Puli, S.R., Reddy, J.B., Bechtold, M.L., Antillon, M.R., & Brugge, W.R. (2009). EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: A meta-analysis and systematic review. Digestive Diseases and Sciences, 54(11), 2330–2337.

To evaluate the effectiveness of endoscopic ultrasound–guided (EUS) celiac plexus neuroloysis (CPN) for relief of the pain of chronic pancreatitis or pancreatic cancer

• Databases searched were MEDLINE, databases of PubMed and Ovid journals, Ovid, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects (DARE), ACO Journal Club, and International Pharmaceutical Abstracts.
• Search keywords were endoscopic ultrasound, endoscopic ultrasonography, celiac plexus block, celiac plexus neurolysis, chronic pancreatitis and pancreatic cancer.
• Studies were included if they were studies of EUS CPN used for control of the pain of chronic pancreatitis or unresectable pancreatic cancer.

The search retrieved 1,439 articles relating to 130 studies. Authors chose for analysis eight studies of pancreatic cancer and nine studies of chronic pancreatitis. Of the studies involving pancreatic cancer, four were abstracts.

The total sample size in studies relating to pancreatic cancer was 243 patients. The range of sample size in studies of pancreatic cancer was 10–71. 

Study procedures conformed with the Quality of Reporting of Meta-analysis (QUORUM) statement. Study design conformed to the guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. Authors removed two studies from pooled analysis because the studies contributed to heterogeneity. Pooled analysis of the remaining six studies showed that 80.12% of patients experienced pain relief (95% CI 74.47–85.22). The complication rate associated with the procedure was low. Across all studies, only two patients had diarrhea, which medication resolved. Subgroup analysis showed that bilateral injection of the celiac plexus resulted in better pain relief than did a single injection. The majority of the studies demonstrated reduction in the use of oral opioid agents for pain relief.

Findings demonstrate that EUS CPN may be an important option in management of the pain of pancreatic cancer. The technique is associated with a very low rate of complications. Pain relief is enhanced with bilateral injection of the celiac plexus. The technique was associated with reduction in oral opioid use.

In advocating for patients with pain due to pancreatic cancer, oncology nurses can discuss EUS CPN as an option. The procedure may be especially helpful to patients for whom opioids cause significant side effects.