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

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, Katherine Morgan, Jaimie D. NathanBashoo Naziruddin, Andrew Posselt, Timothy L. Pruett, Sarah J. Schwarzenberg, Vikesh K. Singh, Kerrington Smith, Martin Wijkstrom, Piotr Witkowski, Melena D. Bellin

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)275-281
Number of pages7
JournalPancreatology
Volume21
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Chronic pancreatitis
  • ERCP
  • Recurrent acute pancreatitis
  • TPIAT
  • Total pancreatectomy and islet autotransplantation

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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