Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

Table 1 Etiology of chronic pancreatitis among patients who underwent intrathecal narcotic pump or total pancreatectomy + islet cell transplantation n (%)

	Idiopathic	Pancreatic divisum	Alcohol induced	Gallstone induced	Auto-immune
ITNP group	6/13 (46.1)	3/13 (23.1)	1/13 (7.7)	2/13 (15.4)	1/13 (7.7)
TP + ICT group	19/30 (63.3)	5/30 (16.7)	4/30 (13.3)	2/30 (6.7)	0/30 (0)

ITNP: Intrathecal narcotic pump; TP: Total pancreatectomy; ICT: Islet cell transplantation.

Table 2 Multiple interventions performed in patients with chronic pancreatitis for pain control before undergoing intrathecal narcotic pump or total pancreatectomy + islet cell transplantation n (%)

	ERCP with sphincterotomy	Celiac Block (EUS or CT)	Jejunal or Gastro-Jejunal tube insertion	Surgeries (denervation or decompression)
ITNP group	13/13 (100)	6/13 (46)	8/13 (61)	8/13 (61)
TP + ICT group	30/30 (100)	15/30 (50)	10/30 (33)	10/30 (33)

ITNP: Intrathecal narcotic pump; TP: Total pancreatectomy; ICT: Islet cell transplantation; EUS: Endoscopic ultrasonography; CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Status of insulin-dependent diabetes among all surgical patients before and after total pancreatectomy with islet cell transplantation

	Number of patients with insulin independence	Average dose of insulin/day (units)	Average HbA1c
Before TP + ICT	30/30 (100%)	0	N/A
After TP + ICT	4/27 (approximately 15%)	25	7.35%

ITNP: Intrathecal narcotic pump; TP: Total pancreatectomy; ICT: Islet cell transplantation.

Table 4 Summary of outcomes among patients with intrathecal narcotic pump and those with total pancreatectomy and islet cell transplantation

	ITNP	TP + ICT	Comparison
Reversibility of the procedure	Yes	No	Different
Success rate for pain control	77%	80%	Similar
Residual narcotic dose usage (mg equivalent of oral morphine sulfate)	Mean = 158 mg/d	Mean = 104 mg/d	Similar
	Median = 8 mg/d	Median = 40 mg/d
Percentage of patients with poor pain control	16.7%	11.1%	Similar
Percentage of patients with new insulin dependent diabetes	0%	Approximately 85%	Different
Procedure related death	0%	10%	Different

ITNP: Intrathecal narcotic pump; TP: Total pancreatectomy; ICT: Islet cell transplantation.