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.
Bibliographical noteFunding Information:
This project was funded by NIDDK R01-DK109124 (PI Bellin). The study investigators would like to acknowledge the contributions of collaborators and coordinators at the participating centers.
M. Bellin discloses research funding from Viacyte and Dexcom, and medical advisory role (DSMB) for Insulet.
To be added. Grant funding, study center personnel. This project was funded by NIDDK R01-DK109124 (PI Bellin). The study investigators would like to acknowledge the contributions of collaborators and coordinators at the participating centers. Minnesota - Jayne Pederson, Peggy Ptacek, Baylor - Rehma Shabbir, Jessica Clark, Cincinnati - Jyoti Patel, Amanda Schreibeis, Dartmouth - Penny Doughty, Johns Hopkins - Mahya Faghih, Pittsburgh - Rita Johnson, Chicago - Lindsay Basto, South Carolina - Jason Hirsch, Ohio State - Jill Buss, UCSF - Joanne Kwan, Louisville - Mechelle Kaufman, Cleveland - Amy Orasko
- Chronic pancreatitis
- Recurrent acute pancreatitis
- Total pancreatectomy and islet autotransplantation
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism