Pancreatology – Dr Alok

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About Pancreatology

The pancreas is an organ situated behind the stomach inside the abdomen. It is composed of two main components, namely the exocrine pancreas and the endocrine pancreas.The exocrine pancreas is responsible for secretion of digestive enzymes that are primarily responsible for digestion of fat, protein and carbohydrate consumed in our diet. The endocrine pancreas produces hormones such as insulin and glucagon, which are responsible for the control of blood glucose.The pancreas could be afflicted by a few specific diseases, namely, acute pancreatitis, chronic pancreatitis, pancreatic cancer, pancreatic neuroendocrine tumours, cystic tumours of the pancreas and autoimmune pancreatitis. Out of these, the first two conditions, i.e. acute and chronic pancreatitis are common in India; and the incidence of pancreatic cancer also appears to be rising.Acute pancreatitis results most commonly from excessive alcohol intake and small stones in the gallbladder. Smoking could also cause acute pancreatitis, along with other causes such as high triglyceride and calcium in the blood, certain drugs and genetic abnormalities. In acute pancreatitis, there is sudden onset of swelling in the pancreas and could be associated with life-threatening situations such as organ failure and infections.Chronic pancreatitis in India is most commonly idiopathic, meaning definite cause cannot be identified on routine testing. Many of these patients have different genetic abnormalities that could contribute to the development of chronic pancreatitis. Other important causes include alcohol and smoking. Chronic pancreatitis is characterised by a decrease in the size of the pancreas, increase in size of the pancreatic duct, the formation of pancreatic duct stones or narrowing (called stricture), calcium deposits in the pancreatic tissue, and development of diabetes. A small proportion of patients with chronic pancreatitis could progress to develop pancreatic cancer, especially those who have disease onset at an early age. The predominant clinical symptom of chronic pancreatitis is a recurrent abdominal pain.Diagnosis:The Asian Institute of Gastroenterology has all the up-to-date biochemical radiological and pathological facilities to diagnose pancreatic diseases and the complications.CT scan, MRI/MRCP and endoscopic ultrasonography (EUS) could detect pancreatitis, pancreatic cysts and tumours. In addition to the routine tests, we also offer a CP nutrition package that assesses the nutritional status and markers of oxidative stress, which is important especially in patients with chronic pancreatitis.We also offer genetic testing for pancreatitis and include 13 common individual genes in the test panel, which is the highest number done in India at present. The results are discussed in details with the patients and their relatives, and they are appropriately counselled before and after the test.Treatment offered:

At AIG, we see over 2000 patients with acute pancreatitis (new and follow-up) and a similar number of patients with chronic pancreatitis every year. We also see a substantial number of patients with pancreatic cystic tumours, pancreatic tuberculosis, pancreatic cancer and occasionally autoimmune pancreatitis.

Most of the new patients with pancreatic diseases are directed to the PANCREAS CLINIC where the preliminary assessments are done. Depending on the patient symptoms, laboratory results and imaging (USG, CECT, MRI/MRCP, EUS findings), individualized treatment is planned for each patient. Patients requiring endoscopic treatment or surgery are then directed to the respective departments for specific treatment. After interventions, the patients return to the PANCREAS CLINIC where they are followed on a regular basis.

For complex problems, a collective decision is taken in a MULTIDISCIPLINARY PANCREAS MEETING, which is conducted every Thursday morning and is attended by pancreatologist, medical gastroenterologist, pancreatic surgeons, interventional radiologists and nutritionist.

The PANCREAS CLINIC is also linked with the research laboratories, and many of the eligible patients are enrolled in research protocols if they provide informed consent to participate. Currently, the PANCREAS CLINIC is involved in research projects on the gut microbiota in pancreatic diseases, diabetes related to pancreatitis (Type 3c DM), development of treatment for inflammation in acute pancreatitis and pain in chronic pancreatitis, to name a few.

Interventions:

The PANCREAS CLINIC works closely with the advanced endoscopy team, surgeons, interventional radiologists, nutritionists, and the basic sciences research team.

For patients requiring endoscopic treatment, we offer ESWL and ERCP for pancreatic stones, ERCP and pancreatic duct stenting for pancreatic duct strictures, EUS guided drainage or walled of pancreatic necrosis. Many patients with walled pancreatic necrosis are treated by percutaneous catheter drainage by the interventional radiologists, and some of them require surgical drainage.

Patients with chronic pancreatitis requiring surgery are offered Whipple’s operation, Frey’s procedure, lateral pancreaticojejunostomy, distal pancreatectomy, depending on the primary diagnosis and patients clinical condition.

For pseudoaneurysms associated with pancreatitis, patients are usually treated with angioembolization by the interventional radiologists’ team, while occasionally patients require surgical intervention.

A specific subgroup of patients who undergo removal of part of the pancreas for chronic pancreatitis are offered islet transplantation, and eligible patients with chronic pancreatitis and related diabetes are offered mesenchymal stem cell transplantation. Details of these two procedures are available in the REGENERATIVE MEDICINE section of this website.