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no edit summary
CONCLUSION: This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
CONCLUSION: This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Database: Ovid MEDLINE(R) ALL <1946 to June 18, 2024>
Search Strategy:
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1 Pancreatitis, Chronic/ (5857)
2 Pain Management/ (42465)
3 1 and 2 (124)
4 from 3 keep 1,3,5-6,9-10,12,17,20-22,26,28,34,40,48 (16)
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[Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis : A Sham-Controlled, Randomized Trial. https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=mesx&DO=10.7326%2fM24-0210]
Source
Annals of Internal Medicine. 177(6):749-758, 2024 Jun.
Authors
Talukdar R; Olesen SS; Unnisa M; Bedarkar A; Sarkar S; Tandan M; Jagtap N; Darisetty S; Kiran S; Koppoju V; Lakhtakia S; Ramchandani M; Kalapala R; Gupta R; Singh VK; Rao GV; Reddy DN; Drewes AM
Abstract
BACKGROUND: No randomized controlled trials have substantiated endoscopic decompression of the pancreatic duct in patients with painful chronic pancreatitis.
OBJECTIVE: To investigate the pain-relieving effect of pancreatic duct decompression in patients with chronic pancreatitis and intraductal stones.
DESIGN: 24-week, parallel-group, randomized controlled trial (ClinicalTrials.gov: NCT03966781).
SETTING: Asian Institute of Gastroenterology in India from February 2021 to July 2022.
PARTICIPANTS: 106 patients with chronic pancreatitis.
INTERVENTION: Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with sham procedures.
MEASUREMENTS: The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Secondary outcomes were assessed after 12 and 24 weeks and included 30% pain relief, opioid use, pain-free days, questionaries, and complications to interventions.
RESULTS: 52 patients in the ESWL/ERP group and 54 in the sham group were included. At 12 weeks, the ESWL/ERP group showed better pain relief compared with the sham group (mean difference in change, -0.7 [95% CI, -1.3 to 0] on the VAS; P = 0.039). The difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up. The number of pain-free days was increased (median difference, 16.2 days [CI, 3.9 to 28.5 days]), and the number of days using opioids was reduced (median difference, -5.4 days [CI, -9.9 to -0.9 days]) in the ESWL/ERP group compared with the sham group at 12-week follow-up. Safety outcomes were similar between groups.
LIMITATION: Single-center study and limited duration of follow-up.
CONCLUSION: In patients with chronic pancreatitis and intraductal stones, ESWL with ERP provided modest short-term pain relief.
[Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials. https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&DO=10.1159%2f000535588]
Source
Digestive Surgery. 41(1):1-11, 2024.
Authors
Cassar N; Cromwell P; Duggan S; van Veldhuisen C; Boermeester M; Besselink M; Conlon K
Abstract
BACKGROUND: Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP.
METHODS: A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief.
RESULTS: Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48-29.43, p < 0.00001) and long term (MD: 17.80, 95% CI: 8.36-27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR: 1.51, 95% CI: 1.19-1.90, p = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19-1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR: 1.97, 95% CI: 1.16-3.36, p = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15-3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99).
CONCLUSIONS: Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment. Copyright © 2024 S. Karger AG, Basel.
Publication Type
Systematic Review. Meta-Analysis.
<3>
Unique Identifier
37074693
Title
Etiology, Diagnosis, and Modern Management of Chronic Pancreatitis: A Systematic Review.
Source
JAMA Surgery. 158(6):652-661, 2023 06 01.
VI 1
Status
MEDLINE
Authors
Cohen SM; Kent TS
Authors Full Name
Cohen, Stephanie M; Kent, Tara S.
Institution
Cohen, Stephanie M. Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Kent, Tara S. Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Kent, Tara S. Harvard Medical School, Boston, Massachusetts.
Abstract
Importance: The incidence of chronic pancreatitis is 5 to 12 per 100000 adults in industrialized countries, and the incidence is increasing. Treatment is multimodal, and involves nutrition optimization, pain management, and when indicated, endoscopic and surgical intervention.
Objectives: To summarize the most current published evidence on etiology, diagnosis, and management of chronic pancreatitis and its associated complications.
Evidence Review: A literature search of Web of Science, Embase, Cochrane Library, and PubMed was conducted for publications between January 1, 1997, and July 30, 2022. Excluded from review were the following: case reports, editorials, study protocols, nonsystematic reviews, nonsurgical technical publications, studies pertaining to pharmacokinetics, drug efficacy, pilot studies, historical papers, correspondence, errata, animal and in vitro studies, and publications focused on pancreatic diseases other than chronic pancreatitis. Ultimately, the highest-level evidence publications were chosen for inclusion after analysis by 2 independent reviewers.
