S75 Effectiveness of Invasive Therapies in Chronic Pancreatitis Pain Control: A Systematic Review and Analysis of Clinical Evidence

Introduction: Management in chronic pancreatitis (CP) focuses on symptomatic relief on pain. High burden and complexity of pain management in CP necessitates a multidisciplinary and mechanism based approach that incorporates procedures in addition to medical, neuromodulatory, or psychological interventions. In this study, we aim to analyze outcomes of invasive therapies such as surgery, endoscopy including endoscopic retrograde cholangiopancreatography/extracorporeal shockwave lithotripsy and celiac block for CP pain management. Methods: A systematic PubMed literature search identified 22 randomized controlled trials evaluating pain management strategies in CP. Five of these randomized controlled trials were included, pain relief outcomes and responder rates data was extracted. Meta-analyses using random-effects models were conducted to pool results for mean changes in pain scores and responder proportions. Results: Overall, surgical interventions were superior to endoscopy or celiac plexus block (OR 3.04, 95% CI 1.30–7.07) for managing CP related pain. Among individual procedures, only surgical drainage of the pancreatic duct demonstrated a significant advantage over endoscopic drainage (OR 6.5, 95% CI 1.60–26.36). Although the ESCAPE trial comparing early surgery with an initial endoscopic approach did not show a statistically significant difference (OR 2.11, 95% CI 0.87–5.13), early surgery was associated with lower integrated pain scores over 18 months. Within-group analysis showed significant improvement in pain scores with pancreaticogastrostomy (MD 84.00, 95% CI 36.18–131.82) and with extracorporeal shockwave lithotripsy plus endoscopic retrograde cholangiopancreatography (MD 5.20, 95% CI 4.68–5.72). In contrast, celiac plexus block showed no significant benefit (MD 26.00, 95% CI 14.20–66.20). Two additional studies comparing celiac block techniques also found no significant difference between approaches (OR 1.23, 95% CI 0.42–3.57). Conclusion: This study shows that surgical and endoscopic interventions play a crucial role in the management of CP pain. Celiac block may not be very effective at week 12. Surgical options such as pancreatic duct drainage procedures, and pancreaticogastrostomy are typically useful compared to other methods in cases of the underlying pancreatic morphology and ductal anatomy. Thus, a multidisciplinary strategy that integrates invasive interventions and personalized treatment offers the most effective approach to managing pain in CP.