Is endoscopic therapy the treatment of choice in all patients with chronic pancreatitis?

Figure 1 The most frequently performed surgical procedures. A: Partington-Rochelle procedure involving lateral (longitudinal) pancreaticojejunostomy (anastomosis between the longitudinally incised main pancreatic duct and Roux-Y jejunal loop); B: Beger procedure involving resection of the pancreatic head preserving the duodenum. The pancreas is transected at a border between the pancreatic head and body, leaving a thin pancreatic disc between the common bile duct and duodenum. The pancreatic body is drained by end-to-end pancreaticojejunostomy and pancreatic head disc is drained by side-to-side pancreaticojejunostomy using a Roux-Y jejunal loop; C: Frey procedure involving coring out of the pancreatic head overlying the main and accessory pancreatic ducts and uncinate process, keeping at least 5 mm pancreatic tissue posteriorly and medially along with opening the main duct in body and tail. The cored head and opened main duct are drained by lateral pancreaticojejunostomy using a Roux-Y jejunal loop; D: Whipple procedure involving pancreaticoduodenectomy with reconstruction by pancreaticojejunostomy, hepaticojejunostomy and gastrojejunostomy.