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The microbiology of infected pancreatic necrosis and its influence on mortality, The International Multicenter Study of infected pancreatic necrosis (ISPAN)
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Abstracts / Pancreatology 16 (2016) S1eS130
successful target lesion.The pooled prevalence of solid lesions was higher with EUS (7.1%) than MRI (2.1%) and viceversa for cystic lesions (27.6% with MRI and 12.2% with EUS). The pooled prevalence of “successful screening” was 6.7% with EUS (95% CI 2-17%; I2¼61%) and 2.6% (95% CI 1%-9%;I2¼68%) with MRI. Conclusion: Screening identifies solid and cystic lesions in 5% and 20% of HRIs respectively. EUS identifies more solid and MRI more cystic lesions. The rate of “successful” screening is as low as 3%.
Abstract ID: 1653. The microbiology of infected pancreatic necrosis and its influence on mortality, The International Multicenter Study of infected pancreatic necrosis (ISPAN) Robert Moran 1, Chandra Umapathy 2, Dhiraj Yadav 2, Enrique Perez Cuadrado 3, Kartik Sampath 4, Timothy Gardner 4, zquez 5, Enrique de-Madaria 5, Vivek Kadiyala 6, No e Quesada Va Peter Banks 6, Tiffany Chua 7, Tyler Stevens 7, Niloofar Yahyapourjalaly 1, Vikesh Singh 1 1
The Johns Hopkins Medical Institutions, Division of Gastroenterology and Hepatology, Department of Medicine, United States 2 University Pittsburg Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine, United States 3 Morales Meseguer Hospital, Department of Gastroenterology, United States 4 Dartmouth-Hitchcock Medical Center, Division of Gastroenterology and Hepatology, United States 5 Hospital General Universitario de Alicante, Department of Gastroenterology, United States 6 Brigham and Women's Hospital, Division of Gastroenterology and Hepatology, United States 7 Cleveland clinic, Division of Gastroenterology and Hepatology, United States Introduction: Few studies have evaluated the microbiology of infected pancreatic necrosis (IPN) and its impact on mortality. Aims: To evaluate how the microbiology of IPN influences mortality. Patients & methods: A retrospective study involving 5 centers in the United States and 2 in Spain identified patients with IPN from the years 1995-2015. Patients with both acute pancreatic necrosis (PN) on contrast enhanced CT and a positive pancreatic tissue culture were included. Multivariable cox proportional hazard analysis was performed to evaluate the microbiological factors associated with mortality. Results: 198 patients met inclusion criteria. A total 73.7% of patients had organ failure, 52.5% of patients had POF and 15.6% of patients died during admission. Mortality rate decreased per unit time (week) as both the length from admission to diagnosis of IPN (HR:0.89, 95% CI:0.800.99,p¼0.04) and the time from admission to surgery increased (HR:0.90,95%CI:0.81-0.99,p¼0.48). POF (HR:7.97, 95% CI:1.0759.04,p¼0.04) but not TOF (HR:2.39, 95%CI:0.26-21.77, p¼0.44) was associated with increased mortality. On multivariate cox proportional hazard analysis evaluating the association between microorganism and mortality, anaerobic (HR:2.55,95%CI:0.93-6.96, p¼0.07), gram negative (HR:1.55, 95%CI:0.67-3.57, p¼0.31), gram positive (HR:1.05, 95%CI:0.452.47, p¼0.91), polymicrobial (HR:1.41, 95%CI:0.45-4.41, p¼0.26) and fungal (HR:1.57, 95%CI: 0.65-3.83, p¼0.32) infections of PN were not associated with mortality. In addition, bacteremia (HR:2.63, 95%CI:0.79-8.79, p¼0.12), the number of episodes of bacteremia (HR:0.86, 95%CI:0.56-1.33, p¼0.51) and fungemia (HR:1.97, 95%CI: 0.56-6.89, p¼0.29) were not associated with mortality when individually evaluated on cox proportional hazard analysis. Conclusion: POF, the time to diagnosis of IPN and the timing of necrosectomy remain the key factors associated with mortality in patients with IPN. The microbial spectrum of IPN does not appear to influence mortality.
