Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series

Background and study aims: Complication rates for EUS-guided celiac plexus blockade (CPB) and celiac plexus neurolysis (CPN) have been largely derived from studies utilizing percutaneous or surgical techniques, with few studies specifically examining rates for EUS-guided CPB and CPN. This study aims to further describe the complication rates of EUS-guided CPB and CPN. Patients and methods: In a retrospective analysis of a prospectively collected EUS database, tracking patients and complications for a single endosonographer at a tertiary-care teaching hospital, data for consecutive patients between August 2003 and March 2008 undergoing either EUS-guided CPB or CPN were analyzed for indications, methods, and complications. Excellent follow-up data were available for all patients. Results: 189 EUS-CPB and 31 EUS-CPN procedures were done in 128 and 30 patients, respectively (60 men, 98 women). Indications for blockades included chronic pancreatitis (122), relapsing pancreatitis with chronic pain (28), upper abdominal pain of suspected pancreatic origin (37), and suspected (yet unproven) pancreatic cancer with pain (2). Neurolyses were performed for refractory pain from cancer (21) or chronic pancreatitis (10). No prophylactic antibiotics were administered. Acid Suppression was not withheld. Complications were defined as procedural side effects treated with anything beyond standard observation. Four complications were observed during clinical follow-up (three after CPB, one after CPN), giving an overall complication rate of 1.8% (CPB 1.6%, CPN 3.2%). Complications included asymptomatic hypotension after neurolysis, retroperitoneal abscess after CPB, and severe self-limited postprocedural pain in two patients after CPB. Conclusions: EUS-guided CPB and CPN are reasonably safe procedures with tolerable side-effect profiles and low overall complication rates.