Current care in Dutch chronic pancreatitis proved not to be in accordance with the European Guidelines which may indicate suboptimal care. The aim is to assess whether standardized care through an evidence-based management algorithm of interventions results in an improved quality of life and pain score as compared to current practice.

Due to the heterogeneity of chronic pancreatitis (CP) in many factors, the optimal treatment remains challenging. In a recently performed study, current care for patients with CP in the Netherlands proved not to be in accordance with the in 2017 published European guideline. This may indicate suboptimal care for these patients. Implementation of an evidence-based management algorithm to standardize care could improve this level of care, lower the complication rate and improve the quality of life in CP patients.

The COMBO trial is a nationwide stepped wedge, cluster randomized controlled trial. All participating hospitals cross over from current practice to care according to the treatment algorithm. The sequence of crossing over is randomized. Study participants will be enrolled during the current practice phase and be followed longitudinally until the end of the study. Eventually, this evidence-based management algorithm will be implemented in all participating hospitals. All CP patients who meet the inclusion criteria and are receiving active treatment in one of the participating centers of the Dutch Pancreatitis Study group will be enrolled. Evidence based management algorithm, consisting of a combination of interventions based on the recommendation of the United European Gastroenterology evidence-based guidelines, will be compared with the current care.  

The main objective is to compare the current practice to an evidence based algorithm in terms of treatment in quality of life and pain severity. Follow up will be 18 months after start intervention.

Amsterdam UMC researchers involved in this project: