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Randomized Controlled Trial
. 2025 Feb 1;160(2):126-133.
doi: 10.1001/jamasurg.2024.5182.

Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial

Charlotte L van Veldhuisen  1   2   3 , Marinus A Kempeneers  1 , Florence E M de Rijk  3   4 , Stefan A Bouwense  4 , Marco J Bruno  5 , Paul Fockens  2   6 , Jan W Poley  7 , Usama Ahmed Ali  8 , Thomas L Bollen  9 , Olivier R Busch  1 , Peter van Duijvendijk  10 , Hendrik M van Dullemen  11 , Casper H van Eijck  12 , Harry Van Goor  13 , Muhammed Hadithi  14 , Jan-Willem Haveman  15 , Yolande Keulemans  16 , Vincent B Nieuwenhuijs  17 , Alexander C Poen  18 , Rogier P Voermans  2   6 , Adriaan C Tan  19 , Willem Thijs  20 , Robert C Verdonk  21 , Ben J Witteman  22 , Jeanin E van Hooft  23 , Hjalmar C van Santvoort  3   24 , Marcel G Dijkgraaf  25   26 , Marc G Besselink  1   2 , Marja A Boermeester  1   2 , Yama Issa  1   2 ; Dutch Pancreatitis Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial

Charlotte L van Veldhuisen et al. JAMA Surg. .

Erratum in

  • Error in Byline and Open Access Status.
    [No authors listed] [No authors listed] JAMA Surg. 2025 Feb 1;160(2):234. doi: 10.1001/jamasurg.2024.6489. JAMA Surg. 2025. PMID: 39745734 Free PMC article. No abstract available.

Abstract

Importance: Patients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach.

Objective: To compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial.

Design, setting, and participants: Between April 2011 and September 2018, 88 patients with painful chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach in 30 hospitals in the Netherlands collaborating in the Dutch Pancreatitis Study Group as part of the ESCAPE randomized clinical trial. For the present cohort study, long-term clinical data were collected after the initial 18-month follow-up. Follow-up was completed in June 2022, and data analysis was performed in June 2023.

Exposure: Patients with chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach.

Main outcomes and measures: The primary end point was pain, assessed by the Izbicki pain score; secondary end points included patient-reported complete pain relief and satisfaction. Predefined subgroups included patients who progressed from endoscopy to surgery and those with ductal clearance obtained by endoscopy. Analysis was performed according to the intention-to-treat principle.

Results: In this cohort study, 86 of 88 overall patients could be evaluated, with a mean (SD) follow-up period of 98 (16) months. Of 88 initial patients, 21 patients (24%) were female, and mean (SD) patient age was 61 (10) years. At the end of long-term follow-up, the mean (SD) Izbicki pain score was significant lower (33 [31] vs 51 [31]) in the early surgery group, as was the rate of patient-reported complete pain relief (14 of 31 patients [45%] vs 6 of 30 patients [20%]), compared to the endoscopy-first group. After the initial 18-month follow-up, 11 of 43 patients in the early surgery group (26%) underwent reinterventions vs 19 of 43 patients in the endoscopy-first group (44%). At the end of follow-up, more patients in the early surgery group were "very satisfied" with their treatment (22 of 31 patients [71%] vs 10 of 30 patients [33%]). Patients who progressed from endoscopy to surgery (22 of 43 patients [51%]) had significantly worse mean (SD) Izbicki pain scores (33 [31] vs 52 [24]) compared to the early surgery group and had a lower rate of complete pain relief (55% for early surgery vs 12% for endoscopy first). In the endoscopy-first group, patients with endoscopic ductal clearance had similar mean (SD) Izbicki pain scores as the remaining patients (49 [34] vs 53 [28]).

Conclusions and relevance: In this cohort study evaluating long-term outcomes of the ESCAPE randomized clinical trial, after approximately 8 years of follow-up, early surgery was superior to an endoscopy-first approach in patients with painful chronic pancreatitis and a dilated main pancreatic duct in pain scores and patient satisfaction. Notably, patients who progressed from endoscopy to surgery had worse outcomes compared to patients undergoing early surgery, and obtaining endoscopic ductal clearance did not improve outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bruno reported grants from Boston Scientific, InterScope, and Mylan and personal fees from Ambu, Cook Medical, and Pentax Medical outside the submitted work. Dr Fockens reported consulting fees from Olympus and Cook Medical outside the submitted work. Dr van Eijck reported personal fees from AIM ImmunoTech outside the submitted work. Dr Voermans reported consultancy fees from Boston Scientific and Cook Medical and speaking fees from Viatris outside the submitted work. Dr van Hooft reported personal fees from Boston Scientific, Cook Medical, Fuijfilm, and Olympus outside the submitted work. Dr Boermeester reported institutional grants from 3M/Solventum and Johnson & Johnson; speaking fees from BD; consultancy and speaker fees from Mölnlycke Health Care and Smith & Nephew; instructor fees from TelaBio; and consultancy fees for AngioDynamics outside the submitted work. No other disclosures were reported.

Comment on

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