Celiac Plexus Block and Neurolysis for Pancreatic Cancer

Introduction: Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer. Methods: We describe a 61-year-old female with a history of pancreatic cancer, unexplained transfusion dependent anemia with a normal recent upper endoscopy, and abdominal pain, who had previously undergone gastrojejunostomy and a Roux-en-Y hepaticojejunostomy as well as chemotherapy and radiation therapy. She suffered from intractable abdominal pain and elected to undergo palliative celiac plexus neurolysis. Results: The patient initially appeared to tolerate celiac plexus block well, however, 45 minutes after the procedure, the patient had bright red blood per rectum followed by bloody diarrhea. Her abdomen was soft and non-tender with minimal distention and positive bowel sounds. The patient’s hemoglobin decreased to 7.5 g/dl from 9.0 g/dl, and she received a blood transfusion. Upper endoscopy and enteroscopy demonstrated diffuse hemorrhagic gastritis and duodenitis. The bleeding was controlled and the patient remained hemodynamically stable. Ultimately, the patient did well and was discharged home. Discussion: We report a case of a patient with known history of gastritis and duodenitis, who developed severe upper GI bleeding immediately following the celiac plexus neurolysis. There are no published reports documenting similar cases. It is difficult to offer a precise physiologic explanation for this complication. However, we speculate that inhibition of sympathetic tone from the celiac plexus neurolysis caused increased blood flow to the GI system, and this resulted in active bleeding from previously indolent hemorrhagic gastritis and duodenitis. Conclusion: It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis. Key words: Case report, pancreatic cancer, celiac plexus neurolysis, anemia, hemorrhagic gastritis and doudenitis, sympathetic block

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Endoscopic Ultrasound-Guided Celiac Plexus Interventions

GE Portuguese Journal of Gastroenterology ◽

10.1159/000508293 ◽

2020 ◽

Vol 28 (1) ◽

pp. 32-38

Author(s):

Pedro Moutinho-Ribeiro ◽

Pedro Costa-Moreira ◽

Ana Caldeira ◽

Sílvia Leite ◽

Susana Marques ◽

...

Keyword(s):

Pancreatic Cancer ◽

Abdominal Pain ◽

Chronic Pancreatitis ◽

Endoscopic Ultrasound ◽

Pancreatic Disease ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Technical Issues ◽

Control Pain ◽

Plexus Block

Abdominal pain related to pancreatic disease is often extremely disabling. Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) is used to control pain associated with chronic pancreatitis. EUS-guided celiac plexus neurolysis (CPN) is typically used to reduce pain associated with pancreatic cancer and can be considered early at the time of diagnosis of inoperable disease. EUS-guided celiac plexus interventions have been shown to be significantly effective in pancreatic pain relief, which is achieved in approximately 70–80% of patients with pancreatic cancer and in 50–60% of those with chronic pancreatitis. Serious complications from CPB and CPN are rare. Most frequent adverse events are diarrhoea, orthostatic hypotension, and a transient increase in abdominal pain. In this article, the Portuguese Group for Ultrasound in Gastroenterology (GRUPUGE) presents an updated perspective of the potential role of EUS-guided celiac plexus interventions, addressing the selection criteria and technical issues of different techniques and analysing recent data on their safety and efficacy.

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Pain Mechanisms Involved and Outcome in Advanced Cancer Patients with Possible Indications for Celiac Plexus Block and Superior Hypogastric Plexus Block

Tumori Journal ◽

10.1177/030089160208800311 ◽

2002 ◽

Vol 88 (3) ◽

pp. 243-245 ◽

Cited By ~ 26

Author(s):

Sebastiano Mercadante ◽

Fabio Fulfaro ◽

Alessandra Casuccio

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Advanced Cancer ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Advanced Cancer Patients ◽

Pain Mechanisms ◽

Pelvic Cancer ◽

Plexus Block ◽

Prospective Longitudinal

Aims and Background There is controversy about the role of neurolytic sympathetic blocks in advanced cancer, when pain syndromes may assume other characteristics, with a possible involvement of structures other than visceral. The aim of the present study was to assess the pain characteristics and the analgesic response of a consecutive sample of home care patients with pancreatic and pelvic pain, which would have possible indications for a celiac plexus block and a superior hypogastric block, respectively. Methods From January 1999 to December 1999, 400 consecutive advanced cancer patients were surveyed for a prospective longitudinal survey. We considered only patients who had pancreatic cancer or pelvic cancer with pain. Results Thirty-six patients were surveyed: 22 patients had pelvic cancers and 14 had pancreatic cancer. Patients with pelvic cancers showed a longer survival than those with pancreatic cancer (P = 0.019). Patients with pelvic cancers more frequently showed a neuropathic component associated with a visceral or somatic mechanism than patients with pain due to pancreatic cancer (P = 0.019). When the pain mechanism was taken into consideration, patients with pelvic cancers with a neuropathic component showed worse pain relief than patients with pain due to pancreatic cancer (P = 0.040). Conclusions Sympathetic procedures for pain conditions due to pancreatic and pelvic cancers should be intended as adjuvant techniques to reduce the analgesic consumption, and not as a panacea, given that multiple pain mechanisms are often involved because progression of disease is able to change the underlying pain mechanisms. Pancreatic pain seems to maintain visceral characteristics amenable to sympathetic block more than pain due to pelvic cancer.

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