In this randomized trial of 39 patients with chronic pancreatitis and a distal obstruction of the pancreatic duct, surgical drainage was more effective at reducing pain than was endoscopic drainage. Complete or partial relief of pain was achieved in 32% of patients assigned to endoscopic treatment and 75% of those assigned to surgery. In patients with chronic pancreatitis and a distal obstruction of the pancreatic duct, surgical drainage was more effective at reducing pain than was endoscopic drainage. In patients with chronic pancreatitis, pain is the predominant symptom and remains a therapeutic challenge. Pancreatic-duct obstruction is considered an important etiologic factor; therefore, ductal decompression is advocated for patients with pain and a markedly dilated duct. Both endoscopic and surgical drainage are treatment options. Surgical drainage is accomplished by longitudinal pancreaticojejunostomy 1 and has a rate of complications of 6 to 30%, a mortality rate of 0 to 2%, and a success rate in achieving long-term pain relief of 65 to 85%. 2 – 9 Endoscopic drainage involves sphincterotomy, dilation of strictures, and removal of stones and has a success rate of . . .