Cahen DL et al. (2007) Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 356: 676–684

Patients with chronic pancreatitis and a dilated pancreatic duct are recommended to undergo ductal decompression. Cahen and colleagues compared endoscopic and surgical drainage of the pancreatic duct in their prospective, randomized study.

In total, 39 patients were randomly allocated to undergo either endoscopic transampullary drainage (n = 19) or surgical pancreaticojejunostomy (n = 20). Baseline assessments included standard laboratory and symptom evaluations, quality-of-life scores (measured using the 36-item Short-Form General Health Survey), and Izbicki pain score (a pancreatitis-specific pain questionnaire). These assessments were repeated at week 6 and months 3, 6, 12, 18 and 24 after the initial procedure.

The maximum Izbicki pain score is 100; after adjustment for baseline scores, the mean Izbicki pain score over the 2 years of follow-up was 24 points lower in surgically treated than in endoscopically treated patients (95% CI 11–36, P <0.001). Complete or partial pain relief was achieved in significantly more surgically treated than endoscopically treated patients (75% vs 32%, P = 0.007). Short-Form 36 physical health scores were markedly lower in the endoscopy group than in the surgery group, and endoscopically treated patients underwent more interventions overall (median eight vs three procedures, P <0.001).

The authors conclude that surgical treatment has better 2-year outcomes than endoscopic treatment, although their results might not be applicable to all patients with chronic pancreatitis; patients in this study had complex pathology, and those with inflammatory masses were excluded. In patients with less-extensive disease, endoscopic treatment might still be valuable.