Supportive Care in Cancer

, Volume 26, Issue 2, pp 353–359 | Cite as

Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis

  • Fan Lu
  • Jifu Dong
  • Yuming Tang
  • He Huang
  • Hui Liu
  • Li Song
  • Kexian ZhangEmail author
Review Article



Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) by bilateral or unilateral approach is widely used in palliative abdominal pain management in pancreatic cancer patients, but the analgesic effect and relative risks of the two different puncture routes remain controversial.


The aim of this systematic review was to evaluate the analgesic efficacy and safety of bilateral EUS-CPN compared with unilateral EUS-CPN.


An electronic database search was performed for randomized controlled trials comparing bilateral and unilateral approaches of EUS-CPN using the Pubmed, Cochrane Library, Web of Science, Google Scholar, and CNKI databases. Meta-analysis was performed using RevMan 5.3 after screening and methodological evaluation of the selected studies. Outcomes included pain relief, treatment response, analgesic reduction, complications, and quality of life (QOL).


Six eligible studies involving 437 patients were included. No significant difference was found in short-term pain relief [SMD = 0.31, 95% CI (− 0.20, 0.81), P = 0.23] and response to treatment [RR = 0.99, 95% CI (0.77, 1.41), P = 0.97] between the bilateral and unilateral neurolysis groups. However, only the bilateral approach was associated with a statistically significant reduction in the postoperative use of analgesics [RR = 0.66, 95% CI (0.47, 0.94), P = 0.02] compared to the unilateral approach. A descriptive analysis was performed for complications and QOL.


The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.


Endoscopic ultrasound Celiac plexus Neurolysis Bilateral Unilateral Meta-analysis 



The authors thank Dr. Jie Tian and Dr. Bixin Zheng for editorial assistance while preparing this manuscript.

Funding information

This review was supported by funding (fund number: 81500956) from the National Nature Science Foundation of China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Fan Lu
    • 1
  • Jifu Dong
    • 1
  • Yuming Tang
    • 1
  • He Huang
    • 1
  • Hui Liu
    • 2
  • Li Song
    • 2
  • Kexian Zhang
    • 1
    Email author
  1. 1.Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduPeople’s Republic of China
  2. 2.Department of Pain Management, West China HospitalSichuan UniversityChengduPeople’s Republic of China

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