Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, 78229, USA.
Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Surg Endosc. 2022 Dec;36(12):8753-8763. doi: 10.1007/s00464-022-09425-1. Epub 2022 Aug 3.
Endoscopic stone removal and stenting of pancreatic strictures are the initial treatment for treating chronic pancreatitis-related pain. Surgery is considered when endoscopic interventions fail to improve symptoms. In this meta-analysis, we have compared early surgery versus endoscopic interventions.
The study was performed as per the PRISMA statement. The literature search was conducted on online databases to identify studies that compared endoscopy and surgery for the management of chronic pancreatitis symptoms. Primary outcomes of interest were pain relief, complications, and exocrine/endocrine insufficiency. Secondary outcomes were mean length of stay and mean number of procedures. Pooled odds ratio (OR) was calculated using random-effects model with 95% confidence interval (CI).
Of a total of 9880 articles that were screened, three randomized controlled trials and two retrospective studies with 602 patients (71.4% males) were found to be eligible. Endoscopic interventions were performed in 317 patients and 285 patients underwent early surgery. Early surgery provided significantly better pain relief compared to endoscopy (OR 0.46; 95%CI 0.27-0.80; p = 0.01; I = 17.65%) and required less number of procedures (Mean difference 1.66; 95%CI 0.9-2.43; p = 0.00; I = 96.46%). There was no significant difference in procedure-related complication (OR 0.91; 95%CI 0.51-1.61; p = 0.74; I = 38.8%), endocrine (OR 1.18; 95%CI 0.63-2.20; p = 0.61; I = 28.24%), or exocrine insufficiency (OR 1.78; 95%CI 0.66-4.79; p = 0.25; I = 30.97%) or the length of stay (Mean difference 1.21; 95%CI -7.12 to 4.70; p = 0.69).
Compared to endoscopy, early surgery appears to be better in controlling chronic pancreatitis-related pain, with no significant difference in procedure-related complications. However, larger randomized controlled trials are needed to ascertain their efficacy.
内镜下取石和支架置入治疗胰腺狭窄是治疗慢性胰腺炎相关性疼痛的初始治疗方法。当内镜介入不能改善症状时，应考虑手术。在这项荟萃分析中，我们比较了早期手术与内镜介入。
本研究按照 PRISMA 声明进行。通过在线数据库检索比较内镜和手术治疗慢性胰腺炎症状的研究。主要研究结果为疼痛缓解、并发症和外分泌/内分泌功能不全。次要结果为平均住院时间和平均手术次数。采用随机效应模型计算合并优势比（OR），置信区间（CI）为 95%。
在筛选出的 9880 篇文章中，共有 3 项随机对照试验和 2 项回顾性研究纳入了 602 名患者（71.4%为男性），符合条件。317 名患者接受了内镜介入治疗，285 名患者接受了早期手术。与内镜相比，早期手术可显著更好地缓解疼痛（OR 0.46；95%CI 0.27-0.80；p=0.01；I=17.65%），且需要的手术次数更少（平均差值 1.66；95%CI 0.9-2.43；p=0.00；I=96.46%）。手术相关并发症（OR 0.91；95%CI 0.51-1.61；p=0.74；I=38.8%）、内分泌（OR 1.18；95%CI 0.63-2.20；p=0.61；I=28.24%）或外分泌功能不全（OR 1.78；95%CI 0.66-4.79；p=0.25；I=30.97%）无显著差异，且住院时间也无显著差异（平均差值 1.21；95%CI -7.12 至 4.70；p=0.69）。
与内镜相比，早期手术在控制慢性胰腺炎相关性疼痛方面似乎更有效，且手术相关并发症无显著差异。然而，需要更大规模的随机对照试验来确定其疗效。
