Abstract
Early pancreatic drainage surgery could be recommended for patients with chronic pancreatitis, according to results of the ESCAPE trial. Yama Issa and colleagues randomly assigned patients with chronic pancreatitis, a dilated main pancreatic duct, and who had recently started using prescribed opioids for severe pain to receive pancreatic drainage surgery within 6 weeks (n=44) or to the standard endoscopy-first approach, including lithotripsy if required, and surgery if required (n=44). At 18 months, a lower Izbicki pain score was observed in the early surgery group compared to the endoscopy-first group (37 vs 49; between-group difference −12 points [95% CI −22 to −2]; p=0·02). In the early surgery group, complete or partial pain relief was achieved in 23 (58%) of 40 patients compared with 16 (39%) of 41 in the endoscopy-first group (p=0·10). Adverse events were similar between groups.
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