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Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis

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Abstract

Background and aims

Pain is one of the consequences of chronic pancreatitis (CP) that has the greatest impact on the quality of life of patients.

Endoscopic and surgical interventions, by producing a decrease in intraductal pancreatic pressure, can provide pain relief. This is the first systematic review that includes only randomized clinical trials (RTCs) comparing outcomes in the short-term (less than 2 years) and long-term (more than 2 years) between these two types of interventions.

Material and methods

A comprehensive search of multiple electronic databases to identify RTCs comparing short and long-term pain relief, procedural complications, and days of hospitalization between endoscopic and surgical interventions was performed following the PRISMA guidelines.

Results

Three RCTs evaluating a total of 199 patients (99 in the endoscopy group and 100 in the surgery group) were included in this study. Surgical interventions provided complete pain relief, with statistical difference, in the long-term (16,4% vs 35.7%; RD 0.19; 95% CI 0.03–0.35; p = 0.02; I2 = 0%), without significant difference in short-term (17.5% vs 31.2%; RD 0.14; 95% CI −0.01–0.28; p = 0.07; I2 = 0%) when compared to endoscopy. There was no statistical difference in short-term (17.5% vs 28.1%; RD 0.11; 95% CI −0.04–0.25; p = 0.15; I2 = 0%) and long-term (34% vs 41.1%; RD 0.07; 95% CI −0.10–0.24; p = 0.42; I2 0%) in partial relief of pain between both interventions. In the short-term, both complications (34.9% vs 29.7%; RD 0.05; 95% CI −0.10–0.21; p = 0.50; I2 = 48%) and days of hospitalization (MD −1.02; 95% CI −2.61–0.58; p = 0.21; I2 = 0%) showed no significant differences.

Conclusion

Surgical interventions showed superior results when compared to endoscopy in terms of complete long-term pain relief. The number of complications and length of hospitalization in both groups were similar.

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Authors and Affiliations

  1. Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Pastor Joaquín Ortiz Mendieta, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Maria Vitória Cury Vieira Scatimburgo, Bruno Salomao Hirsch, Rodrigo Silva de Paula Rocha, Thiago Arantes de Carvalho Visconti, Wanderley Marques Bernardo & Eduardo Guimarães Hourneaux de Moura

  2. Center for Advanced Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA

    Sergio A. Sánchez-Luna

  3. Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham, Birmingham,, Alabama, USA

    Sergio A. Sánchez-Luna

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  1. Pastor Joaquín Ortiz Mendieta
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Contributions

Mendieta, PJO: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Sagae, VMT: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Ribeiro, IB: analysis and interpretation of data, revising the article; de Moura, DTH: analysis and interpretation of data, revising the article; Scatimburgo, MVCV: analysis and interpretation of data, revising the article; Hirsch, BS: analysis and interpretation of data, revising the article; Rocha, RSP: analysis and interpretation of data, revising the article; Visconti, TAC: analysis and interpretation of data, revising the article; Sánchez-Luna, SA: revising the article and linguistic correction; Bernardo, WM: analysis and interpretation of data, drafting the article, final approval; de Moura, EGH analysis and interpretation of data, drafting the article, revising the article, final approval.

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Disclosures

Dr. Eduardo Guimarães Hourneaux de Moura reports personal fees from Boston Scientific and Olympus but these were not relevant to this manuscript. Drs. Pastor Joaquín Ortiz Mendieta, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Maria Vitória Cury Vieira Scatimburgo, Bruno Salomao Hirsch, Rodrigo Silva de Paula Rocha, Thiago Arantes de Carvalho Visconti, Sergio A. Sánchez-Luna, and Wanderley Marques Bernardo have nothing to disclose.

Ethical approval

The study was approved by the Research Ethics Committee of the University of São Paulo School of Medicine Hospital das Clínicas.

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Mendieta, P.J.O., Sagae, V.M.T., Ribeiro, I.B. et al. Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis. Surg Endosc 35, 4085–4094 (2021). https://doi.org/10.1007/s00464-021-08515-w

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