- Email: [email protected]
Risk factors of complications in pancreaticoduodenectomy. Prospective study
Abstracts / Pancreatology 17 (2017) SS1eSS21
30. Analysis and predictive factors of splanchnic vein thrombosis in acute pancreatitis pez Valenciano 1, F. Bolado Concejo 1, H. Canaval Zuleta 2, R. C. Marra-Lo Rivera Irigoin 3, F.J. Grau García 4, J. Boadas Mir 5, J. Millastre Bocos 6, D. Martínez Ares 7, M.A. Marcaide Ruiz de Apodaca 8, E. de Madaria Pascual 9 1
Complejo Hospitalario Navarra, Pamplona, Spain Hospital Son Llatzer, Palma de Mallorca, Spain 3 Hospital Costa del Sol, Marbella, Spain 4 Hospital Arnau Vilanova, Lleida, Spain 5 Consorci Sanitari Terrasa, Terrasa, Spain 6 Hospital Universitario Lozano Blesa, Zaragoza, Spain 7 Complejo Universitario de Vigo, Vigo, Spain 8 Hospital Universitario Araba, Vitoria-Gasteiz, Spain 9 Hospital General Universitario de Alicante, Alicante, Spain 2
Background: Splanchnic vein thrombosis (SVT) is a rare complication of acute pancreatitis (AP) and may adversely influence clinical course of AP. Aim: To determine the incidence and impact of SVT in AP and to identify risk factors for SVT. Methods: A multicentric prospective AP registry was employed. All patients with SVT were selected. Demographic, clinical outcome measures were compared between patients with or without SVT. Both univariate and multivariate logistic regression analysis were applied to identify independent risk factors for SVT. Results: 1661 AP patients from 23 centers were enrolled. SVT was detected in 3.6% (60 patients), more frequent in men, in younger patients and in presence of alcohol consumption. SVT was associated with more severe AP (28.3% vs 6%, p<0.001) and necrotizing AP, increased LOS (27.8 days in SVT-AP group vs 11.2 days in non SVT-AP group, p<0.001). Organ failure (41,6% vs 13%, p<0.001), pancreatic infection (21,6% vs 2,75%, p<0.001) and ICU admission (35% vs 6.6%, p<0.001) were also more common in patients with SVT. Mortality (20% vs 3.6%, p<0.001) was significantly higher in SVT-AP patients. In univariate analysis male gender (OR 2.42 P<0.003), necrotising pancreatitis (OR 14.85 p<0.001), and both parenchymal and peripancreatic acute necrosis (10.84 and 5.11 respectively) were associated to SVT. In multivariate analysis only an acute necrotic parenchymal collection was found as an independent risk factor for thrombosis (OR 7.42 p<0.001). Conclusion: SVT is rare in AP patients. SVT development in AP is associated with worse clinical outcomes. Necrotizing AP patients are more commonly affected by SVT. Parenchimal necrosis, unlike peripancreatic necrosis, was the only independent risk factor identified for SVT.
31. Usefulness of M-ANNHEIM clasiffication for chronic pancreatitis in a Spanish cohort (RIPPE registry) pez Lo pez 1, C. Marra-Lo pez Valenciano 1, M. Casi Villarroya 1, E. S. Lo Martínez Moneo 2, C. Gil García-Ollauri 2, A. del Pozo García 3, J.M. Mateos n Ballester 6, F. Bolado Concejo 1 Rodriguez 4, M.L. Ruiz Rebollo 5, M.D. Higo 1
Complejo Hospitalario de Navarra, Pamplona, Spain Hospital Universitario de Cruces, Barakaldo, Spain 3 Hospital Universitario 12 de Octubre, Madrid, Spain 4 ceres, Spain Hospital San Pedro Alcantara, Ca 5 Hospital Clínico de Valladolid, Valladolid, Spain 6 Hospital Universitario y Politecnico la Fe, Valencia, Spain 2
Background: Chronic pancreatitis (CP) is a complex disease. It results from the interaction of multiple etiologies. The M-ANNHEIM classification is a multiple risk factor system validated for CP. It categorizes clinical presentation and assesses the severity of CP. However its use in clinical practice is uncommon.