Findings: A total of 75 publications were chosen for review. First-line imaging modalities for diagnosis of chronic pancreatitis included computed tomography and magnetic resonance imaging. More invasive techniques such as endoscopic ultrasonography allowed for tissue analysis, and endoscopic retrograde cholangiopancreatography provided access for dilation, sphincterotomy, and stenting. Nonsurgical options for pain control included behavior modification (smoking cessation, alcohol abstinence), celiac plexus block, splanchnicectomy, nonopioid pain medication, and opioids. Supplemental enzymes should be given to patients with exocrine insufficiency to avoid malnutrition. Surgery was superior to endoscopic interventions for long-term pain control, and early surgery (<3 years from symptom onset) had more superior outcomes than late surgery. Duodenal preserving strategies were preferred unless there was suspicion of cancer.
Conclusions and Relevance: Results of this systematic review suggest that patients with chronic pancreatitis had high rates of disability. Strategies to improve pain control through behavioral modification, endoscopic measures, and surgery must also accompany management of the sequalae of complications that arise from endocrine and exocrine insufficiency.
Publication Type
Systematic Review. Journal Article.
Year of Publication
2023
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med23&DO=10.1001%2fjamasurg.2023.0367
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https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:37074693&id=doi:10.1001%2Fjamasurg.2023.0367&issn=2168-6254&isbn=&volume=158&issue=6&spage=652&pages=652-661&date=2023&title=JAMA+Surgery&atitle=Etiology%2C+Diagnosis%2C+and+Modern+Management+of+Chronic+Pancreatitis%3A+A+Systematic+Review.&aulast=Cohen
<4>
Unique Identifier
35922602
Title
Endoscopy versus early surgery for the management of chronic pancreatitis: a systematic review and meta-analysis. [Review]
Source
Surgical Endoscopy. 36(12):8753-8763, 2022 12.
VI 1
Status
MEDLINE
Authors
Boregowda U; Echavarria J; Umapathy C; Rosenkranz L; Sayana H; Patel S; Saligram S
Author NameID
Saligram, Shreyas; ORCID: http://orcid.org/0000-0002-6189-260X
Authors Full Name
Boregowda, Umesha; Echavarria, Juan; Umapathy, Chandraprakash; Rosenkranz, Laura; Sayana, Hari; Patel, Sandeep; Saligram, Shreyas.
Institution
Boregowda, Umesha. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, 78229, USA.
Echavarria, Juan. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Umapathy, Chandraprakash. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Rosenkranz, Laura. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Sayana, Hari. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Patel, Sandeep. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
Saligram, Shreyas. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA. drsaligram@yahoo.com.
Abstract
BACKGROUND AND AIM: 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.
METHODS: 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).
RESULTS: 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; I2 = 17.65%) and required less number of procedures (Mean difference 1.66; 95%CI 0.9-2.43; p = 0.00; I2 = 96.46%). There was no significant difference in procedure-related complication (OR 0.91; 95%CI 0.51-1.61; p = 0.74; I2 = 38.8%), endocrine (OR 1.18; 95%CI 0.63-2.20; p = 0.61; I2 = 28.24%), or exocrine insufficiency (OR 1.78; 95%CI 0.66-4.79; p = 0.25; I2 = 30.97%) or the length of stay (Mean difference 1.21; 95%CI -7.12 to 4.70; p = 0.69).
CONCLUSION: 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. Copyright © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Publication Type
Meta-Analysis. Systematic Review. Journal Article. Review.
Year of Publication
2022
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med22&DO=10.1007%2fs00464-022-09425-1
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https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:35922602&id=doi:10.1007%2Fs00464-022-09425-1&issn=0930-2794&isbn=&volume=36&issue=12&spage=8753&pages=8753-8763&date=2022&title=Surgical+Endoscopy&atitle=Endoscopy+versus+early+surgery+for+the+management+of+chronic+pancreatitis%3A+a+systematic+review+and+meta-analysis.&aulast=Boregowda
<5>
Unique Identifier
35320380
Title
A meta-analysis of the long-term outcomes following surgery or endoscopic therapy for chronic pancreatitis.
Source
Langenbecks Archives of Surgery. 407(6):2233-2245, 2022 Sep.
VI 1
Status
MEDLINE
Authors
Hughes DL; Hughes I; Silva MA
Authors Full Name
Hughes, Daniel Ll; Hughes, Ioan; Silva, Michael A.
Institution
Hughes, Daniel Ll. Department of Oncology, University of Oxford, Old Road Campus Research Building, Old Road Campus, Off, Roosevelt Dr, Headington, Oxford, OX3 7DQ, UK. hughesdaniel32@yahoo.com.
Hughes, Daniel Ll. Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. hughesdaniel32@yahoo.com.
Hughes, Ioan. Queen's University Belfast, University Road, Belfast, Northern Ireland.
