EUS-Guided Celiac Plexus Neurolysis

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is an endoscopic procedure performed to manage the debilitating and refractory chronic pain caused by pancreatic cancer [1] and chronic pancreatitis [2]. Although CPN could be performed percutaneously under ultrasound or computed tomography (CT) guidance [3], EUS has the advantage of easily identifying and getting in close proximity to the celiac plexus, which enhances needle localization and the spread of the injected material and potentially minimizes adverse events and improves pain response [4]. Under EUS guidance, the celiac plexus is injected with a mixture of bupivacaine (0.25%) and dehydrated alcohol (99%) for neurolysis. When EUS-CPN is used for chronic pancreatitis, alcohol is substituted by steroid (Triamcinolone 80 mg) for what is referred to as celiac plexus block.