S11
The Spanish Pancreatic Diseases Patients Registry (RIPPE) is a nationwide registry supported by AESPANC to better understand the natural history of pancreatic disorders. Objective: To evaluate M-ANNHEIM classification in the RIPPE cohort. Methods: RIPPE CP patients recruited between October 2015 and March 2017 were included. A descriptive analysis of demographics and different etiologies were performed. CP diagnostic criteria were adapted under recent guidelines. M-ANNHEIM clinical staging, and severity index (according to clinical features), were calculated for RIPPE patients in a web-tool using a validated scoring system. Results: 121 patients from 19 hospitals were included, 82.6% men (mean age 50.6 years (SD¼13.54)). Charslon score 1.27 (SD¼1.5). Risk factors according to M-ANNHEIM classification are shown in table 1. In this registry, alcohol and nicotine consumption were the main etiologies. 81,82% of patients presented advanced PC at the Clinical stage (table 2). 31,4% of PC shown an advanced or worse severity level (>10 points) in the Severity index (table 3). Conclusions: Analysis of RIPPE under M-ANNHEIM classiffication demonstrates that individuals with similar clinical features can experiment different clinical presentations and grades of severity. This data supports the usefulness of this tool, although large prospective studies are needed. According to RIPPE, CP in early stages is still underestimated.
32. Analysis of hemorrhagic complications in 200 pancreaticoduodenectomies with pancreaticogastrostomy nchez Acedo, J. Herrera Cabezo n, C. Zazpe A. Goikoetxea Urdiain, P. Sa Ripa, A. Traifa Castilla Complejo Hospitalario de Navarra, Pamplona, Spain Background: Recent studies have shown that pancreaticoduodenectomy (PD) with pancreaticogastrostomy (PG) decreases the incidence and severity of postoperative pancreatic fistula (POPF). Postoperative hemorrhage complications (PPH) are increasing their relevance as one of the main complications due to their incidence and severity. Methods: Data from 200 PD with PG were collected prospectively between 2008 and 2016. PPH was defined and classified according to the ISGPS criteria. We analyzed the morbidity according to Clavien-Dindo classification. Results: A total of 106 (53%) patients had postoperative complications. 42 (21%) of them had hemorrhagic complications. Twenty seven (13.5%) were classified as severe (Clavien III). The bleeding was intraluminal in 30 (15%) cases, extraluminal in 10 (5%), and intra-/extraluminal in two (1%). Regarding the time of presentation, in 32 (16%) cases it was late and in 10 (5%) early. Nine (4.5%) patients were reoperated because of hemorrhage: seven due to bleeding of the border of a pancreatic section, one hemoperitoneum, and one for drainage of an infected hematoma. Eight (4%) patients were readmitted with PPH within the first 30 days after surgery. Overall 90 days mortality was 4% (8 patients). 5 patients died due to PPH. Conclusions: One-fifth of the patients suffered hemorrhagic complications. PPH is the second complication in incidence, after delayed gastric emptying. PPH is the first cause of mortality, reoperation and the second cause of readmission in our series.
33. Risk factors of complications in pancreaticoduodenectomy. Prospective study nchez-Acedo, A. Goikoetxea-Urdiain, J. Herrera-Cabezo n, C. ZazpeP. Sa Ripa, A. Tarifa-Castilla Complejo Hospitalario de Navarra, Pamplona, Spain
S12
Abstracts / Pancreatology 17 (2017) SS1eSS21
Background: Pancreaticoduodenectomy (PD) postoperative mortality is less than 5%, but morbidity remains high, between 40-60% in different publications. The study of the risk factors (RF) of pancreatic surgery main complications may help to improve these results. Methods: Prospective observational study of 200 patients undergoing PD with pancreaticogastrostomy (2008-2016). We analyzed the morbidity according to Clavien-Dindo and ISGPS classifications and its association with demographic and clinical characteristics (age, sex, BMI, ASA) and operative RF (pancreas texture, Wirsung diameter, intraoperative transfusion). Results: Multivariate analysis identifies age 70 years (OR 1.85 (1.3; 55)), male gender (OR 1.9 (1.3; 6)) and soft pancreatic texture (OR 3.38(1,5; 7.4) as RF for complications. Soft pancreatic texture and ASA III (OR 2.64 (1;6)) are also associated whit the severity of complications. Regarding delayed gastric emptying, the most significant factors were age >70 years (OR 4 (1.7;9)) and the presence of abdominal complications (OR 6 (2.5;15)). Preoperative biliary manipulation (OR 0.33 (0.13; 0.8)) was identified as a protective factor for postoperative pancreatic fistula (POPF); And soft texture (OR 7.6 (2.5; 22.6)) as a RF for POPF in the multivariate model. Conclusions: In our experience, age 70 years, ASA III and soft pancreatic texture are associated with higher incidence and severity of complications. Soft pancreatic texture is also the main RF for POPF and its severity.
34. Use of statins and nonsteroidal anti-inflammatory drugs and severity of acute pancreatitis rdenas-Ja M. Bozhychko, K. Ca en, M.L. Ruiz-Rebollo, E. de Madaria Hospital General Universitario de Alicante, Alicante, Spain Background: There is evidence from epidemiological studies that statins are associated to a decreased risk of acute pancreatitis (AP). Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently used for the prevention of post-ERCP AP. We hypothesized that both drugs are associated to a decreased risk for moderate-to- severe AP (MTSAP). Methods: We analyzed the prospective AESPANC RIPPE registry, a collaborative Spanish database. Severity was defined according to the revised Atlanta classification. Patients were asked whether they consumed NSAIDs and Statins in the previous 7 days from disease onset. Univariate (chi-square) and multivariate analysis (binary logistic regression) was performed. Results: A total of 233 patients were analyzed, 127 (55%) men. Mean age was 67±17. Etiology was attributed to gallstones in 139(60%) and to alcohol in 29(12%). Sixty-three (27%) patients consumed statins, 24 (10%) NSAIDs and 7 (3%) both. Forty-two (18%) patients had MTSAP. Fifteen (24%) patients consuming statins had a MTSAP compared to 27 (16%) patients without statins, p¼0.162. Seven (29%) patients under NSAIDs treatment had MTSAP versus 35 (17%) patients without NSAIDs, p¼0.134. Patients with combined statin þ NSAIDs treatment had a 3 (43%) MTSAP versus 39 (17%) without combined treatment, p¼0.113. In multivariate analysis statins, NSAIDs, statins and their interaction were not associated to a decreased risk of MTSAP. Conclusions: In our sample of patients NSAIDs and statins were not associated to a decreased risk of MTSAP.
35. Comparsion of clinical effiacy and safety of lumen-apposing metal stent (LAMS) and fully-covered self expandable metal stent (FCSEMS) assisted endoscopic ultrasound (EUS) -guided pancreatic wall-off necrosis (WON) drainage S. Law 1, C. De La Serna Higuera 2, M. P erez-Miranda Castillo 2, P. Gil n 2 Simo
1
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong 2 Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
Background: EUS-guided drainage of pancreatic WON with transmural stent is regarded as firstline therapy. We aim to compare its efficacy and safety with using FCSEMS and LAMS. Methods: A retrospective review was performed on all patients with pancreatic WONs who underwent EUS-guided drainage byeither FCSEMS or LAMS at a tertiary-care hospital over a 5-year period. Results: From 2011 to 2016, 68 patients (66.2%male, median age, 66.5 years) underwent WON drainage ( 22/68 (32.4%)) using FCSEMSs of size 10x60mm (14/22, Hanarostent; 8/22 Wallflex) ; and 46/68(67.6%) using LAMSs (38/46 and 8/46 with AXIOS of size 15x10mm and 10x10 mm respectively). These 2 groups were matched for age (66vs.70 years, p0.514), causes of the WONs (72.7vs.80.4% by gallstone pancreatitis (p0.472); 9.1vs.10.9% by alcoholism (p0.818)), APACHE II ( 11.5vs.10, p0.693), WON size (8.5vs.9cm, p0.322), location( 36.4vs.26.1% at pancreatic head, p0.384; 54.5vs.65.2% at body/tail, p0.395) , site of enterostomy (63.6vs.76.1% via transgastric (p0.285); 31.8vs.19.6% via transduodenal (p0.267)) and their number of necrosectomy (p0.978). The technical (100vs.93.5%, p0.219) , clinical success (95.5 vs.93.5%, p0.749) and adverse event (22.7vs.39.1%, p0.180 : 9.1vs.19.6% with bleeding, p0.271; 4.5vs.13% with spontaneous stent migration, p0.28; 9.1vs.6.5% with dislodgement during necrosectomy, p0.704) of the two groups were comparable. However, the LAMS group associated with early stent revision as compared with FCSEMS group (log rank p 0.048) Conclusion: EUS-guided drainage of WON using FCSEMSs and LAMSs are comparable in efficacy and safety; but the latter is associated with early stent revision.
