The timing of surgical intervention in chronic pancreatitis

Issa Y, Kempeneers MA, Bruno MJ, et al. Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis: The ESCAPE Randomized Clinical Trial. JAMA. 2020 Jan 21;323(3):237-247.

Full-text for Emory users.

Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach.

Conclusions and relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings.


Further reading:

Kempeneers MA, Issa Y, Ali UA, et al.; Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology. 2020 Mar;20(2):149-157. Full-text for Emory users.

Bouwense SAW, et al. Surgery in Chronic Pancreatitis: Indication, Timing and Procedures. Visc Med. 2019 Apr;35(2):110-118. Free full-text.


More PubMed results on timing of surgical intervention in chronic pancreatitis.

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