Endoscopic ultrasound-guided celiac plexus block for painful chronic pancreatitis: A systematic review and meta-analysis

Abstract

Background: The efficacy of endoscopic ultrasound-guided celiac plexus block (EUS-CPB) for treatment of pain in chronic pancreatitis (CP) is unclear. Therefore, we aimed to assess this outcome using a systematic review and meta-analysis.

Methods: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central for evaluating the efficacy of EUS-CPB for pain in CP. We evaluated: A) overall efficacy of EUS-CPB (defined as proportion of patients with any pain relief); B) duration of pain relief; C) efficacy of EUS-CPB at 4, 8, 12, and 26 weeks post-procedurally; and D) adverse events. A proportional meta-analysis was performed using the logit transformation. Outcomes were pooled using a random-effects model.

Results: 11 studies encompassing 729 patients met inclusion and exclusion criteria. The overall efficacy of EUS-CPB was 53% (95% CI 39-67%, I² = 91%). The mean duration of pain relief was 81 days (95% CI 30-217, I² = 96%). The efficacy of EUS-CPB at 4 weeks was 52% (95% CI 22-81%, I² = 90%), at 8 weeks was 57% (95% CI 48-66%, I² = 0%), at 12 weeks was 19% (95% CI 12-27%, I² = 68%), and at 26 weeks was 3% (95% CI 1-8%, I² = 0%). The prevalence of adverse events was 8% (95% CI 4-15%, I² = 67%).

Conclusions: EUS-CPB provides pain relief in 53% of patients with painful CP and the effect lasts on average for 3 months. A sham-controlled clinical trial is needed to determine the analgesic efficacy of EUS-CPB for pain in CP.