Evaluating will become insulin dependent in the long term

Evaluating the treatment of endocrine insufficiency following total pancreatectomy with islet autotransplantation – A systematic reviewWill WilsonA systematic review of the literature was performed to evaluate total pancreatectomy with islet autotransplantation (TPIAT), with the goal of ascertaining the efficacy of the procedure in preventing endocrine insufficiency and its overall viability as a treatment in terms of patient quality of life.Chronic pancreatitis is characterized by irepariable structural and functional deformations as a result of  long-term inflammation of the pancreas. This is associated with unmanageable pain, digestive problems, and diabetes mellitus. Chronic pain is the most debilitating symptom of chronic pancreatitis and often more difficult to manage than its connected endocrine or exocrine problems. A carefully managed progression from non-opioid to opioid painkillers is appropriate in the management of chronic pancreatitis. Laparoscopic surgeries also aim to identify the cause of the blockage and determine the best surgical course of action. If partial surgical measures fail, patents may opt for total pancreatectomy (TP) to eliminate the symptoms of pain.Utilizing islet autotransplantation to treat post operative endocrine insufficiency was first reported thirty years ago. Since the technique was first described, the methods for pancreatic islet isolation after TP have greatly improved. However the efficacy of the procedure in preventing long term endocrine insufficiency have not been determined. This project  systematically reviews the literature on endocrine insufficiency following TPIAT for chronic pancreatitis in an attempt to determine the viability of TPIAT in preventing endocrine insufficiency and how else endocrine function can be restored following TP.If the efficacy of TPIAT is evaluated in preventing endocrine insufficiency then TPIAT will demonstrate full endocrine function in some patients however the majority will become insulin dependent in the long term resulting in extraneous insulin being used to maximize endocrine function. PubMed was searched throughout the course of this study. The following key terms were included: total pancreatectomy with islet autotransplantation, outcomes, postoperative, pancreatic insufficiency, endocrine insufficiency. Search terms were combined using Boolean operators. PRISMA Guidelines were consulted when developing the search strategy.The primary outcome measures was the percentage of patients achieving insulin independence following TPIAT.  Narcotic requirements was used as a secondary outcome measure to quantify patient quality of life. Postoperative insulin independence was reported as an outcome measure in each of the 6 studies. Insulin independence ranged from 30.4%5 to 46.15%7.  Mean follow up dates varied from 6-17 months. Long term data was not provided by each article. 3 of the 6 studies reported narcotic requirements as an outcome measure. Narcotic use postoperative narcotic use ranged from 10.4%.5 to 41.7%6 Almost all patients required narcotics pre-operation. After TPIAT on average 24.03% of patients maintained narcotic requirements. The results of this experiment demonstrate that TPIAT is a viable treatment option for patients dealing with unmanageable pancreatitis related pain as a result of its decline in narcotic requirements, however, full insulin independence is only achieved by approximately 40% of patients indicating a lack of efficacy in eliminating endocrine insufficiency.


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