Issa Y, Kempeneers MA, Bruno MJ, et al. - In order to ascertain if early surgery is more useful than the endoscopy-first approach in terms of clinical outcomes. Researchers designed an unblinded, multicenter, randomized clinical superiority trial including 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. They recruited a sum of 88 individuals with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) between April 2011 and September 2016. In this study, 44 individuals were assigned randomly to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 individuals allocated randomly to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if required. They found that early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months among patients with chronic pancreatitis. Nevertheless, future studies are required to evaluate the persistence of differences over time and to replicate the study findings.