CPB Versus Sham Treatment for Pain Management in Small Duct Chronic Pancreatitis

Randomized Single Blinded Control Trial Comparing EUS Guided Celiac Plexus Block (CPB) Versus Sham Treatment for Pain Management in Small Duct Chronic Pancreatitis

This study assesses the pain response to Endoscopic Ultrasound (EUS) guided Celiac Plexus Block (CPB) treatment in comparison to EUS without a pain block administered. All participants will receive medications for pain as needed.

The purpose of this study is to assess pain response to EUS guided celiac plexus block treatment compared to no treatment. The Visual Analog Scale (VAS) is the primary measure. Secondary aims include the comparison of quality of life scores, need for narcotics, to assess the effect of EUS-CPB on overall mental state using the Beck's Depression Index, and to assess the effect of EUS-CBP on health care utilization and on employment.

Inclusion Criteria:

• All patients referred to UAB Endoscopy Unit for with known chronic pancreatitis
• Patients referred to the endoscopy unit with abdominal pain with suspicion of chronic pancreatitis meeting 5 of 9 parenchymal and ductal changes (i.e. lobulations, hyperechoic stranding, hyperechoic foci, cysts, calcification, irregular duct, hyperechoic walls, side branch dilations and ductal calculi).

Exclusion Criteria:

• Age <19 years
• Unable to safely undergo EUS for any reason
• Coagulopathy (INR >1.6, Prothrombin Time >18secs, Thrombocytopenia <80,000 cells/ml)
• Unable to consent
• Non-English speaking patients.
• Previously undergone CPB
• Pregnancy and Breast feeding
• Patients with ductal strictures, calcification, pancreatic ductal calculi, pseudocysts.
• Previous pancreatic surgery
• Previous pseudocyst drainage
• Other documented causes of abdominal pain.