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Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

Faghih, Mahyab; Garcia Gonzalez, Franciscob; Makary, Martin A.c; Singh, Vikesh K.a,b

Current Opinion in Gastroenterology: September 2017 - Volume 33 - Issue 5 - p 330–338
doi: 10.1097/MOG.0000000000000390
ENDOSCOPY: Edited by Anthony Kalloo

Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis.

Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy.

Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.

aPancreatitis Center

bDivision of Gastroenterology

cDepartment of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Correspondence to Vikesh K. Singh, MD, MSc, Division of Gastroenterology, Johns Hopkins Hospital, 1830 E. Monument Street, Room 428, Baltimore, MD 21205, USA. Tel: +1 410 614 6708; fax: +1 410 614 7631; e-mail: vsingh1@jhmi.edu

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