Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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, <i>p</i> &lt; 0.00001) and long term (MD: 17.80, 95% CI: 8.36–27.23, <i>p</i> = 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, <i>p</i> = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19–1.89, <i>p</i> = 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, <i>p</i> = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15–3.20, <i>p</i> = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99). <b><i>Conclusions:</i></b> Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.