Surgical drainage was more effective than endoscopic drainage in obstruction of the pancreatic duct in chronic pancreatitis.

M e t h o d s Design: Randomized controlled trial (RCT). Allocation: Unclear allocation concealment.* Blinding: Unblinded.* Follow-up period: Median 2 years (range 6 to 24 mo). Setting: Hepato-pancreatico-biliary outpatient clinic of the Academic Medical Center, Amsterdam, the Netherlands. Patients: 39 patients 18 to 80 years of age (mean age 49 y, 67% men) who had CP; distal obstruction of the pancreatic duct; and severe, recurrent pancreatic pain that required opiates or could not be relieved with nonnarcotic analgesics. Exclusion criteria were enlarged pancreatic head > 4 cm, contraindications to surgery or endoscopy, previous pancreatic surgery, suspected pancreatic cancer, life expectancy < 2 years, or pregnancy. Intervention: Endoscopic transampullary drainage (n = 19) or surgical drainage (Partington-Rochelle side-to-side pancreaticojejunostomy) (n = 20). Outcomes: Mean Izbicki pain score (range 0 to 100; higher scores indicate more severe pain, based on frequency and intensity of pain, use of analgesics, and disease-related inability to work). Secondary outcomes included pain relief, physical and mental health (SF-36 quality of life questionnaire scores), mortality, length of hospital stay, number of procedures performed, complications, and markers of endocrine and exocrine function. Patient follow-up: 97% (intention-to-treat analysis).