Preoperative ERCP has no impact on islet yield following total pancreatectomy and islet autotransplantation (TPIAT): Results from the Prospective Observational Study of TPIAT (POST) cohort |
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Authors: | Guru Trikudanathan B. Joseph Elmunzer Yi Yang Maisam Abu-El-Haija David Adams Syed Ahmad Appakalai N. Balamurugan Gregory J. Beilman Srinath Chinnakotla Darwin L. Conwell Martin L. Freeman Timothy B. Gardner Betul Hatipoglu James S. Hodges Varvara Kirchner Luis F. Lara Leslie Long-Simpson Rebecca Mitchell Melena D. Bellin |
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Affiliation: | 1. University of Minnesota Minneapolis, MN, USA;2. Medical University of South Carolina, Charleston, SC, USA;3. Cincinnati Children’s Hospital, Cincinnati, OH, USA;4. University of Cincinnati Medical Center, Cincinnati, OH, USA;5. University of Louisville, Louisville, KY, USA;6. The Ohio State University Wexner Medical Center, Columbus, OH, USA;7. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;8. Cleveland Clinic, Cleveland, OH, USA;9. Baylor Health, Dallas, TX, USA;10. University of California San Francisco, San Francisco, CA, USA;11. John Hopkins Medical Institutions, Baltimore, MD, USA;12. University of Pittsburgh Medical Center, Pittsburgh, PA, USA;13. University of Chicago, Chicago, IL, USA |
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Abstract: | Background and aimsMany patients undergoing total pancreatectomy with islet autotransplant (TPIAT) for severe, refractory chronic pancreatitis or recurrent acute pancreatitis have a history of endoscopic retrograde cholangiopancreatography (ERCP). Using data from the multicenter POST (Prospective Observational Study of TPIAT) cohort, we aimed to determine clinical characteristics associated with ERCP and the effect of ERCP on islet yield.MethodsUsing data from 230 participants (11 centers), demographics, pancreatitis history, and imaging features were tested for association with ERCP procedures. Logistic and linear regression were used to assess association of islet yield measures with having any pre-operative ERCPs and with the number of ERCPs, adjusting for confounders.Results175 (76%) underwent ERCPs [median number of ERCPs (IQR) 2 (1-4). ERCP was more common in those with obstructed pancreatic duct (p = 0.0009), pancreas divisum (p = 0.0009), prior pancreatic surgery (p = 0.005), and longer disease duration (p = 0.004). A greater number of ERCPs was associated with disease duration (p < 0.0001), obstructed pancreatic duct (p = 0.006), and prior pancreatic surgery (p = 0.006) and increased risk for positive islet culture (p < 0.0001). Mean total IEQ/kg with vs. without prior ERCP were 4145 (95% CI 3621-4669) vs. 3476 (95% CI 2521-4431) respectively (p = 0.23). Adjusting for confounders, islet yield was not significantly associated with prior ERCP, number of ERCPs, biliary or pancreatic sphincterotomy or stent placement.ConclusionsERCP did not appear to adversely impact islet yield. When indicated, ERCP need not be withheld to optimize islet yield but the risk-benefit ratio of ERCP should be considered given its potential harms, including risk for excessive delay in TPIAT. |
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Keywords: | Total pancreatectomy and islet autotransplantation TPIAT ERCP Chronic pancreatitis Recurrent acute pancreatitis |
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