36. Effect of serum triglyceride levels in the outcome of acute pancreatitis zquez A. Sanahuja Martínez, I. Pascual Moreno, N. García Gimeno, P. Va ndez, J. Tosca Cuquerella, O. Moreno Primera, A. Garayoa Roca, G. Ferna rraga Purroy, P. Lluch García, F. Mora Miguel Pacheco del Río, J. Liza ncia, Hospital Clínico Universitario de Valencia, Universitat de Vale Spain Background: Conflicting findings have been reported in relation to the association between triglycerides (Tg) serum levels on admission and the severity of the AP episodes. Objective: To assess the outcome of AP episodes according to serum triglycerides levels on admission. Methods: Retrospective analysis of a prospective database, which included all consecutive AP episodes admitted to our hospital in 2 time periods, starting in January 2002 until December 2014. AP episodes were classified into 3 different groups based on serum Tg levels (mg/dl): 1) Tg <200, 2) Tg 200-749, 3) Tg 750. Analyzed data included demographic data, etiology, body mass index (BMI), diabetes mellitus, comorbidities, persistent organ failure, pancreatic necrosis, acute pancreatic collections, intensive care unit (ICU) admission and mortality. Results: 1457 episodes of AP were included. Among them, 1335 were included in group 1, 77 in group 2 and 45 in group 3. The rates of persistent organ failure (4.4% in group 1, 7.8% in group 2 and 11.1% in group 3), necrosis (9.2% in group 1, 14.3% in group 2, 40% in group 3) and acute pancreatic collections (21.6% in group 1, 40.3% in group 2, 55.6% in group 3) were increased significantly and proportionally with Tg levels. On multivariate analysis, Tg 750mg/dl was independently associated with persistent respiratory failure, pancreatic necrosis and acute pancreatic collections.
30. Analysis and predictive factors of splanchnic vein thrombosis in acute pancreatitis pez Valenciano 1, F. Bolado Concejo 1, H. Canaval Zuleta 2, R. C. Marra-Lo Rivera Irigoin 3, F.J. Grau García 4, J. Boadas Mir 5, J. Millastre Bocos 6, D. Martínez Ares 7, M.A. Marcaide Ruiz de Apodaca 8, E. de Madaria Pascual 9 1
Complejo Hospitalario Navarra, Pamplona, Spain Hospital Son Llatzer, Palma de Mallorca, Spain 3 Hospital Costa del Sol, Marbella, Spain 4 Hospital Arnau Vilanova, Lleida, Spain 5 Consorci Sanitari Terrasa, Terrasa, Spain 6 Hospital Universitario Lozano Blesa, Zaragoza, Spain 7 Complejo Universitario de Vigo, Vigo, Spain 8 Hospital Universitario Araba, Vitoria-Gasteiz, Spain 9 Hospital General Universitario de Alicante, Alicante, Spain 2
Background: Splanchnic vein thrombosis (SVT) is a rare complication of acute pancreatitis (AP) and may adversely influence clinical course of AP. Aim: To determine the incidence and impact of SVT in AP and to identify risk factors for SVT. Methods: A multicentric prospective AP registry was employed. All patients with SVT were selected. Demographic, clinical outcome measures were compared between patients with or without SVT. Both univariate and multivariate logistic regression analysis were applied to identify independent risk factors for SVT. Results: 1661 AP patients from 23 centers were enrolled. SVT was detected in 3.6% (60 patients), more frequent in men, in younger patients and in presence of alcohol consumption. SVT was associated with more severe AP (28.3% vs 6%, p<0.001) and necrotizing AP, increased LOS (27.8 days in SVT-AP group vs 11.2 days in non SVT-AP group, p<0.001). Organ failure (41,6% vs 13%, p<0.001), pancreatic infection (21,6% vs 2,75%, p<0.001) and ICU admission (35% vs 6.6%, p<0.001) were also more common in patients with SVT. Mortality (20% vs 3.6%, p<0.001) was significantly higher in SVT-AP patients. In univariate analysis male gender (OR 2.42 P<0.003), necrotising pancreatitis (OR 14.85 p<0.001), and both parenchymal and peripancreatic acute necrosis (10.84 and 5.11 respectively) were associated to SVT. In multivariate analysis only an acute necrotic parenchymal collection was found as an independent risk factor for thrombosis (OR 7.42 p<0.001). Conclusion: SVT is rare in AP patients. SVT development in AP is associated with worse clinical outcomes. Necrotizing AP patients are more commonly affected by SVT. Parenchimal necrosis, unlike peripancreatic necrosis, was the only independent risk factor identified for SVT.
