Na Caleb, He Tony, Khalaf Kareem, Yuan Yuhong, Fugazza Alessandro, Jayaraman Shiva, Pawlak Katarzyna M, Gupta Sunil, Chis Roxana, Teshima Christopher W, Mosko Jeffrey D, May Gary R, Calo Natalia Causada
Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Department of Medicine, London Health Science Centre, London, ON, Canada.
Surg Endosc. 2024 Dec;38(12):7055-7063. doi: 10.1007/s00464-024-11328-2. Epub 2024 Oct 24.
Chronic calcific pancreatitis (CCP) is a debilitating inflammatory condition characterized by the accumulation of calcific deposits in the pancreatic tissue, leading to chronic abdominal pain and functional insufficiencies. This study aims to systematically review and meta-analyse comparative studies assessing the efficacy of endotherapy versus surgery in managing CCP-related pain.
MEDLINE, EMBASE, and Cochrane library (CENTRAL and CDSR), from inception to October 2023, were searched. The inclusion criteria encompassed randomized controlled trials (RCTs) and non-randomized controlled trials (NRS), and cohort studies comparing endoscopic interventions to surgery for pain management in patients with CCP. Pain relief, procedural technical success, and procedural-related complications were the outcomes of interest. Two review authors (CN, KK) independently assessed study eligibility criteria and performed data extraction. Using a random-effects model, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. The level of certainty of the evidence was assessed using the GRADE approach.
Five studies were included. For the outcome of pain relief, a meta-analysis of five studies (3 RCTs and 2 cohort studies) demonstrated a significant therapeutic effect in favour of surgery with an OR of 2.36 (95% CI: 1.12 to 5.00, I = 41.70), with moderate level of certainty of evidence. In the analysis of five studies (3 RCTs, 1 NRS and 2 cohort studies), procedural technical success was comparable between the two groups (OR of 3.02, 95% CI: 0.47 to 19.59, I = 79.27%) as were adverse events (OR 1.31, 95% CI: 0.47 to 3.70, I = 50.93%).
In conclusion, this systematic review and meta-analysis suggest that surgery may be more effective in relieving pain in patients with CCP compared to endoscopic interventions. Disease stage may be important to determine the appropriateness of each procedure. PROSPERO (CRD42023476153).
慢性钙化性胰腺炎（CCP）是一种使人衰弱的炎症性疾病，其特征是胰腺组织中钙沉积的积累，导致慢性腹痛和功能不全。本研究旨在系统评价和荟萃分析比较内镜治疗与手术治疗CCP相关疼痛疗效的研究。
检索了从创刊到2023年10月的MEDLINE、EMBASE和Cochrane图书馆（CENTRAL和CDSR）。纳入标准包括随机对照试验（RCT）和非随机对照试验（NRS），以及比较内镜干预与手术治疗CCP患者疼痛管理的队列研究。疼痛缓解、手术技术成功率和手术相关并发症是感兴趣的结果。两位综述作者（CN，KK）独立评估研究纳入标准并进行数据提取。使用随机效应模型计算合并比值比（OR）及95%置信区间（CI）。采用GRADE方法评估证据的确定性水平。
纳入五项研究。对于疼痛缓解结果，对五项研究（3项RCT和2项队列研究）的荟萃分析表明，手术具有显著治疗效果，OR为2.36（95%CI：1.12至5.00，I²=41.70），证据确定性为中等水平。在对五项研究（3项RCT、1项NRS和2项队列研究）的分析中，两组手术技术成功率相当（OR为3.02，95%CI：0.47至19.59，I²=79.27%），不良事件发生率也相当（OR为1.31，95%CI：0.47至3.70，I²=50.93%）。
总之，本系统评价和荟萃分析表明，与内镜干预相比，手术在缓解CCP患者疼痛方面可能更有效。疾病分期对于确定每种手术的适用性可能很重要。国际前瞻性系统评价注册库（PROSPERO）（CRD42023476153）。
