A Prospective, Randomized Trial Comparing Endoscopic and Surgical Therapy for Chronic Pancreatitis

Dítě, Petr; Růžička, Miloš; Zbořil,; Novotný, Ivo

doi:10.1055/s-2003-40237

Cited by 488 publications

(155 citation statements)

References 21 publications

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“…Two randomized controlled studies provided significantly better pain management with surgical intervention involving a pancreatojejunostomy than with endoscopic treatment [66] [67]. 97% of patients with CP may suffer from abdominal pain, between 35% and 49% experience CBS, and between 6% and 12% have duodenal stenosis [68,69].…”

Section: Discussionmentioning

confidence: 99%

Chronic pancreatitis. Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Chronic pancreatitis. Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

et al. 2015

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“…Thus far, two randomized trials have compared endoscopy with surgery in patients with CP [12,13]. Dite et al [13] included 140 patients with advanced CP (patients had CP for >5 years and were medically treated for their symptoms for at least 3 years) with PD obstruction and pain. Only 72 patients were randomized between endoscopic (without ESWL) and surgical treatment, and 68 patients refused due to a preference for one of the treatment arms.…”

Section: Head-to-head Comparison Of Endoscopic and Surgical Treatmentmentioning

confidence: 99%

“…In patients with an outflow obstruction of the pancreatic duct (PD) due to strictures, calculi or both, it is hypothesized that pain arises from increased ductal and parenchymal pressure [8,9,10,11]. The observation that endoscopic or surgical treatment of the PD obstruction relieves pain supports this hypothesis [12,13]. In addition, several other causes of pain have been suggested, such as ongoing inflammation, local complications (e.g.…”

Section: Introductionmentioning

confidence: 99%

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

et al. 2013

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Chronic pancreatitis is an inflammatory disease of the pancreas with abdominal pain as the most prominent symptom. Adequate treatment of patients with chronic pancreatitis remains a major challenge, mainly because of the lack of evidence-based treatment protocols. The primary goal of treatment is to achieve long-term pain relief, control of the complications associated with the disease, and to restore the quality of life. Currently, a conservative step-up approach is often used for the treatment of pain; progression to severe and intractable pain is considered necessary before invasive treatment is considered. Recent studies, however, suggest that surgical intervention should not be considered only as last-resort treatment, since it can mitigate disease progression, achieve excellent pain control, and preserve pancreatic function. In this review, we present a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery.

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“…Experts believe that endoscopic management has an important role in patients [24] as a primary therapeutic measure in poor surgical candidates where medical management fails. Recent evidence by Díte et al [25] suggests that surgical outcomes were more durable than endoscopic therapy in patients with a dilated pancreatic duct (PD), stones and/ or strictures [25] . Cahen et al [26] recently reported better outcomes in pain control after surgery than with endoscopic intervention.…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…Díte et al [25] analyzed patients with CP secondary to large duct CP and compared endoscopic therapy to lateral pancreatojejunostomy procedure, and found that in the randomized and the non-randomized groups the results were similar. Moreover, on a five year follow up, patients in the surgery group were more likely to be pain free than in the endoscopic group.…”

Section: Surgical Optionsmentioning

confidence: 99%

Endoscopic management of chronic pancreatitis

Oza

Kahaleh²

2013

WJGE

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Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

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A Prospective, Randomized Trial Comparing Endoscopic and Surgical Therapy for Chronic Pancreatitis

Cited by 488 publications

References 21 publications

Chronic pancreatitis. Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

Chronic pancreatitis. Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

Endoscopic management of chronic pancreatitis

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