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Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

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Abstract
There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23-0.47, p < 0.001, I-2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20-3.67, p = 0.01, I-2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32-1.01, p = 0.054, I-2 = 0%] or partial [OR 0.67, 95% CI 0.37-1.22, p = 0.19, I-2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41-2.46, p = 0.99, I-2 = 49%], and hospital stay [OR -0.54, 95% CI -1.23-0.15, p = 0.13, I-2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.
Author(s)
Ka Wing Ma소훈섭Euisoo ShinJanice Hoi Man MokKim Ho Kam YuenTan To Cheung박도현
Issued Date
2021
Type
Article
Keyword
Chronic illnessesDiabetesEndoscopyHospitalsLength of stayLithotripsyMeta-analysisMortalityPainPancreatitisReviewSensitivity analysisSurgerySurgical outcomesSystematic reviewsystemic review
DOI
10.3390/jcm10122636
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8018
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_b5460094e0a3401bb8b4a0ed042ef8fd&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Endoscopic%20versus%20Surgical%20Intervention%20for%20Painful%20Obstructive%20Chronic%20Pancreatitis:%20A%20Systematic%20Review%20and%20Meta-Analysis&amp;offset=0&amp;pcAvailability=true
Publisher
JOURNAL OF CLINICAL MEDICINE
Location
스위스
Language
영어
ISSN
2077-0383
Citation Volume
10
Citation Number
12
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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