Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis

Mendieta, Pastor Joaquín Ortiz; Sagae, Vitor Massaro Takamatsu; Ribeiro, Igor Braga; Scatimburgo, Maria Vitória Cury Vieira; Hirsch, Bruno Salomão; Rocha, Robson S.; Visconti, Thiago Arantes de Carvalho; Sánchez-Luna, Sergio A.; Bernardo, Wanderley Marques; Moura, Eduardo Guimarães Hourneaux de

doi:10.1007/s00464-021-08515-w

Cited by 16 publications

(13 citation statements)

References 25 publications

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“…Ductal obstruction, pseudocysts, and focal acute pancreatitis are structural changes that theoretically could induce pain, 1,8 but similar to previous observations, 8,9,27–32 we found no positive associations between structural pancreatic changes and pain. Still, the lack of significant findings does not rule out the existence of associations for subgroups of patients, exemplified by studies showing pain relief after endoscopic or surgical intervention in patients with obstructive CP 33 . In contrast, we found a negative association between severe calcifications and pain, and one can speculate on whether this may be related to the disputed “burn out” phenomenon, where patients with longstanding CP may experience pain relief with progressive pancreatic insufficiency 1,7,34 .…”

Section: Discussioncontrasting

confidence: 72%

“…Still, the lack of significant findings does not rule out the existence of associations for subgroups of patients, exemplified by studies showing pain relief after endoscopic or surgical intervention in patients with obstructive CP. 33 In contrast, we found a negative association between severe calcifications and pain, and one can speculate on whether this may be related to the disputed "burn out" phenomenon, where patients with longstanding CP may experience pain relief with progressive pancreatic insufficiency. 1,7,34 On the other hand, persistence of pain has been observed in a significant fraction of patients after >10 years of disease, 34,35 and recently, a…”

Section: Discussioncontrasting

confidence: 63%

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Structural imaging findings are related to clinical complications in chronic pancreatitis

et al. 2022

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Background/objectives Structural pancreatic changes and complications related to chronic pancreatitis are well described, but little is known about their relationship. We aimed to explore the associations between pancreatic morphology and clinical complications in a large chronic pancreatitis cohort. Methods The Scandinavian Baltic Pancreatic Club database collects registrations on patients with definite or probable chronic pancreatitis according to the M‐ANNHEIM diagnostic criteria. In this cross‐sectional study, we used multivariate logistic regression analyses to evaluate whether imaging‐based structural pancreatic changes were associated with common clinical complications. We adjusted for sex, age, disease duration, current alcohol abuse and current smoking. Results We included 742 patients with a mean age of 55 years. Among these, 68% were males, 69% had pancreatic exocrine insufficiency, 35% had diabetes, 12% were underweighted and 68% reported abdominal pain. Main pancreatic duct obstruction, severe (i.e. more than 14) calcifications, pancreatic atrophy and parenchymal changes throughout the entire pancreas (continuous organ involvement) were positively associated with pancreatic exocrine insufficiency. Continuous organ involvement and pseudocysts were positively and negatively associated with diabetes, respectively. Pancreatic atrophy and severe calcifications were positively associated with underweight, and severe calcifications were negatively associated with pain. Conclusions This study shows independent associations between distinct structural changes on pancreatic imaging and clinical complications in chronic pancreatitis. Pancreatic atrophy, severe calcifications and continuous organ involvement may be of particular clinical relevance, and these findings should motivate monitoring of pancreatic function and nutritional status.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussioncontrasting

confidence: 63%

Structural imaging findings are related to clinical complications in chronic pancreatitis

et al. 2022

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“…A similar meta-analysis comparing endoscopic therapy and surgery for CP was published by Mendieta et al; however, this meta-analysis did not assess endocrine/exocrine function or quality of life as treatment outcomes [ 45 ]. Quality of life is an important metric to be studied in this cohort of patients with CP.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the long-term outcomes following surgery or endoscopic therapy for chronic pancreatitis

Hughes

Silva

2022

Langenbecks Arch Surg

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Purpose Refractory abdominal pain is a cardinal symptom of chronic pancreatitis (CP). Management strategies revolve around pain mitigation and resolution. Emerging evidence from observational studies highlights that surgery may result in superior pain relief when compared to endoscopic therapy; however, its impact on long-term quality of life or functional outcome has yet to be determined. Methods A search through MEDLINE, PubMed and Web of Science was performed for RCTs that compared endoscopic treatment with surgery for the management of CP. The main outcome measure was the impact on pain control. Secondary outcome measures were the effect on quality of life and the incidence rate of new onset exocrine and endocrine failure. Data was pooled for analysis using either an odds ratio (OR) or mean difference (MD) with a random effects model. Results Three RCTs were included with a total of 267 patients. Meta-analysis demonstrated that operative treatment was associated with a significantly higher rate of complete pain control (37%) when compared to endoscopic therapy (17%) [OR (95% confidence interval (CI)) 2.79 (1.53–5.08), p = 0.0008]. No difference was noted in the incidence of new onset endocrine or exocrine failure between treatment strategies. Conclusion Surgical management of CP results in a greater extent of complete pain relief during long-term follow-up. Further research is required to evaluate the impact of the time interval between diagnosis and intervention on exocrine function, combined with the effect of early up-front islet auto-transplantation in order to determine whether long-term endocrine function can be achieved.

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“…EPs have been shown to provide pain relief with varying effect (36%–80%) 12–15 . Furthermore, CP and its complications impair quality of life (QoL), causing a chronic burden on the patient and the healthcare system 8,16,17 .…”

Section: Introductionmentioning

confidence: 99%

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study

Parhiala,

Nøjgaard,

Bartholdy

et al. 2023

UEG Journal

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BackgroundChronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions.ObjectiveOur aim was to determine the frequency of endoscopic procedures (EP) in CP patients and to analyse pain and quality of life (QoL) in these patients after their EP.MethodsThis study included 1327 CP patients from the Scandinavian Baltic Pancreatic Club (SBPC) database including four countries and eight centres. We analysed patients undergoing EPs and gathered information on the EP, pancreatic function, pain, disease and duration. The EORTC C‐30 QoL questionnaire was gathered prospectively and multivariable analysis was conducted on independent parameters between the groups. The reference population had no interventions (n = 870).Results260 CP patients (22%) underwent EPs, median one year (range 0–39 years) after CP diagnosis. 68% were males. The median age was 59 (20–90) years. Most common aetiological factors were alcohol in 65% and smoking in 71%. Extracorporeal shock wave lithotripsy (ESWL) was used in 6% of the CP population and in 21% of the EP group. Biliary duct stenting was performed on 37% and pancreatic stenting was performed on 56% of the patients. There was no difference in pain patterns between patients who had pancreatic stenting and the reference population. The EP group had slightly better QoL (p = 0.047), functioning and fewer symptoms than the reference population, in the multivariable analysis there was no interaction effect analysis between the groups. The pancreatic stent group had better QoL and the same amount of pain than the reference group. The patients who needed later surgery (23%) had more pain (p = 0.043) and fatigue (p = 0.021).ConclusionsOne in five of the CP patients underwent EP. These patients scored higher on QoL responses and had better symptom scores. CP patients who had pancreatic stenting performed had the same pain patterns as the reference population. Randomised prospective trials are needed to determine the effect of endoscopy procedures on CP patients.

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Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis

Cited by 16 publications

References 25 publications

Structural imaging findings are related to clinical complications in chronic pancreatitis

Structural imaging findings are related to clinical complications in chronic pancreatitis

A meta-analysis of the long-term outcomes following surgery or endoscopic therapy for chronic pancreatitis

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study

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