31. Usefulness of M-ANNHEIM clasiffication for chronic pancreatitis in a Spanish cohort (RIPPE registry) pez Lo pez 1, C. Marra-Lo pez Valenciano 1, M. Casi Villarroya 1, E. S. Lo Martínez Moneo 2, C. Gil García-Ollauri 2, A. del Pozo García 3, J.M. Mateos n Ballester 6, F. Bolado Concejo 1 Rodriguez 4, M.L. Ruiz Rebollo 5, M.D. Higo 1
Complejo Hospitalario de Navarra, Pamplona, Spain Hospital Universitario de Cruces, Barakaldo, Spain 3 Hospital Universitario 12 de Octubre, Madrid, Spain 4 ceres, Spain Hospital San Pedro Alcantara, Ca 5 Hospital Clínico de Valladolid, Valladolid, Spain 6 Hospital Universitario y Politecnico la Fe, Valencia, Spain 2
Background: Chronic pancreatitis (CP) is a complex disease. It results from the interaction of multiple etiologies. The M-ANNHEIM classification is a multiple risk factor system validated for CP. It categorizes clinical presentation and assesses the severity of CP. However its use in clinical practice is uncommon.
S11
The Spanish Pancreatic Diseases Patients Registry (RIPPE) is a nationwide registry supported by AESPANC to better understand the natural history of pancreatic disorders. Objective: To evaluate M-ANNHEIM classification in the RIPPE cohort. Methods: RIPPE CP patients recruited between October 2015 and March 2017 were included. A descriptive analysis of demographics and different etiologies were performed. CP diagnostic criteria were adapted under recent guidelines. M-ANNHEIM clinical staging, and severity index (according to clinical features), were calculated for RIPPE patients in a web-tool using a validated scoring system. Results: 121 patients from 19 hospitals were included, 82.6% men (mean age 50.6 years (SD¼13.54)). Charslon score 1.27 (SD¼1.5). Risk factors according to M-ANNHEIM classification are shown in table 1. In this registry, alcohol and nicotine consumption were the main etiologies. 81,82% of patients presented advanced PC at the Clinical stage (table 2). 31,4% of PC shown an advanced or worse severity level (>10 points) in the Severity index (table 3). Conclusions: Analysis of RIPPE under M-ANNHEIM classiffication demonstrates that individuals with similar clinical features can experiment different clinical presentations and grades of severity. This data supports the usefulness of this tool, although large prospective studies are needed. According to RIPPE, CP in early stages is still underestimated.
32. Analysis of hemorrhagic complications in 200 pancreaticoduodenectomies with pancreaticogastrostomy nchez Acedo, J. Herrera Cabezo n, C. Zazpe A. Goikoetxea Urdiain, P. Sa Ripa, A. Traifa Castilla Complejo Hospitalario de Navarra, Pamplona, Spain Background: Recent studies have shown that pancreaticoduodenectomy (PD) with pancreaticogastrostomy (PG) decreases the incidence and severity of postoperative pancreatic fistula (POPF). Postoperative hemorrhage complications (PPH) are increasing their relevance as one of the main complications due to their incidence and severity. Methods: Data from 200 PD with PG were collected prospectively between 2008 and 2016. PPH was defined and classified according to the ISGPS criteria. We analyzed the morbidity according to Clavien-Dindo classification. Results: A total of 106 (53%) patients had postoperative complications. 42 (21%) of them had hemorrhagic complications. Twenty seven (13.5%) were classified as severe (Clavien III). The bleeding was intraluminal in 30 (15%) cases, extraluminal in 10 (5%), and intra-/extraluminal in two (1%). Regarding the time of presentation, in 32 (16%) cases it was late and in 10 (5%) early. Nine (4.5%) patients were reoperated because of hemorrhage: seven due to bleeding of the border of a pancreatic section, one hemoperitoneum, and one for drainage of an infected hematoma. Eight (4%) patients were readmitted with PPH within the first 30 days after surgery. Overall 90 days mortality was 4% (8 patients). 5 patients died due to PPH. Conclusions: One-fifth of the patients suffered hemorrhagic complications. PPH is the second complication in incidence, after delayed gastric emptying. PPH is the first cause of mortality, reoperation and the second cause of readmission in our series.
