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Treatment options for pancreatitis [Transcript]

Vikesh Singh, MD, MSc, talks about pancreatitis.Vikesh Singh, MD, MSc, discusses treatment options for pancreatitis.
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Featuring Vikesh Singh, M.D., M.Sc., Assistant Professor of Medicine; Director, Pancreatitis Center

Describe what you do.

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 disorders of the pancreas as well as interventional endoscopy.

How is chronic pancreatitis treated?

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, 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 for 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. The goal of this procedure is to dilate strictures, to remove pancreatic duct stones and to place pancreatic duct stents.

What if medical therapy isn’t working?

For those patients with small duct disease, they can be offered procedures such as the Whipple and total pancreatectomy. For those patients with large duct disease, they can be offered procedures such as the Frey and Puestow.

Are there any new options for treating pancreatitis?

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 these 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, as least in the short term as more long term options are pursued. The greatest option that has emerged over the years for the surgical treatment of chronic pancreatitis is total pancreatectomy with or without islet cell transplantation.

What patients could benefit from auto islet transplant?

The selection of the optimal candidate with chronic pancreatitis for 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.

Why should someone come to Johns Hopkins for pancreatitis treatment?

Johns Hopkins offers a team-based approach to the care of patients with chronic pancreatitis. We have a group of dedicated sub-specialists who evaluate each and every patient and then we meet to discuss how we may best offer individualized therapy.

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