Pancreaticobiliary Center Provides Innovative Care

Pancreaticobiliary disorders - diseases of the pancreas, liver, gall bladder and bile duct - are highly complex in nature, making management of these diseases difficult and exacting. Patients are often referred to more than one specialist to deal with the various aspects of their illness; this can this can be time-consuming and might delay treatment. It also causes frustration for the patient. Fortunately, individuals with disorders of the pancreas and hepaticobiliary system can find help and hope at the Pancreaticobiliary Center at Froedtert & The Medical College of Wisconsin.

The Pancreaticobiliary Center, directed by Kulwinder S. Dua, MD, MRCP, DMSc, FACP, FRCP, Associate Professor of Medicine, (Gastroenterology & Hepatology), uses a multidisciplinary approach to care for patients with benign and malignant diseases of the pancreatic and hepatico-biliary systems.

Some of these diseases include acute or chronic pancreatitis; pancreatic cancer; cystic lesions of the pancreas; gallstone-related conditions affecting the gall bladder, bile ducts, and pancreas; obstruction of the bile duct from other causes like strictures and cancers; and conditions affecting the liver such as primary cancers, metastases, abscesses and diseases of the bile ducts within the liver.

"The Pancreaticobiliary Center is incorporated into the Digestive Disease Center and includes experts in many fields," says Dr. Dua. "With many specialists under one roof, we can provide a safe, expedited, multidisciplinary approach to our patients."

The Center offers:

• Some of the country's foremost pancreatic and hepatico-biliary disease specialists.
• Quick evaluation of patients and rapid turnaround, frequently providing answers and treatment before patients leave the hospital.
• On-site treatments ranging from basic to cutting-edge.
• Opportunities to enroll in the latest research studies including new treatment modalities for those in whom standard treatment did not work.
• Patient education.
• Research, innovations and inventions.

A Team Approach
This nationally and internationally recognized Center's multidisciplinary team comprises therapeutic pancreaticobiliary endoscopists, gastroenterologists, radiologists, pancreaticobiliary and laparoscopic surgeons, medical oncologists, radiation oncologists, and pathologists.

Team members are experienced in providing the latest technologies and procedures for treating patients, frequently using innovative new techniques, instrumentation and research protocols, especially for those patients in whom standard treatments have failed. "If a patient is referred to me and I know this is a case that would be better dealt with by a surgeon, I send the patient to the surgeon. We approach all patients as a team," Dr. Dua says.

For example, if a patient comes to the Center and has a pancreatic mass, a group of specialists will treat the individual. The radiologist and the gastroenterologist may use any of a variety of techniques in establishing the diagnosis and evaluating the extent of disease, including:

• pancreas protocol CT scan
• MRI (magnetic resonance imaging)
• MRCP (magnetic resonance cholangeopancreatography)
• endoscopic retrograde cholangio-pancreaticogram
• endoscopic ultrasound with fine needle aspiration
• cytologic brushings
• biopsy

The patient's findings are discussed at the regularly scheduled pancreaticobiliary center meetings attended by all the experts and the patient is then offered the most appropriate treatment plan.

While cancer treatment is a big part of the Center's work, many other diseases are addressed. For example, using a non-surgical endoscopic approach, stones can be removed from the bile duct. "When there is back-up of bile (which causes yellowing of the eyes and skin) due to a narrowing in the bile duct, besides making a diagnosis, we are able to relieve the obstruction with balloon stretching or stenting, somewhat similar to coronary artery heart surgery," says Dr. Dua.

Many other conditions, including leakages in the bile or the pancreatic ducts, cysts, infection in the bile and some congenital pancreaticobiliary disorders can also be treated using endoscopic non-surgical techniques. According to Dr. Dua, these techniques do not preclude subsequent surgery if required. In fact, the physicians will work collaboratively to the benefit of the patient. For example, the surgeon can remove the gall bladder laparoscopically while a stone stuck in the bile duct can be removed endoscopically. This approach may significantly reduce operative time.

Experimental Treatment Modalities
The Pancreaticobiliary Center provides cutting-edge diagnosis and treatment of pancreatic and hepaticobiliary diseases, including an opportunity to take part in new diagnostic and treatment modalities not available elsewhere. "Patients have come here from all over the country for treatment," says Dr. Dua.

The Center is very active in basic and clinical research. Interested and eligible patients are given the opportunity to participate in ongoing clinical research protocols. New techniques and treatments are continuously under investigation to improve the management of Pancreaticobiliary diseases.

"Research is a big pillar of the Pancreaticobiliary Center. We are conducting our own studies or participating in studies on an international basis," Dr. Dua says. Results from these studies have been presented at several international meetings and published in peer-reviewed journals. Members of the Pancreaticobiliary Center have been invited to participate in national and international meetings and have performed procedures in live therapeutic endoscopic courses.

Support is Key
Patients and their families who are looking for support groups can also find them at the Pancreaticobiliary Center. A dedicated nurse coordinator serves to help patients navigate the system, helping to facilitate consultations and referrals.

Combining innovative research, the expertise and excellence of a multidisciplinary team and state-of-the-art technology, the Pancreaticobiliary Center at Froedtert & the Medical College provides a range of services for patients that is matched by few other medical centers. The Center's record for successful outcomes and patient safety in treating pancreatic and biliary diseases is widely recognized, leading to a rapidly rising number of patients being treated by its outstanding medical team.

Patients may reach the Pancreaticobiliary Center by calling the Digestive Disease Center, Division of Gastroenterology & Hepatology, at 414-456-6830, or the Medical College of Wisconsin's Appointment Services line at 414-805-3666 (toll free 800-272-3666).

JoAnn Petaschnick
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.