33. Risk factors of complications in pancreaticoduodenectomy. Prospective study nchez-Acedo, A. Goikoetxea-Urdiain, J. Herrera-Cabezo n, C. ZazpeP. Sa Ripa, A. Tarifa-Castilla Complejo Hospitalario de Navarra, Pamplona, Spain
S12
Abstracts / Pancreatology 17 (2017) SS1eSS21
Background: Pancreaticoduodenectomy (PD) postoperative mortality is less than 5%, but morbidity remains high, between 40-60% in different publications. The study of the risk factors (RF) of pancreatic surgery main complications may help to improve these results. Methods: Prospective observational study of 200 patients undergoing PD with pancreaticogastrostomy (2008-2016). We analyzed the morbidity according to Clavien-Dindo and ISGPS classifications and its association with demographic and clinical characteristics (age, sex, BMI, ASA) and operative RF (pancreas texture, Wirsung diameter, intraoperative transfusion). Results: Multivariate analysis identifies age 70 years (OR 1.85 (1.3; 55)), male gender (OR 1.9 (1.3; 6)) and soft pancreatic texture (OR 3.38(1,5; 7.4) as RF for complications. Soft pancreatic texture and ASA III (OR 2.64 (1;6)) are also associated whit the severity of complications. Regarding delayed gastric emptying, the most significant factors were age >70 years (OR 4 (1.7;9)) and the presence of abdominal complications (OR 6 (2.5;15)). Preoperative biliary manipulation (OR 0.33 (0.13; 0.8)) was identified as a protective factor for postoperative pancreatic fistula (POPF); And soft texture (OR 7.6 (2.5; 22.6)) as a RF for POPF in the multivariate model. Conclusions: In our experience, age 70 years, ASA III and soft pancreatic texture are associated with higher incidence and severity of complications. Soft pancreatic texture is also the main RF for POPF and its severity.
34. Use of statins and nonsteroidal anti-inflammatory drugs and severity of acute pancreatitis rdenas-Ja M. Bozhychko, K. Ca en, M.L. Ruiz-Rebollo, E. de Madaria Hospital General Universitario de Alicante, Alicante, Spain Background: There is evidence from epidemiological studies that statins are associated to a decreased risk of acute pancreatitis (AP). Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently used for the prevention of post-ERCP AP. We hypothesized that both drugs are associated to a decreased risk for moderate-to- severe AP (MTSAP). Methods: We analyzed the prospective AESPANC RIPPE registry, a collaborative Spanish database. Severity was defined according to the revised Atlanta classification. Patients were asked whether they consumed NSAIDs and Statins in the previous 7 days from disease onset. Univariate (chi-square) and multivariate analysis (binary logistic regression) was performed. Results: A total of 233 patients were analyzed, 127 (55%) men. Mean age was 67±17. Etiology was attributed to gallstones in 139(60%) and to alcohol in 29(12%). Sixty-three (27%) patients consumed statins, 24 (10%) NSAIDs and 7 (3%) both. Forty-two (18%) patients had MTSAP. Fifteen (24%) patients consuming statins had a MTSAP compared to 27 (16%) patients without statins, p¼0.162. Seven (29%) patients under NSAIDs treatment had MTSAP versus 35 (17%) patients without NSAIDs, p¼0.134. Patients with combined statin þ NSAIDs treatment had a 3 (43%) MTSAP versus 39 (17%) without combined treatment, p¼0.113. In multivariate analysis statins, NSAIDs, statins and their interaction were not associated to a decreased risk of MTSAP. Conclusions: In our sample of patients NSAIDs and statins were not associated to a decreased risk of MTSAP.
