Endoscopic Ultrasound-Guided Management of Pain in Chronic Pancreatitis and Pancreatic Cancer: an Update.

OPINION STATEMENT: PURPOSE OF REVIEW: Unrelenting pain from chronic pancreatitis (CP) and pancreatic cancer (PC) remain clinical challenges for the physician and a significant cause of decreased quality of life for the patient. Endoscopic ultrasound (EUS)-guided therapy for each condition is distinct and builds on the endosonographer's straightforward access to the celiac axis.

RECENT FINDINGS: Over the past 20 years, generally small studies of modest methodology have surfaced for both EUS-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN). Our review aims to synthesize, analyze, and update the latest literature on the technique, efficacy, and safety of these procedures. EUS-CPB's role in treating CP pain is likely still relevant for a subset of patients and studies have shown efficacy and safety. However, a dramatic drop in research publications on the topic will make optimizing its role (including technique, injectate, and patient selection) increasingly difficult. However, EUS-CPN for PC pain is actively being refined with new information, data, and even guidelines. New EUS-guided strategies to treat PC pain besides conventional neurolysis are also likely to evolve in coming years.