Silva, Michael A. Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Abstract
PURPOSE: Refractory abdominal pain is a cardinal symptom of chronic pancreatitis (CP). Management strategies revolve around pain mitigation and resolution. Emerging evidence from observational studies highlights that surgery may result in superior pain relief when compared to endoscopic therapy; however, its impact on long-term quality of life or functional outcome has yet to be determined.
METHODS: A search through MEDLINE, PubMed and Web of Science was performed for RCTs that compared endoscopic treatment with surgery for the management of CP. The main outcome measure was the impact on pain control. Secondary outcome measures were the effect on quality of life and the incidence rate of new onset exocrine and endocrine failure. Data was pooled for analysis using either an odds ratio (OR) or mean difference (MD) with a random effects model.
RESULTS: Three RCTs were included with a total of 267 patients. Meta-analysis demonstrated that operative treatment was associated with a significantly higher rate of complete pain control (37%) when compared to endoscopic therapy (17%) [OR (95% confidence interval (CI)) 2.79 (1.53-5.08), p = 0.0008]. No difference was noted in the incidence of new onset endocrine or exocrine failure between treatment strategies.
CONCLUSION: Surgical management of CP results in a greater extent of complete pain relief during long-term follow-up. Further research is required to evaluate the impact of the time interval between diagnosis and intervention on exocrine function, combined with the effect of early up-front islet auto-transplantation in order to determine whether long-term endocrine function can be achieved. Copyright © 2022. The Author(s).
Publication Type
Journal Article. Meta-Analysis.
Year of Publication
2022
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med21&DO=10.1007%2fs00423-022-02468-x
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https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:35320380&id=doi:10.1007%2Fs00423-022-02468-x&issn=1435-2443&isbn=&volume=407&issue=6&spage=2233&pages=2233-2245&date=2022&title=Langenbecks+Archives+of+Surgery&atitle=A+meta-analysis+of+the+long-term+outcomes+following+surgery+or+endoscopic+therapy+for+chronic+pancreatitis.&aulast=Hughes
<6>
Unique Identifier
35235728
Title
Chronic Pancreatitis. [Review]
Source
New England Journal of Medicine. 386(9):869-878, 2022 Mar 03.
VI 1
Status
MEDLINE
Authors
Vege SS; Chari ST
Author NameID
Chari, Suresh T; ORCID: https://orcid.org/0000-0002-3924-0971
Authors Full Name
Vege, Santhi Swaroop; Chari, Suresh T.
Institution
Vege, Santhi Swaroop. From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.S.V.); and the Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.T.C.).
Chari, Suresh T. From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.S.V.); and the Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.T.C.).
Publication Type
Journal Article. Review.
Year of Publication
2022
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med21&DO=10.1056%2fNEJMcp1809396
Link to the External Link Resolver
https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:35235728&id=doi:10.1056%2FNEJMcp1809396&issn=0028-4793&isbn=&volume=386&issue=9&spage=869&pages=869-878&date=2022&title=New+England+Journal+of+Medicine&atitle=Chronic+Pancreatitis.&aulast=Vege
<7>
Unique Identifier
31348039
Title
Morphologic Factors Predict Pain Relief Following Pancreatic Head Resection in Chronic Pancreatitis Description of the Chronic Pancreatitis Pain Relief (CPPR) Score.
Source
Annals of Surgery. 273(4):800-805, 2021 04 01.
VI 1
Status
MEDLINE
Authors
Bachmann K; Melling N; Groteluschen R; Fleischauer A; Reeh M; Ghadban T; Bockhorn M; Izbicki JR
Authors Full Name
Bachmann, Kai; Melling, Nathaniel; Groteluschen, Rainer; Fleischauer, Anne; Reeh, Matthias; Ghadban, Tarik; Bockhorn, Max; Izbicki, Jakob R.
Institution
Bachmann, Kai. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrase, Hamburg, Germany.
Abstract
OBJECTIVE: This study analyzes the clinicopathologic findings and their impact on outcome of patients so as to identify which patients benefit most from surgical treatment in chronic pancreatitis, especially in regard to pain relief.
SUMMARY BACKGROUND DATA: The predominant symptom of chronic pancreatitis is chronic pain resulting in reduced quality of life. It is well known that the main reason for development of the disease is abuse of alcohol and nicotine, but only little data on factors influencing outcome are available.
METHODS: One thousand one hundred forty-six consecutive patients who underwent surgery for chronic pancreatitis were included. Clinicopathologic data, including morphology of the pancreas in preoperative diagnostics and the histopathologic results, were evaluated. A long-term follow-up including Quality of Life and pain scores was performed. Additionally, we describe the novel Chronic Pancreatitis Pain Relief Score (CPPR-Score) as a tool for prediction of pain relief.
