Real-Time, Intraoperative Doppler/Ultrasound Monitoring of Islet Infusion During Total Pancreatectomy With Islet Autotransplant: A First Report

Mary Noory, John F. Renz, Philip L. Rosen, Heena Patel, Alexander Schwartzman, Rainer W.G. Gruessner

Research output: Contribution to journalArticle

Abstract

Chronic pancreatitis (CP), secondary to a wide variety of etiologies, is a progressive and irreversible disease. Initially, CP is managed with endoscopic interventions, long-term analgesia for its associated chronic abdominal pain syndrome and pancreatic enzyme replacement for exocrine dysfunction. As the disease advances, pancreatic drainage procedures and partial resections are considered, but they leave diseased tissue behind and usually result in short-term relief only. Total pancreatectomy alone is widely viewed as a last resort treatment option because it causes brittle diabetes mellitus. However, total pancreatectomy with islet autotransplantation (TPIAT) can prevent the development of diabetes and cure the chronic pain syndrome. One serious, albeit rare, complication of TPIAT is (partial) portal vein thrombosis. Its incidence is probably about 5%. To prevent the occurrence of portal vein thrombosis, we propose herein, and have successfully performed, continuous real-time Doppler ultrasonography during the islet infusion to study portal vein and intrahepatic flow patterns, as well as changes in Doppler signals. Flow and signal changes may allow for timely adjustment of the infusion rate, before a marked increase in portal vein pressure is noted and decrease the risk of portal vein thrombosis.

Original languageEnglish (US)
JournalTransplantation Proceedings
DOIs
StateAccepted/In press - Jan 1 2019

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Doppler Ultrasonography
Pancreatectomy
Autografts
Portal Vein
Thrombosis
Autologous Transplantation
Chronic Pancreatitis
Chronic Pain
Portal Pressure
Pancreatic Diseases
Type 1 Diabetes Mellitus
Analgesia
Abdominal Pain
Drainage
Incidence
Enzymes

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Real-Time, Intraoperative Doppler/Ultrasound Monitoring of Islet Infusion During Total Pancreatectomy With Islet Autotransplant : A First Report. / Noory, Mary; Renz, John F.; Rosen, Philip L.; Patel, Heena; Schwartzman, Alexander; Gruessner, Rainer W.G.

In: Transplantation Proceedings, 01.01.2019.

Research output: Contribution to journalArticle

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