Early Surgery vs. Endoscopy for Painful Chronic Pancreatitis

Historically, painful chronic pancreatitis was often treated with surgery, typically distal pancreatectomy or pancreaticoduodenectomy, or with decompressive procedures, such as lateral pancreaticojejunostomy. The rise of therapeutic endoscopy has shifted the management of patients with this condition to gastroenterologists who use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones and treat pancreatic duct strictures and who use endoscopic ultrasound to perform celiac blocks.

Now, investigators in the Netherlands have conducted a prospective multicenter trial (ESCAPE) in which 88 patients with painful chronic pancreatitis requiring strong opioids for less than 2 months were randomized to undergo surgery (including decompr…