RESULTS: Overall the rate of pain relief was 79.8% after surgery. The presence of an inflammatory mass in the pancreatic head larger than 4 cm (P < 0.001), presence of a dilated main pancreatic duct of over 4 mm (P < 0.001), histopathologically detected severe calcifications (P = 0.001) and severe fibrosis (P < 0.001) as well as ethanol induced disease (P < 0.001) found to be strong independent prognostic factors for pain relief. The CPPR-Score (0-5 points) proved to be a very good predictive score for pain-relief (P < 0.001).
CONCLUSIONS: The rate of pain relief after surgical treatment in chronic pancreatitis is high and the commonly used procedures can be performed with acceptable morbidity and mortality. The Chronic Pancreatitis Pain Relief Score allows identifying patients who will benefit most from surgery. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2021
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med20&DO=10.1097%2fSLA.0000000000003439
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https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:31348039&id=doi:10.1097%2FSLA.0000000000003439&issn=0003-4932&isbn=&volume=273&issue=4&spage=800&pages=800-805&date=2021&title=Annals+of+Surgery&atitle=Morphologic+Factors+Predict+Pain+Relief+Following+Pancreatic+Head+Resection+in+Chronic+Pancreatitis+Description+of+the+Chronic+Pancreatitis+Pain+Relief+%28CPPR%29+Score.&aulast=Bachmann
<8>
Unique Identifier
34163102
Title
Pain management in chronic pancreatitis incorporating safe opioid practices: Challenge accepted.
Source
World Journal of Gastroenterology. 27(23):3142-3147, 2021 Jun 21.
VI 1
Status
MEDLINE
Authors
Shah I; Sheth SG; Kothari DJ
Authors Full Name
Shah, Ishani; Sheth, Sunil G; Kothari, Darshan J.
Institution
Shah, Ishani. Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
Sheth, Sunil G. Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States. ssheth@bidmc.harvard.edu.
Kothari, Darshan J. Department of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
Abstract
Patients with chronic pancreatitis often experience severe, unrelenting abdominal pain, which can significantly impact their quality of life. Pain control, therefore, remains central to the overall management of chronic pancreatitis. Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another, as there are no uniform guidelines to direct a stepwise approach towards achieving this goal. In this editorial, we comment on best practice strategies targeted towards pain control in chronic pancreatitis, specifically highlighting the use of opioid medications in this patient population. We discuss various safe and efficacious prescription monitoring practices in this article. Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Publication Type
Editorial.
Year of Publication
2021
Link to the Ovid Full Text or citation
https://login.liboff.ohsu.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med20&DO=10.3748%2fwjg.v27.i23.3142
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https://librarysearch.ohsu.edu/openurl/01ALLIANCE_OHSU/01ALLIANCE_OHSU:OHSU?sid=OVID:medline&id=pmid:34163102&id=doi:10.3748%2Fwjg.v27.i23.3142&issn=1007-9327&isbn=&volume=27&issue=23&spage=3142&pages=3142-3147&date=2021&title=World+Journal+of+Gastroenterology&atitle=Pain+management+in+chronic+pancreatitis+incorporating+safe+opioid+practices%3A+Challenge+accepted.&aulast=Shah
<9>
Unique Identifier
33948714
Title
Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis. [Review]
Source
Surgical Endoscopy. 35(8):4085-4094, 2021 08.
VI 1
Status
MEDLINE
Authors
Mendieta PJO; Sagae VMT; Ribeiro IB; de Moura DTH; Scatimburgo MVCV; Hirsch BS; Rocha RSP; Visconti TAC; Sanchez-Luna SA; Bernardo WM; de Moura EGH
Author NameID
Ribeiro, Igor Braga; ORCID: http://orcid.org/0000-0003-1844-8973
Authors Full Name
Mendieta, Pastor Joaquin Ortiz; Sagae, Vitor Massaro Takamatsu; Ribeiro, Igor Braga; de Moura, Diogo Turiani Hourneaux; Scatimburgo, Maria Vitoria Cury Vieira; Hirsch, Bruno Salomao; Rocha, Rodrigo Silva de Paula; Visconti, Thiago Arantes de Carvalho; Sanchez-Luna, Sergio A; Bernardo, Wanderley Marques; de Moura, Eduardo Guimaraes Hourneaux.
Institution
Mendieta, Pastor Joaquin Ortiz. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Sagae, Vitor Massaro Takamatsu. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Ribeiro, Igor Braga. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. igorbraga1@gmail.com.
de Moura, Diogo Turiani Hourneaux. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Scatimburgo, Maria Vitoria Cury Vieira. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Hirsch, Bruno Salomao. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Rocha, Rodrigo Silva de Paula. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Visconti, Thiago Arantes de Carvalho. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Sanchez-Luna, Sergio A. Center for Advanced Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Sanchez-Luna, Sergio A. 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, Wanderley Marques. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
de Moura, Eduardo Guimaraes Hourneaux. Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Abstract
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.
