Rationale: Chronic pancreatitis is a chronic inflammatory disease of the pancreas which
results in debilitating abdominal pain, decreased productivity and increased health care
costs. Endoscopic ultrasound (EUS) guided celiac plexus block (CPB) is routinely used to
treat pain related to chronic pancreatitis. While EUS guided neurolysis for pancreatic cancer
has significant efficacy, the benefit of CPB for chronic pancreatitis pain is controversial
and has not been studied in a rigorous manner.
Objective: To assess whether EUS guided celiac plexus block decreases suffering,
hospitalization, and opiate requirements related to chronic pancreatitis pain.
Population: Patients undergoing EUS at Los Angeles County Hospital for painful chronic
pancreatitis.
Methods: Patients undergoing EUS to evaluate chronic pancreatitis with a typical visual
analogue pain score >3, regular opiate use, and M ANNHEIM chronic pancreatitis score >6 will
be eligible.
Study Arms: Patients will be randomized to 1) diagnostic endoscopic ultrasound 2) endoscopic
ultrasound with celiac plexus block
Study Outcomes: The primary outcome will be a decrease in chronic pancreatitis pain assessed
by the visual analogue scale and M ANNHEIM system at 24 weeks compared to immediately prior
to the block. The ability to work and conduct normal activities, opiate medication
requirements, and a Careprep symptom assessment at 24 weeks will also be compared prior to
the block.
Analytic Plan: The projected response rate to EUS guided CPB is 52%. Given known 30% placebo
response in patients with pain related to chronic pancreatitis we anticipate that 83 patients
will need to participate to demonstrate a difference. We aim to enroll 90 patients in this
study.