Surgical drainage seemed to be more effective than endoscopic treatment in patients with the pancreatic duct’s obstruction due to chronic pancreatitis, 
according to an article in medio February 2007 of the Surgical Article in the NEJM journals.
Backgrounded with a need of ductal decompression in patients with chronic pancreatitis and a dilated pancreatic duct, Djuna L. Cahen, M.D. and colleagues from the Departments of Gastroenterology and Hepatology, Surgery, Radiology and Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam conducted a trial to compare endoscopic and surgical drainage of the pancreatic duct.
The researchers studied all symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass. Then the random-assigned patients underwent endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function.
Of Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During 2 years of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire. At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage. Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group.
The results of the present study cannot be extrapolated to all patients with ductal obstruction due to chronic pancreatitis. We explicitly excluded patients with an inflammatory mass, because treatment of this condition requires a combination of ductal drainage and a limited resection of the pancreatic head by the Beger or the Frey procedure.
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