Publication Type
Journal Article. Meta-Analysis. Review. Systematic Review.
Year of Publication
2021
Link to the Ovid Full Text or citation
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<10>
Unique Identifier
33635894
Title
Cervical transcutaneous vagal neuromodulation in chronic pancreatitis patients with chronic pain: A randomised sham controlled clinical trial.
Source
PLoS ONE [Electronic Resource]. 16(2):e0247653, 2021.
VI 1
Status
MEDLINE
Authors
Muthulingam JA; Olesen SS; Hansen TM; Brock C; Drewes AM; Frokjaer JB
Author NameID
Frokjaer, Jens Brondum; ORCID: https://orcid.org/0000-0001-8722-0070
Authors Full Name
Muthulingam, Janusiya Anajan; Olesen, Soren Schou; Hansen, Tine Maria; Brock, Christina; Drewes, Asbjorn Mohr; Frokjaer, Jens Brondum.
Institution
Muthulingam, Janusiya Anajan. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Muthulingam, Janusiya Anajan. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Olesen, Soren Schou. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Olesen, Soren Schou. Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark.
Hansen, Tine Maria. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Hansen, Tine Maria. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Brock, Christina. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Brock, Christina. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Drewes, Asbjorn Mohr. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Drewes, Asbjorn Mohr. Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark.
Frokjaer, Jens Brondum. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Frokjaer, Jens Brondum. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND & AIMS: Chronic abdominal pain is the primary symptom of chronic pancreatitis, but unfortunately it is difficult to treat. Vagal nerve stimulation studies have provided evidence of anti-nociceptive effect in several chronic pain conditions. We investigated the pain-relieving effects of transcutaneous vagal nerve stimulation in comparison to sham treatment in chronic pancreatitis patients.
METHODS: We conducted a randomised double-blinded, sham-controlled, crossover trial in patients with chronic pancreatitis. Patients were randomly assigned to receive a two-week period of cervical transcutaneous vagal nerve stimulation using the gammaCore device followed by a two-week sham stimulation, or vice versa. We measured clinical and experimental endpoints before and after each treatment. The primary clinical endpoint was pain relief, documented in a pain diary using a visual analogue scale. Secondary clinical endpoints included Patients' Global Impression of Change score, quality of life and Brief Pain Inventory questionnaire. Secondary experimental endpoints included cardiac vagal tone and heart rate.
RESULTS: No differences in pain scores were seen in response to two weeks transcutaneous vagal nerve stimulation as compared to sham treatment (difference in average pain score (visual analogue scale): 0.17, 95%CI (-0.86;1.20), P = 0.7). Similarly, no differences were seen for secondary clinical endpoints, except from an increase in the appetite loss score (13.9, 95%CI (0.5:27.3), P = 0.04). However, improvements in maximum pain scores were seen for transcutaneous vagal nerve stimulation and sham treatments as compared to their respective baselines: vagal nerve stimulation (-1.3+/-1.7, 95%CI (-2.21:-0.42), P = 0.007), sham (-1.3+/-1.9, 95%CI (-2.28:-0.25), P = 0.018). Finally, heart rate was decreased after two weeks transcutaneous vagal nerve stimulation in comparison to sham treatment (-3.7 beats/min, 95%CI (-6.7:-0.6), P = 0.02).
CONCLUSION: In this sham-controlled crossover study, we found no evidence that two weeks transcutaneous vagal nerve stimulation induces pain relief in patients with chronic pancreatitis.
TRIAL REGISTRATION NUMBER: The study is registered at NCT03357029; www.clinicaltrials.gov.
Publication Type
Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Year of Publication
2021
Link to the Ovid Full Text or citation
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<11>
Unique Identifier
33608104
Title
Short- and long-term outcome of Frey procedure for chronic pancreatitis in adults.
Source
American Journal of Surgery. 222(4):793-801, 2021 Oct.
VI 1
Status
MEDLINE
Authors
Ray S; Das K; Khamrui S; Jana K; Das R; Kumar D; Ansari Z
Authors Full Name
Ray, Sukanta; Das, Kshaunish; Khamrui, Sujan; Jana, Koustav; Das, Roby; Kumar, Dilip; Ansari, Zuber.
Institution
Ray, Sukanta. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India. Electronic address: drsukantaray@yahoo.co.in.
Das, Kshaunish. Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Khamrui, Sujan. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Jana, Koustav. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Das, Roby. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Kumar, Dilip. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Ansari, Zuber. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
Abstract
OBJECTIVE: To report our experience with Frey procedure (FP) for chronic pancreatitis (CP) in adults.