35. Comparsion of clinical effiacy and safety of lumen-apposing metal stent (LAMS) and fully-covered self expandable metal stent (FCSEMS) assisted endoscopic ultrasound (EUS) -guided pancreatic wall-off necrosis (WON) drainage S. Law 1, C. De La Serna Higuera 2, M. P erez-Miranda Castillo 2, P. Gil n 2 Simo
1
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong 2 Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
Background: EUS-guided drainage of pancreatic WON with transmural stent is regarded as firstline therapy. We aim to compare its efficacy and safety with using FCSEMS and LAMS. Methods: A retrospective review was performed on all patients with pancreatic WONs who underwent EUS-guided drainage byeither FCSEMS or LAMS at a tertiary-care hospital over a 5-year period. Results: From 2011 to 2016, 68 patients (66.2%male, median age, 66.5 years) underwent WON drainage ( 22/68 (32.4%)) using FCSEMSs of size 10x60mm (14/22, Hanarostent; 8/22 Wallflex) ; and 46/68(67.6%) using LAMSs (38/46 and 8/46 with AXIOS of size 15x10mm and 10x10 mm respectively). These 2 groups were matched for age (66vs.70 years, p0.514), causes of the WONs (72.7vs.80.4% by gallstone pancreatitis (p0.472); 9.1vs.10.9% by alcoholism (p0.818)), APACHE II ( 11.5vs.10, p0.693), WON size (8.5vs.9cm, p0.322), location( 36.4vs.26.1% at pancreatic head, p0.384; 54.5vs.65.2% at body/tail, p0.395) , site of enterostomy (63.6vs.76.1% via transgastric (p0.285); 31.8vs.19.6% via transduodenal (p0.267)) and their number of necrosectomy (p0.978). The technical (100vs.93.5%, p0.219) , clinical success (95.5 vs.93.5%, p0.749) and adverse event (22.7vs.39.1%, p0.180 : 9.1vs.19.6% with bleeding, p0.271; 4.5vs.13% with spontaneous stent migration, p0.28; 9.1vs.6.5% with dislodgement during necrosectomy, p0.704) of the two groups were comparable. However, the LAMS group associated with early stent revision as compared with FCSEMS group (log rank p 0.048) Conclusion: EUS-guided drainage of WON using FCSEMSs and LAMSs are comparable in efficacy and safety; but the latter is associated with early stent revision.
36. Effect of serum triglyceride levels in the outcome of acute pancreatitis zquez A. Sanahuja Martínez, I. Pascual Moreno, N. García Gimeno, P. Va ndez, J. Tosca Cuquerella, O. Moreno Primera, A. Garayoa Roca, G. Ferna rraga Purroy, P. Lluch García, F. Mora Miguel Pacheco del Río, J. Liza ncia, Hospital Clínico Universitario de Valencia, Universitat de Vale Spain Background: Conflicting findings have been reported in relation to the association between triglycerides (Tg) serum levels on admission and the severity of the AP episodes. Objective: To assess the outcome of AP episodes according to serum triglycerides levels on admission. Methods: Retrospective analysis of a prospective database, which included all consecutive AP episodes admitted to our hospital in 2 time periods, starting in January 2002 until December 2014. AP episodes were classified into 3 different groups based on serum Tg levels (mg/dl): 1) Tg <200, 2) Tg 200-749, 3) Tg 750. Analyzed data included demographic data, etiology, body mass index (BMI), diabetes mellitus, comorbidities, persistent organ failure, pancreatic necrosis, acute pancreatic collections, intensive care unit (ICU) admission and mortality. Results: 1457 episodes of AP were included. Among them, 1335 were included in group 1, 77 in group 2 and 45 in group 3. The rates of persistent organ failure (4.4% in group 1, 7.8% in group 2 and 11.1% in group 3), necrosis (9.2% in group 1, 14.3% in group 2, 40% in group 3) and acute pancreatic collections (21.6% in group 1, 40.3% in group 2, 55.6% in group 3) were increased significantly and proportionally with Tg levels. On multivariate analysis, Tg 750mg/dl was independently associated with persistent respiratory failure, pancreatic necrosis and acute pancreatic collections.