{
  "abstract": "Background The optimal management strategy for symptomatic chronic pancreatitis (CP)- endoscopic retrograde cholangiopancreatography (ERCP) versus early surgical intervention, remains unclear. This study compares real-world effectiveness to inform treatment selection.Methods Propensity score-matched cohort study of 4,004 patients with CP from 70 healthcare organisations in the USA. Endoscopic intervention (n=2,002): ERCP with stenting, duct dilation, or sphincterotomy within 6 months of diagnosis. Surgical intervention (n=2,002): pancreatectomy, Whipple procedure, or ampulla excision. Outcomes assessed over 1,095 days included chronic opioid prescriptions, opioid use disorder, celiac plexus procedures, mortality, emergency visits, acute pancreatitis, pancreatic insufficiency, repeat interventions, and pain diagnoses.Results Endoscopic therapy demonstrated significantly higher chronic opioid prescription rates (8.7% vs 5.3%, OR 1.706, 95% CI 1.298–2.241, p<0.001; HR 1.765, 95% CI 1.356–2.298, p<0.001) with 3-year opioid-free survival of 89.0% versus 93.7%. Exocrine pancreatic insufficiency was markedly elevated in the endoscopic cohort (28.6% vs 11.5%, OR 3.085, 95% CI 2.369–4.017, p<0.001). Pain-related diagnoses remained high (38.2% vs 37.0%, p=0.689). Surgical intervention was associated with increased acute pancreatitis (14.6% vs 10.8%, OR 0.741, 95% CI 0.602–0.912, p=0.004). Opioid use disorder (4.6% vs 3.9%, p=0.335), celiac plexus utilisation (17.6% vs 15.9%, p>0.05), all-cause mortality (8.2% vs 6.6%, p>0.05), emergency department visits (11.9% vs 8.4%, p=0.004), and endocrine insufficiency (10.8% vs 14.6%, p=0.004) showed varying patterns. Mean follow-up: 726 days (endoscopic) versus 781 days (surgical).Conclusions Endoscopic therapy is associated with 64% increased chronic opioid prescriptions and threefold higher exocrine insufficiency compared to surgery. Surgical management carries a higher acute pancreatitis risk but may offer superior pain control with reduced opioid dependency. These findings should inform shared decision-making regarding intervention timing and modality in CP management.",
  "authors": [
    {
      "affiliations": [
        "Sheffield Teaching Hospitals and NHS Foundation Trust, United Kingdom"
      ],
      "name": "Arkadeep Dhali"
    },
    {
      "affiliations": [
        "Roswell Park Comprehensive Cancer Center, United States"
      ],
      "name": "Fayaz Khan"
    },
    {
      "affiliations": [
        "Indian Institute of Technology, Kharagpur, India"
      ],
      "name": "Rick Maity"
    }
  ],
  "title": "IDDF2026-ABS-0327 Endoscopic therapy versus early surgery in chronic pancreatitis: real-world comparative effectiveness for opioid use and clinical outcomes",
  "uid": "f1565891-1272-572d-b1e1-091d04e95175"
}