The overall goals of the proposed application are: (1) to prepare the principal investigator for an independent career in patient-oriented clinical research and (2) to definitively establish and validate baseline endoscopic ultrasound (EUS) test characteristics used for the diagnosis of chronic pancreatitis (CP). Dr. Gardner hypothesizes that cataloguing and standardizing EUS abnormalities will improve interoperative agreement and therefore enable a higher degree of diagnostic accuracy for CP. Dr. Gardner completed an advanced fellowship in clinical pancreatology at the Mayo Clinic in Rochester, MN where he refined his skills in EUS and cemented his interest in caring for patients with CP. He is currently the Director of Pancreatic Disorders at Dartmouth-Hitchcock Medical Center where he performs 500 EUS examinations yearly and has completed several preliminary studies evaluating the role of EUS in diagnosing early CP. This award should provide the framework for Dr. Gardner to pursue his long-term goal of establishing and validating a novel, evidence-based diagnostic criteria for CP through an R01 or equivalent. During the grant period he will take coursework in clinical research and biostatistics leading to a Masters of Science degree at the Dartmouth Institute. He has enlisted the support of world-renowned clinician/researchers to support his career development and the research proposal. For this project, he will survey expert endosonographers, conduct a videoclip interpretation study and perform tandem EUS examinations to learn which morphologic features are most relevant to endosonographers when diagnosing CP and the inter- and intra-rater reliability of each morphologic EUS feature between endosonographers. Additionally, he will perform EUS exams on patients with and without pancreatic disease to learn which features are present in normal patients and whether any alterations occur with aging and the influence of body mass index, clinical symptoms, health habits, and comorbidity on EUS features. Finally Dr. Gardner will perform combined secretin-enhanced EUS in patients with suspected CP to learn the duodenal bicarbonate concentration in subjects with and without pancreatic disease. This study should lead to better consensus among endosonographers, more appropriate classification of EUS abnormalities in the normal and diseased pancreas, and validation of secretin EUS as a practical and useful tool for the diagnosis of CP.

Public Health Relevance

As it is increasingly apparent that early stage chronic pancreatitis needs to be diagnosed appropriately so that disease modifying therapies can be initiated, the importance of accurate EUS diagnosis is critical. Cataloguing and standardizing EUS abnormalities will allow physicians to better understand how to interpret this test so that patients can be confidently diagnosed and treated.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
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Dartmouth College
Internal Medicine/Medicine
Schools of Medicine
United States
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Gardner, Timothy B (2014) Celiac disease and congenital malformations: muddying the waters. Clin Gastroenterol Hepatol 12:1117-8
Gardner, Timothy B; Munson, Jeffrey C; Morden, Nancy E (2014) The FDA and prescription pancreatic enzyme product cost. Am J Gastroenterol 109:624-5
Gardner, Timothy B; Taylor, Dean J; Gordon, Stuart R (2014) Reported findings on endoscopic ultrasound examinations for chronic pancreatitis: toward establishing an endoscopic ultrasound quality benchmark. Pancreas 43:37-40
Glass, Lisa M; Whitcomb, David C; Yadav, Dhiraj et al. (2014) Spectrum of use and effectiveness of endoscopic and surgical therapies for chronic pancreatitis in the United States. Pancreas 43:539-43
Gardner, Timothy B; Hessami, Nigeen; Smith, Kerrington D et al. (2014) The effect of neoadjuvant chemoradiation on pancreatic cancer-associated diabetes mellitus. Pancreas 43:1018-21
Levenick, John M; Andrews, Catherine L; Purich, Edward D et al. (2013) A phase II trial of human secretin infusion for refractory type B pain in chronic pancreatitis. Pancreas 42:596-600
Gardner, Timothy B; Glass, Lisa M; Smith, Kerrington D et al. (2013) Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol 108:1546-50
Gardner, Timothy B; Purich, Edward D; Gordon, Stuart R (2012) Pancreatic duct compliance after secretin stimulation: a novel endoscopic ultrasound diagnostic tool for chronic pancreatitis. Pancreas 41:290-4
Pelley, Joshua R; Gordon, Stuart R; Gardner, Timothy B (2012) Abnormal duodenal [HCO3-] following secretin stimulation develops sooner than endocrine insufficiency in minimal change chronic pancreatitis. Pancreas 41:481-4
Klibansky, David A; Reid-Lombardo, Kaye M; Gordon, Stuart R et al. (2012) The clinical relevance of the increasing incidence of intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol 10:555-8

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