Comparison of Endoscopic Therapy with Surgery fo...

4　Comparison of Endoscopic Therapy with Surgery for Chronic Obstructive Pancreatitis

The most common surgical procedure for pancreatic ductal drainage is the modified Puestow operation or lateral pancreaticojejunostomy.Two randomized controlled trials compared endoscopic therapy and surgery for patients with painful chronic calcific pancreatitis.Table 9.4 summarizes the results of these studies（Dite et al.2003；Cahen et al.2007，2011）.

Table 9.3　Plastic stenting for main pancreatic duct strictures

aMultiple stents approach:each patient had a median number of three stents，with diameters ranging from 8.5-to 11.5-Fr

Table 9.4　Randomized controlled trials of endoscopic therapy and surgery for painful obstructive chronic pancreatitis

E endotherapy
S surgery(https://www.daowen.com)

Theseresults show that endotherapy and surgery has similar early benefits for pain relief but in the long-term，surgery provides more durable pain relief.However，as surgery has significant morbidity and mortality（18%-53%and 0%-5%，respectively，for resections，and 0%-4%mortality for MPD drainage）（Dumonceau et al.2012），an individualized approach should be considered in the discussion with patients.

Endotherapy may reduce the need for surgical procedures，act as a bridge to surgery，or predict the response to surgical drainage.However，in patients with pancreatic stones or strictures prominently located at the tail region，surgery may be the better initial approach due to the lower success rate of endotherapy to address diseases in the distal upstream region（Dumonceau et al.2012）.