Endoscopy or surgery for patients with chronic pancreatitis and dilated pancreatic duct

Ahmed Ali U, Pahlplatz JM, Nealon WH, van Goor H, Gooszen HG, Boermeester MA

Published Online:

January 18, 2012

Endoscopy and surgery are the treatments of choice in patients with chronic pancreatitis and a dilated pancreatic duct. In this review we compared these two intervention modalities. We found that surgery achieved pain relief in a higher proportion of patients than with endoscopy. Surgery also had other advantages like improved quality of life and reduced risk of developing exocrine pancreatic insufficiency. The studies seemingly showed no difference in complications after intervention between endoscopy and surgery, but lacked the power to establish this with sufficient reliability. We also compared surgery to conservative treatment. Results of one trial suggested that surgery early in the disease achieved better pain relief and preservation of pancreatic function. The trial, however, was small, which precluded drawing reliable conclusions.

Abstract (click to read)

Background:

Endoscopy and surgery are the treatment modalities of choice in patients with obstructive chronic pancreatitis. Physicians face the decision between endoscopy and surgery for this group of patients, without clear consensus.

Objectives:

To assess and compare the effectiveness and complications of surgical and endoscopic interventions in the management of pain for obstructive chronic pancreatitis.

Search strategy:

We searched The Cochrane Library, MEDLINE, EMBASE and the Conference Proceedings Citation Index; and performed a cross-reference search. Two review authors performed the selection of trials independently.

Selection criteria:

All randomised controlled trials (RCTs) investigating endoscopic or surgical interventions for obstructive chronic pancreatitis. All trials were included irrespective of blinding, number of patients randomised and language of the article.

Data collection and analysis:

Two authors independently extracted data from the articles. The methodological quality of included trials was evaluated. Authors were requested additional information in the case of missing data.

Main results:

We screened 2082 publications and identified three eligible trials. Two trials compared endoscopic intervention to surgical intervention. These included a total of 111 patients, 55 in the endoscopic group and 56 in the surgical group. A higher proportion of patients with pain relief was found in the surgical group compared to the endoscopic group (partial or complete pain relief: RR 1.62, 95% confidence interval (CI) 1.11 to 2.37; complete pain relief: RR 2.45, 95% CI 1.18 to 5.09). Surgical intervention resulted in improved quality of life and improved preservation of exocrine pancreatic function in one trial. The number of patients did not allow for a reliable evaluation of morbidity and mortality between the two treatment modalities. One trial compared surgical intervention to conservative treatment. It included 32 patients: 17 in the surgical group and 15 in the conservative group. The trial showed that surgical intervention resulted in a higher percentage of patients with pain relief and better preservation of pancreatic function. The trial had methodological limitations and the number of patients was relatively small.

Authors' conclusions:

For patients with obstructive chronic pancreatitis and dilated pancreatic duct, this review showed that surgery is superior to endoscopy in terms of pain control. Morbidity and mortality seemed not to differ between the two intervention modalities, but the small trials identified do not provide sufficient power to detect the small differences expected in this outcome.

Regarding the comparison of surgical intervention versus conservative treatment, this review has shown that surgical intervention in an early stage of chronic pancreatitis seems to be a promising approach in terms of pain control and pancreatic function. Confirmation of these results is needed in other trials due to the methodological limitations and limited number of patients of the present evidence.

This record should be cited as:

Ahmed Ali U, Pahlplatz JM, Nealon WH, van Goor H, Gooszen HG, Boermeester MA. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD007884. DOI: 10.1002/14651858.CD007884.pub2

Assessed as up to date:

November 3, 2011

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Upper Gastrointestinal and Pancreatic Diseases Group

Health topics:

Gastroenterology > Pancreatitis > Chronic

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Endoscopy or surgery for patients with chronic pancreatitis and dilated pancreatic duct

More like this

Copyright © 2012 - The Cochrane Collaboration