Treatment of Chronic Pancreatitis with Endotherapy or Surgery: Critical Review of Randomized Control Trials

The goal of this Society for Surgery of the Alimentary Tract postgraduate course was to review critically the highest level of published evidence focused on treating the disabling chronic abdominal pain due to chronic pancreatitis. Just eight randomized controlled trials (RCTs) have been reported since 1995. All are from Europe. These eight RCTs utilized 380 patients to compare a diverse variety of surgical resections, surgical drainage vs. endotherapy (trans-ampullary pancreatic stents for drainage), or endotherapy with or without shock wave lithotripsy. Therefore, these trials contained a paucity of patients for each treatment compared. Heterogeneity was evident after analysis of the study designs because they used a diverse set of inclusion and exclusion criteria usually not based on objective criteria such as ductal anatomy. All but one had short follow-up. Because of the lack of homogeneity for these study designs that were somewhat underpowered, the RCTs on the treatment of chronic pancreatitis to relieve disabling abdominal pain must be read carefully. In addition to RCTs, the case series still remains a valuable part of our literature.