The University of Colorado Department of Surgery has been named a Pancreatitis Center of Excellence by the National Pancreas Foundation, providing potential new treatment options — including surgical options — for people with chronic inflammation of the pancreas.
“Chronic pancreatitis is often not treated surgically as soon or as often as it should be, which results in patients living with a great deal of pain,” says Marco Del Chiaro, MD, PhD, director of the new center of excellence and professor of surgery and division chief of surgical oncology in the CU School of Medicine. “Several studies have shown that surgery is superior to endoscopic procedures for certain types of pancreatitis, but surgery needs to be done early if you want to have an effect.”
Team of specialists
Patients in the new center will be seen by a multidisciplinary team, similar to the teams that see patients at the CU Cancer Center. Specialists from multiple disciplines will gather to discuss a patient’s case and come up with a treatment plan.
“Instead of coming to see me as a surgeon or going to a gastroenterologist, the patient comes to a place where you have a group of experts in the field working together to find the best path of treatment, then revising it together as needed,” Del Chiaro says. “A patient’s case might be reviewed by a nutritionist, a diabetologist, an endoscopist, a gastroenterologist, a surgeon, a radiologist, and a pathologist.”
Causes and treatments
Chronic pancreatitis has many potential causes, including alcohol use, smoking, autoimmune conditions, metabolic disease, and the abnormal growths of tissue known as neoplasms. In the long term, some studies show that chronic pancreatitis has a mortality rate similar to some types of cancer, Del Chiaro says, primarily because it causes intense pain that is typically managed with opioids that have the potential for abuse.
The condition can be managed through endoscopic procedures such as placing a stent or draining fluid, but in more serious cases, surgery may be needed to remove obstructions or drain pancreatic ducts. It’s important to develop a treatment plan as soon as possible, Del Chiaro says, not only because the extreme pain caused by the condition can affect quality of life, but because if it is left untreated, the pain can become permanent.
“When it becomes really bad, those patients are unable to work, unable to drive, because they are generally taking massive amounts of painkiller drugs, mostly narcotics,” he says. “We only have a short window of intervention, especially for surgery. The pain is located in the pancreas at the beginning, but after a certain amount of time, the pain becomes what we call a central pain that is located in the brain. If you miss the window of opportunity, the risk is that the pain will become untreatable, and the patient will live with the pain for the rest of their life.”
