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Article: Endoscopic versus surgical intervention for painful obstructive chronic pancreatitis: a systematic review and meta-analysis

TitleEndoscopic versus surgical intervention for painful obstructive chronic pancreatitis: a systematic review and meta-analysis
Authors
KeywordsPancreatitis
Systemic review
Meta-analysis
Issue Date2021
PublisherMDPI AG. The Journal's web site is located at http://www.mdpi.com/journal/jcm
Citation
Journal of Clinical Medicine, 2021, v. 10 n. 12, article no. 2636 How to Cite?
AbstractThere is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.
Persistent Identifierhttp://hdl.handle.net/10722/305049
ISSN
2020 Impact Factor: 4.241
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorMa, KW-
dc.contributor.authorSo, H-
dc.contributor.authorShin, E-
dc.contributor.authorMok, JHM-
dc.contributor.authorYuen, KHK-
dc.contributor.authorCheung, TT-
dc.contributor.authorPark, DH-
dc.date.accessioned2021-10-05T02:39:01Z-
dc.date.available2021-10-05T02:39:01Z-
dc.date.issued2021-
dc.identifier.citationJournal of Clinical Medicine, 2021, v. 10 n. 12, article no. 2636-
dc.identifier.issn2077-0383-
dc.identifier.urihttp://hdl.handle.net/10722/305049-
dc.description.abstractThere is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.-
dc.languageeng-
dc.publisherMDPI AG. The Journal's web site is located at http://www.mdpi.com/journal/jcm-
dc.relation.ispartofJournal of Clinical Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectPancreatitis-
dc.subjectSystemic review-
dc.subjectMeta-analysis-
dc.titleEndoscopic versus surgical intervention for painful obstructive chronic pancreatitis: a systematic review and meta-analysis-
dc.typeArticle-
dc.identifier.emailYuen, KHK: kimyuen1@hku.hk-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.authorityMa, KW=rp02758-
dc.identifier.authorityCheung, TT=rp02129-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3390/jcm10122636-
dc.identifier.pmid34203858-
dc.identifier.pmcidPMC8232696-
dc.identifier.scopuseid_2-s2.0-85114064363-
dc.identifier.hkuros326129-
dc.identifier.volume10-
dc.identifier.issue12-
dc.identifier.spagearticle no. 2636-
dc.identifier.epagearticle no. 2636-
dc.identifier.isiWOS:000666085800001-
dc.publisher.placeSwitzerland-

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