Computed tomography-guided single celiac plexus neurolysis analgesic efficacy and safety: a systematic review and meta-analysis

Purpose To perform a systematic review and meta-analysis of published studies to evaluate the analgesic efficacy and safety of computed tomography (CT)-guided single celiac plexus neurolysis (CPN) with the injection of a neurolytic agent into the celiac plexus in one session (CT-guided single CPN). Methods PubMed, the Cochrane Library, and Ichushi-Web were searched for English or Japanese articles published up to February 2022, which reported findings about patients who underwent CT-guided single CPN. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales from 0 to 10 before and after the intervention and the rate of minor and major complications. Results The pooled pain measurement scales at pre-intervention and 1- or 2-, 7-, 30-, 60-, 90-, and 180-day post-intervention was 6.72 (95% confidence interval [CI], 4.77–9.46, I 2 = 98%), 2.31 (95% CI 2.31–4.44, I 2 = 92%), 2.84 (95% CI 1.39–5.79, I 2 = 95%), 3.36 (95% CI 1.66–6.77, I 2 = 98%), 3.19 (95% CI 1.44–7.08, I 2 = 59%), 3.87 (95% CI 1.88–7.97, I 2 = 0%), and 3.40 (95% CI 3.02–3.83, I 2 = not applicable), respectively. The pooled minor complication rates of diarrhea, hypotension, nausea or vomiting, and pain associated with the procedure were 18% (95% CI 8–37%, I 2 = 45%), 16% (95% CI 2–58%, I 2 = 76%), 6% (95% CI 2–16%, I 2 = 1%), and 7% (95% CI 2–21%, I 2 = 17%), respectively. There was no major complication in the included studies. Conclusion CT-guided single CPN can be performed safely and provides immediate analgesic efficacy although the amount of heterogeneity is characterized as large. Further investigation of its long-term analgesic efficacy is required. Graphical abstract