Early Surgery Provides Superior Pain Control for Chronic Pancreatitis

van Veldhuisen CL, Kempeneers MA, de Rijk FEM, et al. Long-Term Outcomes of Early Surgery vs. Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial. JAMA Surg. 2024; in press.

Sallinen V, Kokkola A, Puolakkainen P. Surgery-First for Painful Chronic Pancreatitis. JAMA Surg. 2024; in press.

Painful chronic pancreatitis with ductal dilation can be treated with endoscopic ductal decompression or surgical decompression of the entire length of the duct (Frey procedure). Available evidence has suggested that a surgery-first approach provides superior pain control compared to endoscopy-first approaches, but long-term outcomes data have been lacking.

This article reported data on 88 patients followed for a mean interval of 98 months who participated in the ESCAPE randomized trial, first reported in 2020. The main outcome of interest was pain control, based on an accepted pain scale.

The data showed that 71% of surgical patients had satisfactory pain control at the conclusion of the follow up interval compared with 33% of patients treated endoscopically. Endoscopy-first patients underwent significantly more reinterventions than surgery-first patients.

The authors concluded that a surgery-first approach was superior to an endoscopy-first approach.

In the editorial that accompanied the article, Sallinen and coauthors noted that these data are valuable and add support for a surgery-first approach. However, the study is limited by the small sample size gathered over a prolonged time interval. In addition, the study did not provide separate data for high-volume versus low-volume centers. Additional studies that deal with these limitations are needed.