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BACKGROUND: In chronic pancreatitis (CP), obstruction of the mainpancreatic duct (MPD) may participate in the pathogenesis of pain. Pilotstudies suggest that extracorporeal shock wave lithotripsy (ESWL) alonerelieves pain in calcified CP. AIMS: We compared ESWL alone with ESWL plusendoscopic drainage of the MPD for the treatment of pain in CP. SUBJECTS:Patients with uncomplicated painful CP and calcification(s) obstructing theMPD. METHODS: Fifty-five patients were randomized to ESWL alone (n=26) or ESWLplus endoscopy (n=29). RESULTS: Two years after trial intervention, 10 (38%)and 13 (45%) patients of the ESWL alone and ESWL plus endoscopy group,respectively, had presented pain relapse (primary outcome) (odds ratio 0.77;95% CI, 0.23, 2.57). In both groups there was a similar decrease aftertreatment in the MPD diameter (mean decrease, 1.7 mm; 95% CI, 0.9-2.6;P=0.0002), and in the number of pain attacks/year (mean decrease, 3.7; 95% CI,2.6-4.9; P<0.0001). Treatment costs per patient were 3 times higher in theESWL plus endoscopy compared to the ESWL alone group (P=0.001). The mediandelay between the onset of CP and persistent pain relief for both groups was1.1 year (95% CI, 0.7-1.6), as compared to 4 years (95% CI, 3- 4) for thenatural history of CP in a reference cohort (P<0.0001). CONCLUSIONS: ESWL isa safe and effective first line therapy for selected patients with painfulcalcified CP. Adding systematic endoscopy on top of ESWL adds to the cost ofpatient care without improving outcome of pancreatic pain.Leggi l'articolo Full-textdisponibile per i soci AIGO !!!!