ORIGINAL ARTICLE Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis George K. John 1 & Vikesh K. Singh 1,2 & Robert A. Moran 1,2 & Daniel Warren 3 & Zhaoli Sun 3 & Niraj Desai 3 & Christi Walsh 1 & Rita R. Kalyani 4 & Erica Hall 4 & Kenzo Hirose 2,3 & Martin A. Makary 2,3 & Ellen M. Stein 1,2,5 Received: 12 September 2016 /Accepted: 30 December 2016 # 2017 The Society for Surgery of the Alimentary Tract Abstract Background The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. Methods A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key Results The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and Inferences Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP- IAT and will need to be better recognized and differentiated to improve the management of these patients. Keywords Post-TP-IAT dysmotility . QOL . Chronic pancreatitis Introduction Total pancreatectomy with islet autotransplantation (TP-IAT) in appropriately selected patients with chronic pancreatitis leads to a sustained improvement in quality of life (QOL) and high rates of opioid independence following surgery. 1 – 5 Recent data also suggests that TP-IAT is associated with de- creased cost and increased quality-adjusted survival leading to lower health care expenditure compared to medical manage- ment of chronic pancreatitis. 6 Apart from the need for insulin in some patients and exocrine failure requiring optimization of pancreatic enzyme replacement and nutrition, TP-IAT has not been associated with many long-term side effects. 3 , 7 , 8 However, we found that 36% of patients experience early The preliminary data for this study was presented as oral and poster presentations on May 19, 2015 and May 24, 2016 at the Digestive Diseases Week at Washington, D.C. and San Diego, respectively. * Ellen M. Stein estein6@jhmi.edu 1 Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD 21287, USA 2 Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD 21287, USA 3 Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD 21287, USA 4 Division of Transplant Surgery, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD 21287, USA 5 Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD 21287, USA J Gastrointest Surg DOI 10.1007/s11605-016-3348-z