METHODS: Adult patients with CP, who underwent a FP between August 2007 and July 2018, were retrospectively reviewed.
RESULTS: Of the total 138 patients, 95 (69%) were male. The median age at operation was 36.5 years. The median pain-surgery interval was 48 months. Alcohol abuse was identified in 64 (46%) patients. The major indication for surgery was disabling pain (94%). There was no postoperative mortality. Postoperative complications developed in 43 (31%) patients. Median postoperative hospital stay was 9 days. Over a median follow-up of 65 months, 84% of patients had complete pain relief. Continuous pain and high preoperative Izbicki pain score were associated with incomplete pain control. New-onset diabetes and exocrine insufficiency developed in 31% and 27% of patients respectively. Longer duration of disease and previous pancreatic surgery were associated with the development of new-onset diabetes after the FP.
CONCLUSIONS: Frey procedure is safe with an acceptable perioperative complications and good long-term pain control. Copyright © 2021 Elsevier Inc. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2021
Link to the Ovid Full Text or citation
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<12>
Unique Identifier
32792253
Title
International consensus guidelines on interventional endoscopy in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club.
Source
Pancreatology. 20(6):1045-1055, 2020 Sep.
VI 1
Status
MEDLINE
Authors
Kitano M; Gress TM; Garg PK; Itoi T; Irisawa A; Isayama H; Kanno A; Takase K; Levy M; Yasuda I; Levy P; Isaji S; Fernandez-Del Castillo C; Drewes AM; Sheel ARG; Neoptolemos JP; Shimosegawa T; Boermeester M; Wilcox CM; Whitcomb DC
Authors Full Name
Kitano, Masayuki; Gress, Thomas M; Garg, Pramod K; Itoi, Takao; Irisawa, Atsushi; Isayama, Hiroyuki; Kanno, Atsushi; Takase, Kei; Levy, Michael; Yasuda, Ichiro; Levy, Phillipe; Isaji, Shuiji; Fernandez-Del Castillo, Carlos; Drewes, Asbjorn M; Sheel, Andrea R G; Neoptolemos, John P; Shimosegawa, Tooru; Boermeester, Marja; Wilcox, C Mel; Whitcomb, David C.
Institution
Kitano, Masayuki. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan. Electronic address: kitano@wakayama-med.ac.jp.
Gress, Thomas M. Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital, Philipps-Universitat Marburg, Marburg, Germany. Electronic address: gress@med.uni-marburg.de.
Garg, Pramod K. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: pgarg10@hotmail.com.
Itoi, Takao. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. Electronic address: itoi@tokyo-med.ac.jp.
Irisawa, Atsushi. Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan. Electronic address: irisawa@dokkyomed.ac.jp.
Isayama, Hiroyuki. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. Electronic address: isahiro4104@gmail.com.
Kanno, Atsushi. Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: atsushih@med.tohoku.ac.jp.
Takase, Kei. Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: ktakase@rad.med.tohoku.ac.jp.
Levy, Michael. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: Levy.Michael@mayo.edu.
Yasuda, Ichiro. Third Department of Internal Medicine, University of Toyama, Toyama, Japan. Electronic address: yasudaich@gmail.com.
Levy, Phillipe. Service de Pancreatologie-Gastroenterologie, Pole des Maladies de l'Appareil Digestif, DHU UNITY, Hopital Beaujon, APHP, Clichy Cedex, Universite Paris 7, France. Electronic address: philippe.levy@bjn.aphp.fr.
Isaji, Shuiji. Department of Surgery, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: shujiisaji1@mac.com.
Fernandez-Del Castillo, Carlos. Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: CFERNANDEZ@mgh.harvard.edu.
Drewes, Asbjorn M. Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: amd@rn.dk.
Sheel, Andrea R G. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. Electronic address: andrea.sheel@liverpool.ac.uk.
Neoptolemos, John P. Department of General Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: john.neoptolemos@med.uni-heidelberg.de.
Shimosegawa, Tooru. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: tshimosegawa@int3.med.tohoku.ac.jp.
Boermeester, Marja. Department of Surgery, Amsterdam University Medical Centers, location AMC, and Amsterdam Gastroenterology & Metabolism, Amsterdam, the Netherlands. Electronic address: m.a.boermeester@amc.uva.nl.
Wilcox, C Mel. Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: melw@uab.edu.
Whitcomb, David C. Departments of Medicine, Cell Biology & Molecular Physiology and Human Genetics, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.
Abstract
BACKGROUND/OBJECTIVES: This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy.
METHODS: An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements.
RESULTS: Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis.
CONCLUSIONS: This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis. Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Publication Type
Guideline. Journal Article.
Year of Publication
2020
Link to the Ovid Full Text or citation
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<13>
Unique Identifier
31961419
Title
Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis: The ESCAPE Randomized Clinical Trial.
