What are the Treatment Options for Pancreatitis? | Q&A


[MUSIC] I am Vikesh Singh, I am a
gastroenterologist at Johns Hopkins. I am the director of the Pancreatitis
Center. And I am the Medical Director of the Islet
Auto-Transplantation program. I specialize in inflammatory dis,
disorders of the pancreas, as well as interventional
endoscopy. [MUSIC] There are many options for the treatment
of chronic pancreatitis. These include medical, endoscopic, and
surgical options. All patients are offered medical options
for treatment. These treatments focus on the pain of
chronic pancreatitis. These typically include adherence to a low
fat diet, avoidance of alcohol and tobacco, the use of pancreatic enzyme
supplements, as well as pain medication. Unfortunately, most patients will not
respond to medical treatments for chronic
pancreatitis. The other options include endoscopic and surgical treatment of chronic
pancreatitis. Endoscopic therapy is most commonly
offered to those patients who have a dilated
pancreatic duct. These patients can undergo an endoscopic
procedure known as an endoscopic retrograde
cholangiopancreatography, and the goal of this procedure is to dilate strictures, to
remove pancreatic duct stones and to place
pancreatic ducts stents. [MUSIC] For those patients with small duct disease
they can be offered procedures such as the Whipple,
and total pancreatectomy. And for patients with large duct disease,
they can be offered procedures such as the Frey and
Puestow. [MUSIC] At Johns Hopkins, we have a team-based
approach to evaluating and managing patients with
chronic pancreatitis. We are constantly looking for new medical,
endoscopic and surgical therapies for treating the
very difficult patients. There have been some developments in the field of endoscopic ultrasound with celiac
plexus blockade. This procedure can be used to help alleviate the pain associated with chronic
pancreatitis. At least in the short term as more long
term options are pursued. The the greatest option that has emerged
over the years for the surgical treatment of chronic pancreatitis is total pancreatectomy with or without islet cell
auto-transplantation. [MUSIC] The selection of the optimal candidate
with chronic pancreatitis for a total pancreatectomy with or without islet cell auto-transplantation is a complex and
difficult process. This typically involves the coordinated
evaluation of the patient by a team of specialists including a
gastroenterologist, a surgeon, a pain management specialist, and an
endocrinologist. [MUSIC] Johns Hopkins offers a team-based approach
to the care of patients with chronic
pancreatitis. We have a group of dedicated subspecialists who evaluate each and every
patient. And then we meet to discuss how we may
best offer individualized therapy. [MUSIC]