A comparison of percutaneous and endoscopic-guided celiac plexus block/neurolysis in pancreatic cancer patients.

e15767 Background: Celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are options for pain control in pancreatic cancer. Conventionally they are performed percutaneously (PC) with fluoroscopic or CT guidance. However endoscopic ultrasound (EUS) guidance is being increasingly used. The aim of this retrospective study is to compare PC-guided and EUS-guided CPB/CPN for pain control. Methods: Our retrospective cohort study included pancreatic cancer patients who underwent CPN/CPB for pain control from 2008 to 2015 at Johns Hopkins. Patients were assessed immediately post-procedure and at 1 month. Patients were selected using CPT and ICD diagnosis code guided searches of the EHR. Pain intensity was assessed using a Numeric Rating Scale (NRS). A response was defined as a decrease in NRS scores by = > 3 points. The validated FACT-Hep score was used to assess quality of life (QOL). Opiate usage was converted into morphine dosage equivalents. Wilcox rank-sum and Fisher’s exact test were used to compare the EUS and PC cohorts. Results: Of 107 patients, 46 (43%) had EUS-CPN, 57 (53%) PC-CPN, and 4 (4%) PC-CPB. 10 patients had procedural complications (7% EUS and 11% PC, p = 0.51) with the most common being chronic diarrhea. The baseline median NRS score was 7 with significantly higher scores for those receiving EUS compared to PC (9 vs 7, p < 0.001). Immediately post-procedure, more PC patients (87%) had a response when compared to EUS patients (72%), although it did not reach statistical significance (p = 0.08). By one month, there was no difference in response rates. (43% CPN vs 34% EUS, p = 0.42) FACT-Hep score declined significantly in all patients with a median drop of 8 points at 1 month and no difference between PC and EUS (9 vs 8, p = 0.46). There was no difference in opiate usage at 1 month (88% PC vs 93% EUS, p = 0.51). Conclusions: Both EUS and PC-guided CPN were effective at reducing post-procedural pain in pancreatic cancer patients but their effectiveness waned by 1 month. EUS did have slightly fewer complications although PC did have slightly higher rates of response post-procedurally. QoL declined and opiate usage was unchanged in both groups. Both procedures had temporary efficacy and need further evaluation.