Source
JAMA. 323(3):237-247, 2020 01 21.
VI 1
Status
MEDLINE
Authors
Issa Y; Kempeneers MA; Bruno MJ; Fockens P; Poley JW; Ahmed Ali U; Bollen TL; Busch OR; Dejong CH; van Duijvendijk P; van Dullemen HM; van Eijck CH; van Goor H; Hadithi M; Haveman JW; Keulemans Y; Nieuwenhuijs VB; Poen AC; Rauws EA; Tan AC; Thijs W; Timmer R; Witteman BJ; Besselink MG; van Hooft JE; van Santvoort HC; Dijkgraaf MG; Boermeester MA
Corporate Author
Dutch Pancreatitis Study Group
Authors Full Name
Issa, Yama; Kempeneers, Marinus A; Bruno, Marco J; Fockens, Paul; Poley, Jan-Werner; Ahmed Ali, Usama; Bollen, Thomas L; Busch, Olivier R; Dejong, Cees H; van Duijvendijk, Peter; van Dullemen, Hendrik M; van Eijck, Casper H; van Goor, Harry; Hadithi, Muhammed; Haveman, Jan-Willem; Keulemans, Yolande; Nieuwenhuijs, Vincent B; Poen, Alexander C; Rauws, Erik A; Tan, Adriaan C; Thijs, Willem; Timmer, Robin; Witteman, Ben J; Besselink, Marc G; van Hooft, Jeanin E; van Santvoort, Hjalmar C; Dijkgraaf, Marcel G; Boermeester, Marja A.
Institution
Issa, Yama. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Kempeneers, Marinus A. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Bruno, Marco J. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Amsterdam, the Netherlands.
Fockens, Paul. Department of Gastroenterology and Hepatology; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Poley, Jan-Werner. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Amsterdam, the Netherlands.
Ahmed Ali, Usama. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Bollen, Thomas L. Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands.
Busch, Olivier R. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Dejong, Cees H. Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Dejong, Cees H. Department of Surgery, Universitatsklinikum Aachen, Aachen, Germany.
van Duijvendijk, Peter. Department of Surgery, Gelre Hospital, Apeldoorn, the Netherlands.
van Dullemen, Hendrik M. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
van Eijck, Casper H. Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
van Goor, Harry. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Hadithi, Muhammed. Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, the Netherlands.
Haveman, Jan-Willem. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Keulemans, Yolande. Department of Gastroenterology and Hepatology, Zuyderland Hospital, Sittard/Heerlen, the Netherlands.
Nieuwenhuijs, Vincent B. Department of Surgery, Isala Hospital, Zwolle, the Netherlands.
Poen, Alexander C. Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, the Netherlands.
Rauws, Erik A. Department of Gastroenterology and Hepatology; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Tan, Adriaan C. Department of Gastroenterology and Hepatology, Canisius-Wilhemina Hospital, Nijmegen, the Netherlands.
Thijs, Willem. Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands.
Timmer, Robin. Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands.
Witteman, Ben J. Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands.
Besselink, Marc G. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
van Hooft, Jeanin E. Department of Gastroenterology and Hepatology; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
van Santvoort, Hjalmar C. Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
van Santvoort, Hjalmar C. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Dijkgraaf, Marcel G. Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands.
Boermeester, Marja A. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Comments
Comment in (CIN)
Abstract
Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function.
Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes.
Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for <=2 months or weak opioids for <=6 months) were included. The 18-month follow-up period ended in March 2018.
Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed.
Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality.
Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach.
Conclusions and Relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings.
Trial Registration: ISRCTN Identifier: ISRCTN45877994.
Publication Type
Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Year of Publication
2020
Link to the Ovid Full Text or citation
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<14>
Unique Identifier
31560756
Title
Ultrasound-Guided Subcostal TAP Block with Depot Steroids in the Management of Chronic Abdominal Pain Secondary to Chronic Pancreatitis: A Three-Year Prospective Audit in 54 Patients.
Source
Pain Medicine. 21(1):118-124, 2020 01 01.
VI 1
Status
MEDLINE
Authors
Niraj G; Kamel Y
Authors Full Name
Niraj, Gopinath; Kamel, Yehia.
Institution
Niraj, Gopinath. University Hospitals of Leicester NHS Trust, Leicester, UK.
Kamel, Yehia. University Hospitals of Leicester NHS Trust, Leicester, UK.
Abstract
BACKGROUND: Chronic pancreatitis is a common cause of recurrent chronic abdominal pain that utilizes significant health care resources. Pain in chronic pancreatitis can be of two types. Visceral pain occurs during ongoing pancreatic inflammation. Once pancreatic inflammation subsides, the pain generator can move to the abdominal wall as a result of viscerosomatic convergence and present as abdominal myofascial pain syndrome. Subcostal transversus abdominis plane block is an abdominal plane block that has been proven effective in upper abdominal pain of somatic origin.
