title: Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.
abstract: BACKGROUND
  For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.
  
  
  METHODS
  All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function.
  
  
  RESULTS
  Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, P<0.001) and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (P=0.003). At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, P<0.001).
  
  
  CONCLUSIONS
  Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis. (Current Controlled Trials number, ISRCTN04572410 [controlled-trials.com].).
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. djca@zha.nl
authors.forename: Djuna L
authors.initials: DL
authors.lastname: Cahen
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Yung
authors.initials: Y
authors.lastname: Nio
authors.forename: Erik A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Johan S
authors.initials: JS
authors.lastname: Laméris
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Kees
authors.initials: K
authors.lastname: Huibregtse
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
mesh_terms: D000328:Adult; D002137:Calculi / Q000601:surgery / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000628:therapy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010183:Pancreatic Ducts / Q000601:surgery*; D010193:Pancreaticojejunostomy; D050500:Pancreatitis, Chronic / Q000601:surgery / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic; D015607:Stents