S128 Meta-Analysis Comparing Different Modalities of Celiac Plexus Neurolysis for Pancreatic Cancer-Associated Abdominal Pain

Introduction: Celiac plexus neurolysis (CPN) is widely recognized as a safe and effective interventional option for severe cases of pancreatic cancer (PC) associated pain that is unresponsive to conventional pain management. There is limited data on the comparative efficacy between percutaneous image-guided CPN and endoscopic ultrasound (EUS)-guided CPN. This meta-analysis aimed to compare the therapeutic efficacy of each approach in patients with PC-associated pain. Methods: We performed a comprehensive literature search of PubMed/MEDLINE, EMBASE, and Cochrane from database inception to May 7, 2025, for all studies that reported treatment response to EUS-guided CPN and percutaneous CPN. We defined the primary outcome as the estimated difference in mean pain scores between both groups 1 week after the initiation of treatment. We used a random-effects model to estimate the mean differences and CI across studies. A P-value <0.05 was considered statistically significant. Heterogeneity across studies was assessed using the Higgins I² index. Results: We included 2 studies involving 260 patients. The mean difference in pain score between EUS-guided CPN and percutaneous CPN was 2.082 (95% CI, 0.129 to 3.737, P = 0.011). There was considerable heterogeneity between studies indicated by an I² of 84.68%. Conclusion: EUS-guided CPN and percutaneous image-guided CPN appear to have similar efficacy in treating PC-associated pain. To our knowledge, this was the first meta-analysis comparing EUS-guided CPN and image-guided CPN for treatment of PC-associated pain. Larger prospective studies are warranted to better assess these treatment modalities.