title: Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis.
abstract: OBJECTIVE
  A randomized trial that compared endoscopic and surgical drainage of the pancreatic duct in patients with advanced chronic pancreatitis reported a significant benefit of surgery after a 2-year follow-up period. We evaluated the long-term outcome of these patients after 5 years.
  
  
  METHODS
  Between 2000 and 2004, 39 symptomatic patients were randomly assigned to groups that underwent endoscopic drainage or operative pancreaticojejunostomy. In 2009, information was collected regarding pain, quality of life, morbidity, mortality, length of hospital stay, number of procedures undergone, changes in pancreatic function, and costs. Analysis was performed according to an intention-to-treat principle.
  
  
  RESULTS
  During the 79-month follow-up period, one patient was lost and 7 died from unrelated causes. Of the patients treated by endoscopy, 68% required additional drainage compared with 5% in the surgery group (P = .001). Hospital stay and costs were comparable, but overall, patients assigned to endoscopy underwent more procedures (median, 12 vs 4; P = .001). Moreover, 47% of the patients in the endoscopy group eventually underwent surgery. Although the mean difference in Izbicki pain scores was no longer significant (39 vs 22; P = .12), surgery was still superior in terms of pain relief (80% vs 38%; P = .042). Levels of quality of life and pancreatic function were comparable.
  
  
  CONCLUSIONS
  In the long term, symptomatic patients with advanced chronic pancreatitis who underwent surgery as the initial treatment for pancreatic duct obstruction had more relief from pain, with fewer procedures, than patients who were treated endoscopically. Importantly, almost half of the patients who were treated with endoscopy eventually underwent surgery.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands. d.cahen@erasmusmc.nl
authors.forename: Djuna L
authors.initials: DL
authors.lastname: Cahen
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
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: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Pereira
authors.forename: David
authors.initials: D
authors.lastname: Wonderling
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
mesh_terms: D003365:Costs and Cost Analysis; D004322:Drainage / Q000379:methods; D016145:Endoscopy, Digestive System; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D010146:Pain / Q000453:epidemiology; D010183:Pancreatic Ducts / Q000503:physiopathology* / Q000601:surgery; D010193:Pancreaticojejunostomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome