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Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness

Sahai, Anand V., MD, MSc (Epid), FRCPC1; Lemelin, Valéry, MD, FRCPC1; Lam, Eric, MD, FRCPC1; Paquin, Sarto C., MD, FRCPC1

American Journal of Gastroenterology: February 2009 - Volume 104 - Issue 2 - p 326–329

OBJECTIVES: Endoscopic ultrasound (EUS)-guided celiac plexus block/neurolysis (CPB/N) can be performed by injecting at the base (central) or on either side (bilateral) of the celiac axis. Central CPB/N is easier and possibly safer. Bilateral CPB/N is more difficult but may be more effective as it reaches more ganglia. The aim of this study was to compare the short-term safety and efficacy of central and bilateral CPB/N.

METHODS: Consecutive patients referred for CPB/N to a quaternary EUS center were eligible for this study. Central CPB/N was used in the first half of the study period and bilateral CPB/N in the last half. The primary outcome was the percent reduction in visual analog pain scores at day 7.

RESULTS: A total of 184 patients were eligible. Of these, 24 (13%) were excluded for incomplete data. A total of 160 were left (71 central, 89 bilateral). The groups were similar for all cogent variables. Bilateral CPB/N was more effective than central CPB/N (mean percent pain reduction 70.4% (61.0-80.0) vs. 45.9% (32.7-57.4);P=0.0016). The only predictor of a >50% pain reduction was bilateral CPB/N (odds ratio 3.55, 1.72-7.34). Only one complication was noted: self-limited bleeding because of laceration of the adrenal artery following bilateral celiac plexus (CP) block in an anticoagulated patient.

CONCLUSIONS: (i) Bilateral CPB/N is more effective than central CPB/N; (ii) bilateral CPB/N is safe, but on rare occasions can cause trauma to the left adrenal artery; it should therefore be avoided in patients with a bleeding diathesis.

Am J Gastroenterol 2009; 104:326-329; doi:10.1038/ajg.2008.64; published online 6 January 2009

1Gastroenterology, CHUM, Montreal, Quebec, Canada.

Correspondence: Anand V. Sahai, MD, MSc (Epid), FRCPC, Department of Gastroenterology, CHUM, Montreal, Quebec, Canada. E-mail:

Received 16 April 2008; accepted 4 September 2008

© The American College of Gastroenterology 2009. All Rights Reserved.
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