Surgical drainage of the pancreatic duct is generally more effective than endoscopic treatment in patients who have chronic pancreatitis and a dilated pancreatic duct, according to a Dutch study. Pain is the pre-dominant symptom in chronic pancreatitis, with pancreatic duct obstruction being the most important aetiological factor. Decompression of the duct can be achieved surgically by pancreaticojejunostomy or endoscopically with sphincterotomy and dilatation. Researchers conducted a randomised controlled trial to compare the efficacy of surgical and endoscopic drainage. Of the 39 patients in the trial, 19 underwent endoscopic treatment and 20 had operative pancreaticojejunostomy. Outcomes included pain relief, physical and mental health, morbidity, mortality, and pancreatic function. Patients in the surgical arm experienced more rapid and effective pain relief and a better state of physical health. The surgical patients also underwent fewer subsequent procedures. Despite these findings, the researchers comment that endoscopic treatment is still a viable alternative, particularly in people with less extensive disease.
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