Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Center for Advanced Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Surg Endosc. 2021 Aug;35(8):4085-4094. doi: 10.1007/s00464-021-08515-w. Epub 2021 May 4.
Pain is one of the consequences of chronic pancreatitis (CP) that has the greatest impact on the quality of life of patients. Endoscopic and surgical interventions, by producing a decrease in intraductal pancreatic pressure, can provide pain relief. This is the first systematic review that includes only randomized clinical trials (RTCs) comparing outcomes in the short-term (less than 2 years) and long-term (more than 2 years) between these two types of interventions.
A comprehensive search of multiple electronic databases to identify RTCs comparing short and long-term pain relief, procedural complications, and days of hospitalization between endoscopic and surgical interventions was performed following the PRISMA guidelines.
Three RCTs evaluating a total of 199 patients (99 in the endoscopy group and 100 in the surgery group) were included in this study. Surgical interventions provided complete pain relief, with statistical difference, in the long-term (16,4% vs 35.7%; RD 0.19; 95% CI 0.03-0.35; p = 0.02; I2 = 0%), without significant difference in short-term (17.5% vs 31.2%; RD 0.14; 95% CI -0.01-0.28; p = 0.07; I2 = 0%) when compared to endoscopy. There was no statistical difference in short-term (17.5% vs 28.1%; RD 0.11; 95% CI -0.04-0.25; p = 0.15; I2 = 0%) and long-term (34% vs 41.1%; RD 0.07; 95% CI -0.10-0.24; p = 0.42; I2 0%) in partial relief of pain between both interventions. In the short-term, both complications (34.9% vs 29.7%; RD 0.05; 95% CI -0.10-0.21; p = 0.50; I2 = 48%) and days of hospitalization (MD -1.02; 95% CI -2.61-0.58; p = 0.21; I2 = 0%) showed no significant differences.
Surgical interventions showed superior results when compared to endoscopy in terms of complete long-term pain relief. The number of complications and length of hospitalization in both groups were similar.
疼痛是慢性胰腺炎（CP）的后果之一，对患者的生活质量影响最大。内镜和手术干预通过降低胰管内压力，可以提供疼痛缓解。这是第一项仅纳入比较这两种干预方式短期（<2 年）和长期（>2 年）结果的随机临床试验（RCT）的系统评价。
根据 PRISMA 指南，全面检索多个电子数据库，以确定比较内镜和手术干预的短期（<2 年）和长期（>2 年）疼痛缓解、程序并发症和住院天数的 RCT。
本研究共纳入 3 项 RCT，共计 199 名患者（内镜组 99 名，手术组 100 名）。手术干预在长期（16.4% vs. 35.7%；RD 0.19；95%CI 0.03-0.35；p=0.02；I2=0%）时提供完全疼痛缓解，具有统计学差异，而在短期（17.5% vs. 31.2%；RD 0.14；95%CI -0.01-0.28；p=0.07；I2=0%）时无统计学差异。与内镜相比，两种干预方式在短期（17.5% vs. 28.1%；RD 0.11；95%CI -0.04-0.25；p=0.15；I2=0%）和长期（34% vs. 41.1%；RD 0.07；95%CI -0.10-0.24；p=0.42；I2=0%）的疼痛部分缓解方面无统计学差异。在短期，两种干预方式的并发症（34.9% vs. 29.7%；RD 0.05；95%CI -0.10-0.21；p=0.50；I2=48%）和住院天数（MD -1.02；95%CI -2.61-0.58；p=0.21；I2=0%）均无显著差异。
与内镜相比，手术干预在完全长期疼痛缓解方面显示出更好的结果。两组的并发症数量和住院时间相似。
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