作者
Noel Cassar,Paul Cromwell,Sinead N. Duggan,Charlotte van Veldhuisen,Marja A. Boermeester,Marc G. Besselink,Kevin C. Conlon
摘要
Background: Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). Objectives: 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 randomised 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.