Endoscopic Ultrasound Guided Versus Percutaneous Celiac Plexus Block in Patients With Intractable Upper Abdominal Pain

Upper abdominal pain is a common and often debilitating symptom in patients with pancreatic cancer and chronic pancreatitis, and is frequently under-treated by standard opioid therapy despite dose escalation and associated side effects \[1\]. In chronic pancreatitis, abdominal pain is present in the great majority of patients and is often the dominant factor driving impaired quality of life, with celiac plexus block considered an interventional option for temporary relief \[2\]. Pain arising from both malignant and benign upper abdominal pathology is transmitted through the celiac plexus, an autonomic plexus located in the retroperitoneum at the root of the celiac trunk, making it a rational target for pain-relieving intervention in either disease process \[3\]. Two image-guided approaches have been developed to interrupt this pathway: the percutaneous route, performed under fluoroscopic or CT guidance \[5\], and the endoscopic ultrasound-guided route, performed transgastrically at the time of upper endoscopy, which allows direct visualization of the celiac plexus and may reduce the risk of injury to adjacent structures compared with the percutaneous approach \[3,9\]. Neurolytic celiac plexus block has been shown to improve pain relief in patients with unresectable pancreatic cancer \[6\], while EUS-guided celiac plexus block has similarly demonstrated efficacy in relieving pain associated with chronic pancreatitis \[7\]. Direct comparisons between the two approaches, however, remain limited: existing trials and meta-analyses in both chronic pancreatitis \[2,8\] and pancreatic cancer \[4,9\] show inconsistent superiority of one technique over the other, and the choice between them in practice has historically relied more on institutional expertise than on robust head-to-head evidence