Endoscopic Ultrasound–Guided Celiac Plexus Block and Neurolysis for Pain in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis of Randomized Trials

Ilsyafitri  Bonita; Dipta Anggara

doi:10.64531/byefsg61

Authors

Ilsyafitri Bonita Resident, Departement of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Sriwijaya Author
Dipta Anggara Staff lecturer, Department of Anesthesiology and Intensive Care, Muhammad Hoesin Hospital, Palembang, Indonesia Author

DOI:

https://doi.org/10.64531/byefsg61

Keywords:

Pancreatic cancer, Endoscopic ultrasound, Celiac plexus block, Celiac plexus neurolysis, Pain management, Opioid-sparing

Abstract

Introduction: Pain in unresectable pancreatic cancer is prevalent, severe, and often inadequately controlled with systemic opioids alone. Endoscopic ultrasound–guided celiac plexus block or neurolysis (EUS-CPN) has been proposed as an interventional adjunct, but evidence from randomized trials has been inconsistent. Methods: We systematically searched PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect up to June 2025 for randomized controlled trials comparing EUS-CPN with medical therapy or alternative interventions in adults with unresectable pancreatic cancer. Pain intensity, opioid consumption, and adverse events were the primary outcomes. Data were synthesized using a random-effects meta-analysis. Results: Three randomized controlled trials including 249 patients met the inclusion criteria. Pooled analysis demonstrated a significant reduction in pain scores with EUS-CPN compared to systemic therapy (mean difference approximately –2 points on a 10-point scale), a clinically meaningful improvement. EUS-CPN was also associated with a modest reduction in opioid dose escalation over follow-up. Adverse events were uniformly mild, including transient hypotension, diarrhea, and abdominal discomfort, with no serious procedure-related complications. Heterogeneity was noted across trials, largely reflecting differences in background opioid regimens and procedural techniques. Conclusion: EUS-CPN provides safe and effective short-term analgesia in unresectable pancreatic cancer, with the added benefit of reducing opioid escalation. Its role appears most valuable in patients with refractory pain despite optimized systemic therapy, whereas its incremental value may be diminished where potent opioids are readily available. Future trials with standardized protocols and long-term follow-up are warranted to refine its application in palliative care.