Pancreatic duct surgical drainage is more effective than endoscopy

Surgical drainage is more effective than endoscopy for pancreatic duct obstruction due to pancreatitis, shows this week's New England Journal of Medicine.

For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended.

Dr Djuna Cahen and colleagues from the Netherlands conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.

All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study.

The team randomly assigned 19 patients to undergo endoscopic transampullary drainage of the pancreatic duct.

75% with surgical drainage had complete or partial pain relief

New England Journal of Medicine

A further 20 patients were randomized to operative pancreaticojejunostomy.

The researchers' 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, and length of hospital stay.

Number of procedures undergone, and changes in pancreatic function were also secondary end points.

During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores.

The researchers found that patients who underwent surgery had better physical health summary scores on the Short Form-36 quality of health questionnaire.

At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage.

The research team noted that 75% of patients assigned to surgical drainage had complete or partial pain relief.

The team observed that rates of complications, length of hospital stay, and changes in pancreatic function were similar in the 2 treatment groups.

However, patients receiving endoscopic treatment required more procedures than did patients in the surgery group.

Dr Cahen's team concludes, “Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis.”