Comparison of Outcomes in Splanchnic Nerve and Celiac Plexus Cryoneurolysis for the Treatment of Refractory Abdominal Pain

Background: Visceral upper abdominal pain caused by malignant and non-malignant etiologies can be treated by neurolysis of the splanchnic nerves and the celiac plexus. The purpose of this report is to compare the effect of cryoneurolysis of the celiac plexus vs the splanchnic nerves in patients with intractable upper abdominal pain as well as report outcomes and adverse events (AEs) of these procedures. Methods: A retrospective study of 36 patients who underwent either CT-guided celiac plexus (n = 9) or CT-guided splanchnic nerve (n = 27) cryoneurolysis for treatment of intractable upper abdominal pain. Pre- and post-procedural pain scores, supplemental analgesic use, procedural length, and AEs were assessed. Results: Pre-treatment Visual Analog Scale (VAS) pain scores were significantly improved at 1 week (7.7 ± 2.2 vs 3.5 ± 3, P < 0.001), 1 month (7.7 ± 2.2 vs 4.3 ± 2.8, P < 0.001) and 3 months (7.7 ± 2.2 vs 3.6 ± 3.2, P < 0.001) after cryoneurolysis in patients undergoing splanchnic cryoneurolysis. Similarly, in the celiac cohort VAS pain scores at 1 week (7.6 ± 2.5 vs 4.8 ± 3, P = 0.024), 1 month (7.6 ± 2.5 vs 3 ± 2.4, P = 0.003) and 3 months ((7.6 ± 2.5 vs 4 ± 3.3, P = 0.025) after cryoneurolysis were significantly improved as compared to pre-treatment. No significant difference in post-procedural numeric pain improvement, percentage pain improvement, procedural length, changes in supplemental analgesics, and AEs was observed between the two cohorts (P > 0.05, for all). Conclusion: Both celiac plexus and splanchnic nerve cryoneurolysis provide significant analgesia in patients with intractable upper abdominal with no significant difference in analgesic effect or safety profile between the two techniques.