Chronic pancreatitis, marked by persistent abdominal pain and compromised quality of life, is commonly treated with surgery or endoscopy. A randomised trial, initially conducted in the Netherlands, compared these two approaches in 88 patients (mean age 54) with chronic pancreatitis, dilated ducts, and chronic pain. The trial found that after 18 months, surgery provided slightly better pain relief than endoscopy, though the difference was not significant.

In the latest follow-up, with a median of 98 months, surgery continued to show greater pain relief and higher patient satisfaction compared to endoscopic treatment. However, overall quality of life and disease progression markers were similar between the two groups. Notably, about half of the endoscopy-first patients eventually crossed over to surgery due to inadequate pain relief, and these patients had worse outcomes than those who initially underwent surgery. Conversely, about one-third of surgery-first patients required endoscopic interventions during follow-up.

These findings suggest that surgery may offer more durable pain relief, but the decision should be individualized. While surgery appears more effective in the long term, endoscopy can still be a viable first option for some patients, especially those seeking less invasive treatment. A stepwise, flexible approach that adapts to patient response may provide the best outcomes. Further research is needed to refine treatment strategies and better understand the long-term impact of both methods.

Source: JAMA Surgery