Pancreas Program - Clinical Initiatives

The Comprehensive Pancreas Program has defined clinical initiatives for all pancreatic conditions. The Program is a leader in all areas. Please see the Leadership page.

Acute Pancreatitis

  • Use clinical decision support tools to foster multidisciplinary care, increase use of accepted clinical best practices, improve clinical outcomes and lower hospitalization costs for patients.
  • Evaluate patients following hospital discharge for idiopathic and/or recurrent pancreatitis
  • Manage complications (pseudocysts, pancreatic necrosis, infected necrosis, gastric outlet obstruction).
  • Reduce risks and severity of acute pancreatitis due to the procedure endoscopic retrograde cholangio-pancreatography (ERCP), with the goal of improving outcomes and lowering costs

Chronic Pancreatitis

  • Utilize established clinical diagnostic criteria for chronic pancreatitis and offer additional testing to clarify diagnosis and related treatment plan
  • Review and complete testing to establish the most correct etiologies of pancreatitis
  • Minimize risk of pancreatitis attacks and complications by modifying disease cofactors
  • Identify and manage pancreatitis-related complications, including exocrine pancreatic insufficiency, malnutrition, bone disease, diabetes, pain, biliary obstruction, pseudocysts, pseudoaneurysms and less commonly cancer
  • Coordinate multidisciplinary (medical, endoscopic and surgical) treatments for pain
  • Enter patients into longitudinal patient registry for monitoring care quality and patient outcomes

Autoimmune Pancreatitis

  • Utilize established clinical diagnostic criteria for autoimmune pancreatitis and offer additional testing to clarify diagnosis and related treatment plan
  • Differentiate autoimmune pancreatitis (treatable with medications) from chronic pancreatitis and pancreatic cancer
  • Apply the care model for chronic pancreatitis focused on improving quality of life by lowering the risk of pancreatitis and complications, identifying and treating complications, building mutual understanding of treatment options and entering patients into a patient registry.

Hereditary Pancreatitis

  • Confirm the diagnosis and/or offer appropriate testing to establish or eliminate hereditary pancreatitis as a cause of pancreatitis
  • Offer individual and family genetic counseling in the Gastrointestinal Genetics clinic
  • Apply the care model for chronic pancreatitis focused on improving quality of life by lowering the risk of pancreatitis and complications, identifying and treating complications, building mutual understanding of treatment options and entering patients into a patient registry.
  • Arrange appropriate and timely screening for pancreatic cancer

Exocrine Pancreatic Insufficiency

  • Offer testing for exocrine pancreatic insufficiency (EPI) due to chronic pancreatitis, cystic fibrosis and benign and malignant causes of pancreatic ductal obstruction
  • Differentiate EPI from non-pancreatic causes of maldigestion that may interfere with the effectiveness of pancreatic enzyme replacement therapy
  • Screen for and treat micronutrient deficiency and bone disease

Cystic Fibrosis

  • Offer gastrointestinal and pancreatic disease management for patients under evaluation in the multidisciplinary cystic fibrosis center
  • Investigate and treat exocrine pancreatitis insufficiency and nutritional complications
  • Evaluate and manage luminal gastrointestinal disorders that contribute to symptoms of pain, bloating and constipation in patients with pancreatic disorders
  • Counsel patients on the increased risk of GI malignancy and recommendations to undergo colon cancer screening at age 40 and earlier if they are organ transplant recipients

Pancreatic Cysts

  • Provide multidisciplinary evaluation of pancreatic cysts
  • Utilize latest medical advances and clinical guidelines in the diagnosis and management of pancreatic cysts
  • Provide evidence-based risk stratification of cysts
  • Employ endoscopic or surgical therapy when clinically appropriate

Pancreatic & Ampullary Cancer

  • Provide multidisciplinary evaluation of pancreatic masses to differentiate cancer, chronic pancreatitis and autoimmune pancreatitis
  • Establish diagnosis with endoscopic ultrasound with fine needle aspiration or biopsy
  • Relieve biliary obstructions with endoscopic retrograde cholangiopancreatography (ERCP) or intestinal obstruction with endoscopic stenting
  • Aid targeted radiation therapy with placement of fiducials by endoscopic ultrasound
  • Resect ampullary adenomas endoscopically when appropriate
  • Offer genetic testing and counselling for suspected hereditary pancreatic cancer syndrome or GI cancer syndromes
  • Consider whether pancreatic or ampullary cancer associates with multi-organ GI cancer syndromes (e.g. familial adenomatous polyposis)
 

Neuroendocrine Tumor

  • Differentiate pancreatic neuroendocrine tumor from other solid and cystic pancreatic lesions
  • Classify tumors as functioning (secreting specific hormones) or non-functioning
  • Clarify whether tumors are sporadic or associated with multi-organ syndromes
  • Determine appropriateness of monitoring vs surgical resection of tumors