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Pancreatic surgery with islet cell autotransplant is safe and effective to treat the pain of chronic pancreatitis

For appropriately selected patients, pancreatic surgery with autotransplantation of islet cells (pancreatic cells that produce insulin to regulate blood-sugar levels) is a safe and effective treatment of the intractable pain associated with chronic inflammation of the pancreas (pancreatitis), concludes a new study. This condition, most often due to alcoholism, typically causes intermittent anorexia, nausea, vomiting, and abdominal pain. As the disease becomes severe, many patients become malnourished and develop debilitating chronic abdominal pain. Surgery is usually recommended when medical management (with alcohol cessation, diet modification, pancreatic enzyme replacement, and pain control) and endoscopic therapies for obstructing stones or other problems don't work.

Pancreatic surgery without transplanting islet cells recovered from the patient's own pancreas to their liver can create several problems, explain the University of Alabama researchers. It can induce total insulin dependency (and diabetes-related problems) as well as the reduction or absence of other regulatory hormones, resulting in "brittle" diabetes, an unstable metabolic state that is difficult to control.

The researchers retrospectively studied 21 patients who underwent total pancreatic surgery and 6 patients who underwent partial removal of the pancreas with autotransplantation of islet cells at 1 hospital from April 2005 to December 2007. They examined medical charts and hospital clinical databases to track patient outcomes. At 6 months after surgery, 80 percent of reporting patients had decreased or eliminated their use of narcotic medication, and all total pancreatectomy patients required insulin (mean of 23 units per day). Also, patients still had a 13 percent weight loss, underscoring the need for pancreatic enzymes to prevent malabsorption.

The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS13852).

See "Pancreatic resection with islet cell autotransplant for the treatment of severe chronic pancreatitis," by Joshua L. Argo, M.D., Juan L. Contreras, M.D., Mary M. Welsey, M.P.H., and John D. Christein, M.D., in the June 2008 The American Surgeon 74(6), pp. 530-537.

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