Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials.
Dig Surg
; 41(1): 1-11, 2024.
Article
en En
| MEDLINE
| ID: mdl-38190810
ABSTRACT
BACKGROUND:
Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP.METHODS:
A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief.RESULTS:
Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48-29.43, p < 0.00001) and long term (MD 17.80, 95% CI 8.36-27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR 1.51, 95% CI 1.19-1.90, p = 0.0006) and long term (73% vs. 47%, RR 1.50, 95% CI 1.19-1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR 1.97, 95% CI 1.16-3.36, p = 0.01) and long term (35% vs. 18%, RR 1.92, 95% CI 1.15-3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99).CONCLUSIONS:
Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Pancreatitis Crónica
/
Manejo del Dolor
Tipo de estudio:
Clinical_trials
/
Guideline
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Dig Surg
/
Dig. surg
/
Digestive surgery
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Irlanda
Pais de publicación:
Suiza