DESIGN: The authors discuss the two distinct types of chronic abdominal pain as a result of pancreatitis and present a prospective audit of a management pathway.
METHODS: Over a three-year period, 54 patients with chronic abdominal pain as a result of pancreatitis were prospectively audited at a tertiary care university hospital. Patients were offered bilateral subcostal transversus abdominis plane block with depot steroids as the primary interventional treatment in the pathway.
RESULTS: In patients with myofascial pain secondary to chronic pancreatitis, the block was effective in producing clinically significant pain relief at three months (95%, 20/21) and durable pain relief lasting six months (62%, 13/21). In patients with visceral pain, the block produced a transient benefit lasting two to three weeks in one-third (six of 17).
CONCLUSIONS: Subcostal transversus abdominis plane block may be an option in the management of abdominal myofascial pain syndrome secondary to chronic pancreatitis. The block is ineffective in producing clinically significant pain relief in the presence of ongoing pancreatic inflammation. Copyright © 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Publication Type
Clinical Trial. Journal Article. Research Support, Non-U.S. Gov't.
Year of Publication
2020
Link to the Ovid Full Text or citation
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<15>
Unique Identifier
31603076
Title
Study protocol for a randomised double-blinded, sham-controlled, prospective, cross-over clinical trial of vagal neuromodulation for pain treatment in patients with chronic pancreatitis.
Source
BMJ Open. 9(7):e029546, 2019 08 23.
VI 1
Status
MEDLINE
Authors
Muthulingam JA; Olesen SS; Hansen TM; Brock C; Drewes AM; Frokjaer JB
Author NameID
Frokjaer, Jens Brondum; ORCID: https://orcid.org/0000-0001-8722-0070
Authors Full Name
Muthulingam, Janusiya Anajan; Olesen, Soren Schou; Hansen, Tine Maria; Brock, Christina; Drewes, Asbjorn Mohr; Frokjaer, Jens Brondum.
Institution
Muthulingam, Janusiya Anajan. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Muthulingam, Janusiya Anajan. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Olesen, Soren Schou. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Olesen, Soren Schou. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Hansen, Tine Maria. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Hansen, Tine Maria. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Brock, Christina. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Brock, Christina. Aalborg University Hospital, Aalborg, UK.
Drewes, Asbjorn Mohr. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Drewes, Asbjorn Mohr. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Frokjaer, Jens Brondum. Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Frokjaer, Jens Brondum. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
INTRODUCTION: The management of chronic pancreatitis (CP) is challenging and requires a personalised approach focused on the individual patient's main symptoms. Abdominal pain is the most prominent symptom in CP, where central pain mechanisms, including sensitisation and impaired pain modulation, often are involved. Recent clinical studies suggest that vagal nerve stimulation (VNS) induces analgesic effects through the modulation of central pain pathways. This study aims to investigate the effect of 2 weeks transcutaneous VNS (t-VNS) on clinical pain in patients with CP, in comparison to the effect of sham treatment.
METHODS AND ANALYSIS: Twenty-one patients with CP will be enrolled in this randomised, double-blinded, single-centre, sham-controlled, cross-over study. The study has two treatment periods: A 2-week active t-VNS using GammaCore device and a 2-week treatment with a sham device. During both treatment periods, the patients are instructed to self-administer VNS bilaterally to the cervical vagal area, three times per day. Treatment periods will be separated by 2 weeks. During the study period, patients will record their daily pain experience in a diary (primary clinical endpoint). In addition, all subjects will undergo testing which will include MRI, quantitative sensory testing, cardiac vagal tone assessment and collecting blood samples, before and after the two treatments to investigate mechanisms underlying VNS effects. The data will be analysed using the principle of intention to treat.
ETHICS AND DISSEMINATION: The regional ethics committee has approved the study: N-20170023. Results of the trial will be submitted for publication in peer-reviewed journals.
TRIAL REGISTRATION NUMBER: The study is registered at www.clinicaltrials.gov: NCT03357029. Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Publication Type
Clinical Trial Protocol. Journal Article. Research Support, Non-U.S. Gov't.
Year of Publication
2019
Link to the Ovid Full Text or citation
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<16>
Unique Identifier
29460919
Title
A Role for Total Pancreatectomy and Islet Autotransplant in the Treatment of Chronic Pancreatitis.
Source
American Journal of Gastroenterology. 113(3):324-326, 2018 03.
VI 1
Status
MEDLINE
Authors
Bellin MD
Authors Full Name
Bellin, Melena D.
Institution
Bellin, Melena D. Departments of Pediatrics and Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Publication Type
Journal Article.
Year of Publication
2018
Link to the Ovid Full Text or citation
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