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Medicine Grand Rounds - The Dartmouth TPIAT Experience: Have We Made a Difference in a Hopeless Disease?

Dr. Gardner describes several genetic pathways, including the PRSS1, SPINK1 and cystic fibrosis genes that can lead to fibrosis in the pancreas, and reviews the pathophysiology of chronic pancreatitis. He discusses the severe, chronic pain and gastric complications that accompany this condition and the current paradigm for treatment, which favors less invasive measures initially and reserves pancreatectomy for the most refractory cases. Prior to TPIAT (Total Pancreatectomy with Islet Auto Transplantation), patients developed uncontrollable diabetes post pancreatectomy, leading to management challenges and long term metabolic complications that made the procedure a treatment of last recourse. Dr. Gardner chronicles the establishment of a highly successful interdisciplinary team at Dartmouth-Hitchcock that makes possible the recovery and transplantation of the patient’s own islet cells at the time of surgery. This has reduced the risk for severe and labile hyperglycemia, making definitive surgical cure a more appealing option that can prevent significant morbidity and suffering.

Activity Details

Start Date: October 5, 2018
End Date: October 5, 2020

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  • Timothy B. Gardner, MD, MS
    Director, Pancreatic Disorders 
    Medical Director, Pancreatic Islet Autotransplant Program
    Dartmouth-Hitchcock Medical Center
    Associate Professor of Medicine
    Geisel School of Medicine at Dartmouth

    Dr. Gardner completed his undergraduate studies at Dartmouth College, received his MD from the University of Connecticut and completed his Internal Medicine residency, Chief Residency and Gastroenterology fellowship at Dartmouth-Hitchcock Medical Center.  He completed a subspecialty fellowship in Clinical Pancreatology and Advanced Endoscopy at the Mayo Clinic in Rochester, Minnesota.  In 2013, he received a Master’s Degree in Clinical and Translational Research from the Dartmouth Institute.  He is currently the Director of the Gastroenterology and Hepatology fellowship program and Co-Director of the Advanced Therapeutic Endoscopy fellowship. His main focus of research is the treatment of acute and chronic pancreatitis, and he has published over 130 original manuscripts, two books, and edited several reviews on pancreatic disease.  He is a co-author of the American Gastroenterological Association guidelines on the management of acute pancreatitis and is the first author of the upcoming American College of Gastroenterology guidelines on the management of chronic pancreatitis. He is an associate editor of the American Journal of Gastroenterology and serves on the editorial boards of Gastroenterology, Gastrointestinal Endoscopy, and the Journal of Clinical Gastroenterology.
Learning Outcome

At the conclusion of this presentation, learners will be able to describe the physiology and known genetic conditions related to chronic pancreatitis in the United States. They will be able to describe the Dartmouth-Hitchcock experience with total pancreatectomy with islet autotransplantation and discuss avenues for future research to improve the health of patients who have this challenging disease.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for The Dartmouth TPIAT Experience: Have We Made a Difference in a Hopeless Disease? (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Takeda. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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