Diseases of the pancreas and biliary tract are often complex and difficult to manage. A new clinic at The Nebraska Medical Center, the Comprehensive Pancreatobiliary Disorders and Autologous Islet Transplantation Clinic, was developed to provide a full spectrum of diagnostic and therapeutic approaches for a wide variety of non-malignant pancreatic and biliary diseases. The most common conditions treated at the clinic include acute and chronic pancreatitis.
The clinic brings together the expertise of gastroenterologists, endocrinologists, surgeons, pain specialists, nutritionists, nurse coordinators and social workers who collaborate and develop a personalized plan of care for each patient.
“These patients have complex problems and often they get left behind,” says Luciano Vargas, MD, surgeon at The Nebraska Medical Center, who specializes in diseases of the pancreas, liver and kidneys, as well as liver, pancreas and intestinal transplantation.
Together, Dr. Vargas and his colleagues bring a wealth of experience and expertise in diseases of the liver and pancreas that allow them to draw from three distinct perspectives to provide a comprehensive plan of care that is concise, well thought out and employs a very efficient use of the patient’s time.
About 300,000 cases of acute pancreatitis occur annually in the United States. Among gastrointestinal diseases, acute pancreatitis is the most common single reason for hospitalization. The majority of cases of acute pancreatitis are related to gallstones and alcohol use. Most cases of acute pancreatitis will resolve on their own. However, about 20 percent of cases can progress to severe acute pancreatitis. Repeated episodes of acute pancreatitis can lead to scarring in the pancreas and development of chronic pancreatitis.
“Chronic pancreatitis patients often have chronic pain, frequent flare-ups and may need repeated hospitalizations,” says Dr. Vargas. “Some are unable to work due to chronic pain.”
Compounding the problem is the fact that chronic pancreatitis can be difficult to diagnose and is often misdiagnosed and underdiagnosed, says Shailender Singh, MD, gastroenterologist at the clinic, who specializes in diseases of the pancreas. “A CAT scan or MRI can look completely normal and endoscopic ultrasound by itself is a very subjective test that can be difficult to evaluate unless you have a lot of experience.”
Dr. Singh has received specialized fellowship training in endoscopic ultrasound and performs the secretin stimulated endoscopic pancreatic function test. This is considered to be the most accurate and sensitive diagnostic test available for chronic pancreatitis and is available nowhere else in the region.
Management of the condition often involves diet restrictions, the elimination of alcohol and smoking, pancreatic enzyme replacement and narcotics to control the pain. If this does not relieve symptoms, other approaches will be explored including several endoscopic approaches and surgical procedures, all of which are performed by physicians at the clinic. “We offer the entire spectrum of care options,” says Dr. Vargas.
If patients continue to have debilitating pain despite all medical and endoscopic therapies, the patient will be evaluated for total pancreatectomy with auto islet cell transplant, a procedure performed at only a few medical centers in the country.
Dr. Vargas who trained at The Nebraska Medical Center, is one of the early adopters of this transplant procedure. “The procedure can literally change a person’s life,” says Dr. Vargas.
Unfortunately, not all patients end up with total pain relief. “There is no one panacea for most patients,” says Dr. Singh. “Our goal is to help them manage their pain at a level that is tolerable and allows them to function normally. We are a place that these patients can go and know that they are receiving the most advanced treatment options available anywhere. We are in it with them for the rest of their lives.”