Endoscopic Versus Surgical Approach to the Management of Pain in Chronic Pancreatitis: Systematic Review and Meta Analysis

Aims The formation of stones or stenosis in the main pancreatic duct are complications of chronic pancreatitis associated with pain, which has a great impact on the quality of life of the patient, leading to frequent hospital admissions. The objective of this study is to gather the evidence available in the literature comparing endoscopic and surgical therapy for its management.

Methods This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) recommendations. We searched through MEDLINE, EMBASE, Cochrane CENTRAL, and Lilacs/Bireme databases with no restrictions regarding year of publication or language. Only Randomized Clinical Trials were selected comparing endoscopic and surgical therapy for pain relief in patients with chronic pancreatitis in middle and long term, complications and days of hospitalization. Risk of bias assessed using the Cochrane RoB 2 tool and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). Data extracted were meta-analyzed using RevMan software.

Results A total of 199 patients were evaluated in three Randomized Clinical Trials (99 in the endoscopy group and 100 in the surgery group), showing the following results: Complete pain relief: significant difference in long-term (16,4 % vs 35.7 %; p = 0.02), without statistical difference in middle term (17.5 % vs 31.2 %; p = 0.07). Partial pain relief: no statistical difference in middle term (17.5 % vs 28.1 %; p = 0.15) and long term (34 % vs 41.1 %; p = 0.42). Complications: no statistical difference in middle term (34.9 % vs 29.7 %; p = 0.50). Days of hospitalization: without significant difference in middle term (p = 0.21) ([Table 1]).

Tab. 1 statistical analysis. RD: Risk Difference; CI: Confidence Interval; MD: Main difference.

OUTCOMES	OVERALL ANALYSIS	OUTCOMES	OVERALL ANALYSIS
Complete pain relief middle term	RD 0.14; 95 % CI -0.01, 0.28; p = 0.07; I2 = 0 %	Complete pain relief long term	RD 0.19; 95 % CI 0.03, 0.35; p = 0.02; I2 = 0 %
Partial pain relief Middle term	RD 0.11; 95 % CI -0.04, 0.25; p = 0.15; I2 = 0 %	Partial pain relief long term	RD 0.07; 95 % CI -0.10, 0.24; p = 0.42; I2 0 %
Complications	RD 0.05; 95 % CI -0.10, 0.21; p = 0.50; I2 = 48 %	Days of hospitalization	MD -1.02; 95 % CI -2.61, 0.58; p = 0.21; I2 = 0 %

Conclusions Surgery has better results than endoscopic therapy in terms of complete long-term pain relief. There is no difference in the meantime of hospitalization and complications.

Citation: Ortiz Mendieta PJ, Takamatsu Sagae VM, Braga RibeiroI I et al. OP169 ENDOSCOPIC VERSUS SURGICAL APPROACH TO THE MANAGEMENT OF PAIN IN CHRONIC PANCREATITIS: SYSTEMATIC REVIEW AND META ANALYSIS. Endoscopy 2021; 53: S69.

Publication History

Article published online:
19 March 2021