Post written by Elisa Karhu, MD, from the Department of Internal Medicine, Stanford University, Palo Alto, California, USA.
Median arcuate ligament syndrome (MALS) is often considered in the differential diagnosis of patients with intractable postprandial abdominal pain. However, diagnosis of this condition can be difficult.
To aid in diagnosis, a symptomatic response to celiac plexus block can help identify patients who may respond to median arcuate ligament (MAL) release surgery. Celiac plexus blockade (CPB) has traditionally been performed CT-guided through the back, but the focus of our study was to investigate the safety and outcomes of EUS-guided celiac plexus block.
We felt it was important to examine the safety and efficacy of EUS-guided celiac plexus block in the diagnostic and treatment algorithm for MALS, especially as an option when CT-guided CPB is unavailable or contraindicated because of spinal abnormalities.
Our study suggests that EUS-guided celiac plexus block is a safe approach to evaluating patients with MALS anatomy for possible surgery and adds to the evidence supporting the use of celiac plexus block response as a predictor of symptom improvement after MAL release surgery.
Ideally, larger randomized controlled trials could be used to confirm the benefit of preoperative celiac block both for the diagnosis of MALS and the prediction of symptom response to MAL release surgery.
However, given the already demonstrated use in patient evaluation for surgery and the safety of the procedure, EUS-guided celiac plexus block should be considered in the diagnostic and treatment algorithm for MALS.
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CT angiogram revealing hooked appearance of the celiac trunk with mild narrowing and post-stenotic dilation (arrow). Celiac A, Celiac artery; SMA, superior mesenteric artery.
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