Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis The ESCAPE Randomized Clinical Trial
Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis The ESCAPE Randomized Clinical Trial
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DOI：
10.1001/jama.2019.20967
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发表时间：
2020-01-21
影响因子：
120.7
通讯作者：
Guchelaar, Iris
中科院分区：
文献类型：
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作者：
Issa, Yama;Kempeneers, Marinus A.;Guchelaar, Iris
对于疼痛性慢性胰腺炎患者，手术治疗推迟到药物和内窥镜治疗失败。观察性研究表明，早期手术可以缓解疾病进展，提供更好的疼痛控制和保持胰腺功能。目的探讨早期手术是否比内镜先入路更有效。ESCAPE试验是一项非盲法、多中心、随机临床优势试验，涉及30家荷兰医院参与荷兰胰腺炎研究组。从2011年4月到2016年9月，共有88名慢性胰腺炎患者，主胰管扩张，最近才开始使用处方阿片类药物治疗严重疼痛
IMPORTANCE For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function.OBJECTIVE To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes.DESIGN, SETTING, AND PARTICIPANTS The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for