Table 7

Consensus statements on the optimal management of endoscopic ultrasonography-guided celiac plexus ablation (neurolysis and gangliolysis) (EUS-CPN and -CGN)

StatementsFinal level of agreementEvidence level
Indications for the procedure
1 EUS-guided CPN is recommended in patients suffering from pain due to unresectable upper abdominal cancer, particularly for pancreatic cancerAppropriate (8.0)High
2 EUS-guided CPN for treatment of pain arising from chronic pancreatitis is not recommendedAppropriate (7.0)Moderate
Optimal approach for drainage
3 The EUS-guided approach is recommended over percutaneous image-guided techniques for celiac plexus ablationAppropriate (9.0)Moderate
Pre-procedural preparations
4 Prophylactic antibiotics are suggested to be given when bupivacaine with steroids is used for EUS-CPBAppropriate (7.0)Low
Procedural considerations
5 10–20 mL of absolute ethanol is recommended for EUS-CPN and the volume may be reduced in EUS-CGNAppropriate (8.0)High
6 Phenol may be used instead of alcohol for EUS-guided CPN in patients with alcohol intolerance due to aldehyde dehydrogenase deficiency, but the comparative efficacy and safety of the two agents is uncertainAppropriate (8.0)Low
7 In order to perform EUS-CGN, the celiac ganglia can be identified between the aorta and the left adrenal gland in most patients. Otherwise, they may be located cephalad to the origin of the celiac axis in othersAppropriate (8.0)Moderate
Efficacy of treatment
8 Early EUS-CPN at the time of EUS-guided fine needle aspiration is recommended as it reduces pain and may moderate opioid consumption compared with best medical therapyAppropriate (7.5)High
9 When the ganglion cannot be identified, EUS-CPN is performed by single or bilateral injections but evidence is contradictory on which approach is superiorAppropriate (8.5)High
10 EUS-guided CGN is recommended over single or bilateral injections around the celiac artery for improved pain reliefAppropriate (8.0)High
11 Celiac broad plexus neurolysis may be associated with improved efficacy but routine use is not recommendedAppropriate (7.5)Moderate
Management of complications
12 The complications of EUS-CPN and CGN are generally minor and do not need specific treatmentAppropriate (8.0)Low
13 Repeated injections for chronic pancreatitis should be avoided to prevent development of major complicationsAppropriate (8.0)Low
Competency and training
14 Training in EUS-guided celiac plexus ablation is recommended in endoscopists experienced in EUS and EUS-FNAAppropriate (9.0)Very Low
  • CGN, celiac ganglia neurolysis; CPB, celiac plexus block; CPN, celiac plexus neurolysis.