Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be less effective or likely to be more harmful than the comparison for key outcomes.
Population: Adults with painful obstructive chronic pancreatitis
Intervention: Endoscopic drainage ᵃ
Comparison: Surgical drainage (pancreaticojejunostomy, duodenum‐preserving pancreatic head resection, pancreatoduodenectomy [Whipple's resection], Frey's procedure, or left pancreatic resection) ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Pain relief (follow‐up: 2 to 3 years) | Favours comparison | Moderate |
Major complications (time period unclear) | No statistically significant difference ᵇ | Low |
Mortality (time period unclear) | No statistically significant difference ᵇ | Low |
Quality of life – physical health (median follow‐up: 24 months) | Favours comparison | Moderate |
Quality of life – mental health (median follow‐up: 24 months) | No statistically significant difference | Moderate |
Endocrine pancreatic insufficiency (new onset; follow‐up: 2 to 3 years) | No statistically significant difference | Low |
Exocrine pancreatic insufficiency (new onset; follow‐up: 2 to 3 years) | No statistically significant difference | Moderate |
Note The Cochrane review which this Cochrane Clinical Answer (CCA) is based upon states that while surgery is superior to endoscopy in terms of pain relief, it cannot draw reliable conclusions with regards to morbidity and mortality. Therefore, patients should be fully informed as to the risks of both treatments and the current gaps in knowledge. ᵃ This evidence table summarises the findings for the comparison of endoscopic drainage versus surgical drainage, which is the main comparison as stated in the Cochrane review Summary of Findings table. See the full CCA for information on other comparisons (surgical intervention versus conservative treatment). ᵇ Results reported narratively (two RCTs with 179 participants found no statistically significant difference between groups).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do outcomes compare after endoscopic or surgical intervention in people with painful obstructive chronic pancreatitis?
- In people with chronic pancreatitis, how does duodenum-preserving pancreatic resection compare with pancreaticoduodenectomy at improving outcomes?
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