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January 21, 2020

Tracing the Evidence to Address Painful Chronic Pancreatitis With Surgery

Author Affiliations
  • 1David Geffen School of Medicine, Department of Surgery, University of California, Los Angeles
JAMA. 2020;323(3):219-220. doi:10.1001/jama.2019.19988

Chronic pancreatitis is characterized by pancreatic endocrine and exocrine insufficiency, along with persistent, and in some cases, unrelenting pain. While pancreatic insufficiency is effectively managed with pharmacologic intervention, the pain associated with this condition is difficult to control and commonly leads to severe consequences for the patient. A search of ClinicalTrials.gov for chronic pancreatitis revealed 152 studies, nearly all of which consist of interventions for pain. The current modalities, including pain medication, pancreatic enzyme replacement, behavioral therapy, endoscopic treatment, and surgery, all have varying degrees of efficacy. Less-invasive modalities include endoscopic retrograde pancreatography (ERP) with stone extraction, ERP with endoscopic lithotripsy and stent placement, and extracorporeal shock wave lithotripsy (ESWL). Surgical interventions include drainage procedures with attachment of the main pancreatic duct to the intestine or resection of the involved pancreas.