Safety and Efficacy of CT-guided Bilateral Splanchnic Nerve Cryo- or Alcohol Neurolysis For the Management of Multifactorial Intractable Abdominal Pain: A Single Institution Experience

Celiac plexus ablations have been well documented as efficacious for the management of abdominal pain. The splanchnic nerves represent the outflow fibers from the celiac plexus. They also carry fibers from the inferior mesenteric plexus, intermesenteric plexi, aorticorenal plexus, hepatic hilar plexus, and hypogastric plexi - potentially representing a target to cover a wider geographic area of pain transmission. Our goal is to provide a single institution experience on the safety and efficacy of bilateral CT-guided splanchnic nerve cryo- or alcohol neurolysis for the management of multifactorial intractable abdominal pain. This would represent the largest retrospective cohort reported to date {1,2}

Materials and Methods: The electronic medical record was queried for patients who underwent splanchnic nerve cryo- or alcohol neurolysis from 2020-2024 for abdominal pain. Cohort was analyzed for demographics, etiology (post-traumatic/surgical, neoplastic, miscellaneous), complications, treatment response (≥50% reduction in pain scores), time to follow-up, and reintervention. T-test and Fisher’s Exact were used to evaluate the effect of the aforementioned factors on efficacy and re-intervention (P value ≤ 0.05).

Results: Preliminary analysis on 41 patients showed all procedures were performed successfully with the majority of patients undergoing cryoneurolysis (78%). Two patients had postprocedural pneumothorax requiring chest tube placement with eventual resolution. Majority of patients were female (61%) and presented with abdominal pain related to a neoplastic process (68.3%). Average pre/postprocedural pain scores were 9.3 (SD 1.1) and 4.8 (SD 2.8), respectively. Both pre/postprocedural pain scores were available for 30 patients of which 53.3% responded to treatment. Median post-procedural time to follow-up was 1 month (0.3-3 months). Re-intervention occurred in 4 patients all of which had initially undergone cryoneurolysis.  Positive treatment response was not significantly associated with any factors or type of neurolysis. Lower reintervention rates were associated with neoplastic etiology (25%, p-value 0.025).

Conclusion: CT-guided cryo- or alcohol neurolysis of bilateral splanchnic nerves is safe, durable, and reasonably efficacious for intractable multifactorial abdominal pain. Of note, operators should be aware of postprocedural pneumothorax as a possible complication. Larger retrospective and prospective studies are needed to help guide patient selection.