Efficacy of Endoscopic Interventions versus Surgery for Pain Management in Patients with Chronic Calcific Pancreatitis
Bibliographic record
Abstract
Aims Chronic calcific pancreatitis (CCP) is a debilitating inflammatory conditioncharacterized by the accumulation of calcific deposits in the pancreatic tissue,leading to chronic abdominal pain and functional insufficiencies. The multifactorialorigins of pain in CCP, rooted in persistent inflammation and fibrosis, pose acomplex challenge for clinicians. To address this, various interventions, notablyendoscopic procedures and surgery, have been explored. This study aims tosystematically review and meta-analyse comparative studies assessing theefficacy of endoscopic interventions versus surgery in managing pain associatedwith CCP. Methods This systematic review employed a comprehensive search strategy across keyelectronic databases, including PubMed, Embase, Cochrane Library, and Scopus.The inclusion criteria encompassed randomized controlled trials, cohort studies,and case-control studies comparing endoscopic interventions (sphincterotomy,pancreatic duct stenting, pancreatic stone retrieval, extracorporeal shock wavelithotripsy) to surgery for pain management in patients with CCP. Pain relief,technical success and complications were the outcomes of interest. Covidence, anonline systematic review management tool, facilitated study screening, dataextraction, and risk of bias assessment. Standard meta-analysis was employedusing the random-effects model, and heterogeneity was assessed by I2%statistics. Effect sizes were expressed as Odds Ratio (OR) and 95% ConfidenceIntervals (CI). Results For the primary outcome of pain relief, a meta-analysis of four studiesdemonstrated a significant overall effect in favour of surgery (p=0.0186), with anodds-ratio of 0.452 (95% CI: -1.457 to -0.133). Although moderate heterogeneitywas observed (I2=34.39%), the test of homogeneity was not statisticallysignificant (p=0.2376). In the analysis of technical success, surgery showed apreference over endoscopy (p=0.2457), with an odds-ratio of 0.403 (95% CI: -2.443 to 0.626). Substantial heterogeneity was present (I2=75.59%), and thetest of homogeneity was statistically significant (p=0.0049). Regarding adverseevents, no significant difference was found between endoscopic interventions andsurgery (p=0.6077), with an odds-ratio of 1.311 (95% CI: -0.765 to 1.308).Moderate heterogeneity was observed (I2=50.93%), and the test of homogeneityapproached significance (p=0.0809). Conclusions In conclusion, this systematic review and meta-analysis suggest that surgery maybe more effective in relieving pain in patients with CCP compared to endoscopicinterventions. Moreover, the technical success of surgery appears superior. Thefindings emphasize the need for individualized treatment approaches, consideringnot only pain relief and procedural success but also potential adverse events. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.012 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".