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TOPLINE:

Patients with painful chronic pancreatitis and a dilated pancreatic duct benefit more from early surgical intervention than an endoscopy-first approach in the long term.

METHODOLOGY:

• Researchers sought to determine whether the finding from the ESCAPE trial that early surgery was more effective in relieving pain than an endoscopy-first approach in patients with chronic pancreatitis held up in the long term.
• The ESCAPE trial included 88 patients with symptomatic chronic pancreatitis and a dilated main pancreatic duct (mean age, 61 years; 24% women) who only recently started receiving opioids for pain and were randomly assigned 1:1 to either early surgery or an endoscopy-first approach across 30 hospitals in the Netherlands.
• For the current study, the long-term outcomes were evaluated in 86 patients from the ESCAPE trial who were followed for a mean duration of 98 months. Thirty-one patients from the early surgery group and 30 from the endoscopy-first group completed the long-term analysis.
• The primary endpoint was pain assessment using the Izbicki pain score, and secondary endpoints included patient-reported complete pain relief and satisfaction with treatment.

TAKEAWAY:

• At the end of long-term follow-up, patients in the early surgery group reported a significantly lower mean Izbicki pain score than those in the endoscopy-first group (33 vs 51; P = .03).
• A higher proportion of patients in the early surgery vs endoscopy-first group reported complete pain relief (45% vs 20%; P = .04) and said that they were “very satisfied” with the treatment (71% vs 33%; P = .003). The visual analog scale score for pain was also significantly lower in the early surgery group (29 vs 47; P = .02).
• The early surgery group required fewer interventions per patient than the endoscopy-first group.
• Patients who ultimately progressed from endoscopy to surgery had a worse Izbicki pain score than those in the early surgery group at the end of follow-up period (52 vs 33).
• Endoscopic ductal clearance also failed to improve pain scores among patients in the endoscopy-first group.

IN PRACTICE:

“The present findings clearly strengthen the recommendation that early surgery should be the preferred approach for these patients and leave little room for an endoscopy-first approach,” the authors concluded.

“As perhaps the most important finding of this long-term follow-up study, surgery was still superior to endoscopy even if ductal clearance was achieved, let alone if the endoscopy failed,” experts from Helsinki University Hospital and University of Helsinki, Helsinki, Finland, wrote in an accompanying invited commentary. “What is needed now is clinical implementation of the evidence.”

SOURCE:

This study, led by Charlotte L. van Veldhuisen, MD, Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands, was published online in JAMA Surgery.

LIMITATIONS:

The long-term follow-up period was not standardized, leading to varying data collection timepoints for different patients. Researchers used a single measurement point for pain evaluation, which may not have adequately reflected the fluctuating nature of pain patterns.

DISCLOSURES:

No funding was received for the study; however, the original ESCAPE trial received funding by grants from The Netherlands Organization for Health Research and Development and the Dutch Digestive Diseases Foundation. The authors and commentators reported no conflicts of interest related to the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.