Endosonography-Guided Celiac Plexus Block

EUS-guided celiac plexus block（CPB）may be considered in patients with persistent pain despite adequate medical therapy，including the use of opioid and non-opioid analgesics.Alcohol and tobacco cessation，psychosocial support to reduce opioid dependence，and pancreatic enzyme and antioxidant supplementation are important adjuncts.In EUS-guided CPB，a mixture of corticosteroid and local anaesthetic is injected into the coeliac plexus to disrupt the afferent pain signals.

In comparison with other approaches（CT-，fluoroscopy-or ultrasound-guided），EUS-guided celiac plexus block has better pain relief，lower cost and is the preferred choice of the patient（Gress et al.1999；Santosh et al.2009）.Also，the EUS-guided approach avoids the potential neurological risks of paraplegia associated with the posterior transcutaneous approach.(https://www.daowen.com)

Success rates range from 50 to 60%，although recent data showed pain relief in up to 76%after the first procedure in 248 patients（Puli et al.2009；Kaufman et al.2010；Sey et al.2015）.However，pain relief is transient and most patients require repeated sessions.The median duration of response after the first session was 10 weeks（Sey et al.2015）.Another study showed an initial pain response in 55%which reduced to 10%after 24 weeks（Gress et al.2001）.Also，a meta-analysis reported lower median pain relief duration of 11-37 days post procedure，although persistent benefit was seen in some patients for up to 48 weeks（Kaufman et al.2010）.In patients who had more than one EUS-guided CPB procedure，predictors of pain relief after subsequent blocks were older age and presence of pain relief after the first procedure（Sey et al.2015）.

Complications of this procedure include transient diarrhea secondary to sympathetic denervation，hypotension，pancreatitis and local infections.These may occur in up to one-third of patients（Kaufman et al.2010），and usually resolve with supportive management of intravenous fluids，anti-diarrhoeal agents or prophylactic antibiotics.