Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis; a prospective randomised trial.

1. A diagnosis of CP, based on clinical symptoms in combination with morphological changes established by imaging studies (calcifications or ductal changes) and/or pancreatic functional insufficiency;

2. A dominant obstruction of the Pancreatic Duct, demonstrated by presence of a stenosis and/or intraductal stones on MRCP and abdominal CT-scan, located left from the spine, with pre-stenotic ductal dilatation of at least 5 mm;

3. Severe recurrent pancreatic pain with insufficient relieve by non-narcotic analgesics or requiring opiates.

1. Age below 18 or over 80 years;

2. Pancreatic head enlargement > 4 cm;

3. Contra-indication for surgery; ASA class 4, severe portal hypertension;

4. Contra-indications for endoscopy: gastrectomy with Billroth II reconstruction, other pancreatitis related complications (bile duct stricture, pseudocyst) requiring surgery;

5. Previous pancreatic surgery;

6. Suspected pancreatic malignancy;

7. Limited life expectancy (< 2 years);

8. Pregnancy.