Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis.

Autor: Mendieta PJO; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Sagae VMT; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Ribeiro IB; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. igorbraga1@gmail.com., de Moura DTH; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Scatimburgo MVCV; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Hirsch BS; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Rocha RSP; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Visconti TAC; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Sánchez-Luna SA; Center for Advanced Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.; Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham, Birmingham,, Alabama, USA., Bernardo WM; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., de Moura EGH; Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2021 Aug; Vol. 35 (8), pp. 4085-4094. Date of Electronic Publication: 2021 May 04.
DOI: 10.1007/s00464-021-08515-w
Abstrakt: Background and Aims: 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.
Material and Methods: 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.
Results: 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.
Conclusion: 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.
Databáze: MEDLINE
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