TY - JOUR
T1 - Preoperative ERCP has no impact on islet yield following total pancreatectomy and islet autotransplantation (TPIAT)
T2 - Results from the Prospective Observational Study of TPIAT (POST) cohort
AU - Trikudanathan, Guru
AU - Elmunzer, B. Joseph
AU - Yang, Yi
AU - Abu-El-Haija, Maisam
AU - Adams, David
AU - Ahmad, Syed
AU - Balamurugan, Appakalai N.
AU - Beilman, Gregory J.
AU - Chinnakotla, Srinath
AU - Conwell, Darwin L.
AU - Freeman, Martin L.
AU - Gardner, Timothy B.
AU - Hatipoglu, Betul
AU - Hodges, James S.
AU - Kirchner, Varvara
AU - Lara, Luis F.
AU - Long-Simpson, Leslie
AU - Mitchell, Rebecca
AU - Morgan, Katherine
AU - Nathan, Jaimie D.
AU - Naziruddin, Bashoo
AU - Posselt, Andrew
AU - Pruett, Timothy L.
AU - Schwarzenberg, Sarah J.
AU - Singh, Vikesh K.
AU - Smith, Kerrington
AU - Wijkstrom, Martin
AU - Witkowski, Piotr
AU - Bellin, Melena D.
N1 - Publisher Copyright:
© 2020
PY - 2021/1
Y1 - 2021/1
N2 - BACKGROUND AND AIMS: Many 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.METHODS: Using 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.RESULTS: 175 (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.CONCLUSIONS: ERCP 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.
AB - BACKGROUND AND AIMS: Many 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.METHODS: Using 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.RESULTS: 175 (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.CONCLUSIONS: ERCP 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.
KW - Chronic pancreatitis
KW - ERCP
KW - Recurrent acute pancreatitis
KW - TPIAT
KW - Total pancreatectomy and islet autotransplantation
KW - Recurrence
KW - Pancreatectomy/methods
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Male
KW - Pancreatitis/surgery
KW - Young Adult
KW - Islets of Langerhans/diagnostic imaging
KW - Cholangiopancreatography, Endoscopic Retrograde/methods
KW - Adolescent
KW - Islets of Langerhans Transplantation/methods
KW - Adult
KW - Female
KW - Aged
KW - Child
KW - Pancreatic Diseases/surgery
KW - Cohort Studies
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U2 - 10.1016/j.pan.2020.11.008
DO - 10.1016/j.pan.2020.11.008
M3 - Article
C2 - 33323311
AN - SCOPUS:85097657532
SN - 1424-3903
VL - 21
SP - 275
EP - 281
JO - Pancreatology
JF - Pancreatology
IS - 1
ER -