randomized, double blind, controlled trial of early EUS-guided celiac plexus neurolysis (EUS-Cpn) versus conventional management for pain in patients with inoperable pancreatic cancer. Gastrointest Endosc. 2008;67(5):M1438. doi:10.1016/j.gie.2008.03.1025.CrossRef

44.

Gunaratnam NT, Sarma AV, Norton ID, Wiersema MJ. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc. 2001;54(3):316–324. doi:10.1067/mge.2001.117515.CrossRefPubMed

45.

Levy MJ, Topazian MD, Wiersema MJ, et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am J Gastroenterol. 2008;103(1):98–103.PubMed

46.

LeBlanc JK, Dewitt J, McHenry L, Sherman S, Imperiale T, Collins E. A prospective evaluation of EUS-guided celiac plexus block in patients with chronic pancreatitis and pancreas cancer. Gastrointest Endosc. 2004;59(5):236. doi:10.1016/S0016-5107(04)01063-6.CrossRef

47.

Catalano MF, Ahmed U, Chauhan SS, Patel SN, Geenen JE. Celiac plexus neurolysis (CPN) in the treatment of refractory pain of pancreatic cancer (PCA): site specific response to therapy. Gastrointest Endosc. 2005;61(5):AB273. doi:10.1016/S0016-5107(05)01417-3.CrossRef

48.

O’Toole TM, Shire NJ, Chauhan SS, Schmulewitz N. Predictors of response to EUS-guided celiac plexus blockade for abdominal pain in patients with chronic pancreatitis. Gastrointest Endosc. 2007;65(5):AB209. doi:10.1016/j.gie.2007.03.422.CrossRef

49.

LeBlanc J, De Witt J, Calley C, et al. A prospective randomized trial of 1 versus 2 injections during a single EUS-guided celiac plexus block (CPB) procedure for chronic pancreatitis pain: final results. Gastrointest Endosc. 2008;67(5):M1488. doi:10.1016/j.gie.2008.03.560.CrossRef

50.

Lemelin V, Lam E, Sahai A. A prospective trial of central versus bilateral celiac plexus bloc/neurolysis in 160 patients: bilateral injection is safe and is more effective. Gastrointest Endosc. 2005;61(5):AB77. doi:10.1016/S0016-5107(05)00591-2.CrossRef

51.

Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999;94(4):900–905. doi:10.1111/j.1572-0241.1999.01042.x.CrossRefPubMed

52.

Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96(2):409–416. doi:10.1111/j.1572-0241.2001.03551.x.CrossRefPubMed

53.

Mahajan RJ, Nowell W, Hira K, Oaks K, Adams LJ. Patients’ perspective on endoscopic ultrasound (EUS) guided celiac plexus pain block (CPB) in treatment of unremitting pain of chronic pancreatitis (CP). Am J Gastroenterol. 2002;97(9-suppl 1):S59–S60.

54.

Gress F, Ciaccia D, Sherman S, Lehman G. Multi-center evaluation of endoscopic ultrasound (EUS)-guided celiac plexus neurolysis (CPN) for treating abdominal pain associated with chronic pancreatitis (CP). Gastroenterology. 1998;114(15-suppl 1):A463.

55.

Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg. 1995;80:290–295. doi:10.1097/00000539-199502000-00015.CrossRefPubMed

Title: EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review
Authors: Srinivas R. Puli
Jyotsna B. K. Reddy
Matthew L. Bechtold
Mainor R. Antillon
William R. Brugge
Publication date: 01-11-2009
Publisher: Springer US
Published in: Digestive Diseases and Sciences / Issue 11/2009
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-008-0651-x

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2009

Over-Expression of EphA2 and EphrinA-1 in Human Gastric Adenocarcinoma and Its Prognostic Value for Postoperative Patients

Outcome of Colonoscopy in Elderly African-American Patients

Impact of Capsule Endoscopy Findings on Patient Outcomes

MTHFR 677T Carrier Influences the Methylation Status of H. Pylori-Infected Gastric Mucosa in Older Subjects

Understanding Liver Health Using the National Center for Health Statistics

Time from Positive Screening Fecal Occult Blood Test to Colonoscopy and Risk of Neoplasia

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page