Abstract ID: 1657. Results of non-operative management for intraductal papillary mucinous neoplasms with an indication for surgery: A meta-analysis Giuseppe Vanella 1, Gabriele Capurso 1, Gianfranco Delle Fave 1, Massimo Falconi 2, Stefano Crippa 2 1
Digestive and Liver Disease Unit, Sant-Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy 2 Vita-Salute, San Raffaele Division of Pancreatic Surgery, Universita Scientific Institute, Milan, Italy Introduction: Guidelines suggest surgery for Main Duct (MD) and Branch Duct (BD) IPMN patients with high-risk stigmata. Recent studies suggested that a non-operative strategy in elderly patients with elevated surgical risk might be considered. However, the safety of such approach is based on heterogeneous data often obtained in small subgroups and is therefore debatable. Aims: To perform a systematic review and meta-analysis to determine the risk of death in IPMN patients with an indication for surgery undergoing non-operative management. Patients & methods: A MEDLINE search was performed until January 2016, and methodology based on PRISMA statement. Incidence rate of IPMN-related deaths was calculated by dividing number of events by number of person-years (pyrs) of follow-up. Subgroup analyses were performed for MD and BD-IPMNs. Heterogeneity determined by I2statistic. Results: 13 studies were included in the qualitative analysis (750 patients). 6 studies reported data on mortality for 483 patients during a follow-up ranging 24.9-56.4 months. Pooled rates of overall and IPMNrelated mortality were 30.9% (95%CI 20-45%) and 14.2% (95%CI 11-18%) respectively with considerable heterogeneity for both (I2¼82.5 and 81.3%). The pooled estimate rate of overall mortality was 78/1000pyrs (I2¼79.5%), while for IPMN-related mortality it was 35/1000pyrs (I2¼70.8%). The rate was 7/1000pyrs in BD and 39/1000pyrs in MD-IPMNs. Conclusion: Non-operative management of IPMN patients with an indication for surgery might be safe, with a relatively low risk of IPMNrelated death, as 86% don't die of IPMN. The reported 3.5/100pyrs rate of IPMN-related mortality should be carefully balanced with the high mortality of pancreatic surgery for elderly/comorbid patients in this setting.
Abstract ID: 1659. Short-term outcomes after distal pancreatectomy: Experience from Clinical Center of Serbia Nemanja Bidzic, Vladimir Djordjevic, Aleksandar Bogdanovic, Nemanja Zaric, Djordje Knezevic, Danijel Galun, Dragan Basaric, Zoran Kujacic, Predrag Bulajic, Srbislav Knezevic Clinical Center of Serbia, Serbia Introduction: Distal pancreatectomy is standard procedure for lesions of the body and tail of the pancreas. Recent advances in surgical technique and perioperative management has reduced mortality rate but morbidity is still high. Postoperative pancreatic fistula (POPF) is the most frequent complication and also underlying problem for other morbidities, such as abdominal abscess, sepsis, postpancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). Aims: The aim of this study was to evaluate rate of morbidity after distal pancreatectomy in our institution and to compare it to published data. Patients & methods: We performed retrospective study. Between May 2010 and September 2015 there were 55 patients undergoing open distal splenopancreatectomy for malignant neoplasms. In all cases we used oversewn technique. All complications are defined according to International Study Group of Pancreatic Fistula and International Study Group of Pancreatic Surgery.
Abstracts / Pancreatology 16 (2016) S1eS130
successful target lesion.The pooled prevalence of solid lesions was higher with EUS (7.1%) than MRI (2.1%) and viceversa for cystic lesions (27.6% with MRI and 12.2% with EUS). The pooled prevalence of “successful screening” was 6.7% with EUS (95% CI 2-17%; I2¼61%) and 2.6% (95% CI 1%-9%;I2¼68%) with MRI. Conclusion: Screening identifies solid and cystic lesions in 5% and 20% of HRIs respectively. EUS identifies more solid and MRI more cystic lesions. The rate of “successful” screening is as low as 3%.
Abstract ID: 1653. The microbiology of infected pancreatic necrosis and its influence on mortality, The International Multicenter Study of infected pancreatic necrosis (ISPAN) Robert Moran 1, Chandra Umapathy 2, Dhiraj Yadav 2, Enrique Perez Cuadrado 3, Kartik Sampath 4, Timothy Gardner 4, zquez 5, Enrique de-Madaria 5, Vivek Kadiyala 6, No e Quesada Va Peter Banks 6, Tiffany Chua 7, Tyler Stevens 7, Niloofar Yahyapourjalaly 1, Vikesh Singh 1 1
The Johns Hopkins Medical Institutions, Division of Gastroenterology and Hepatology, Department of Medicine, United States 2 University Pittsburg Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine, United States 3 Morales Meseguer Hospital, Department of Gastroenterology, United States 4 Dartmouth-Hitchcock Medical Center, Division of Gastroenterology and Hepatology, United States 5 Hospital General Universitario de Alicante, Department of Gastroenterology, United States 6 Brigham and Women's Hospital, Division of Gastroenterology and Hepatology, United States 7 Cleveland clinic, Division of Gastroenterology and Hepatology, United States Introduction: Few studies have evaluated the microbiology of infected pancreatic necrosis (IPN) and its impact on mortality. Aims: To evaluate how the microbiology of IPN influences mortality. Patients & methods: A retrospective study involving 5 centers in the United States and 2 in Spain identified patients with IPN from the years 1995-2015. Patients with both acute pancreatic necrosis (PN) on contrast enhanced CT and a positive pancreatic tissue culture were included. Multivariable cox proportional hazard analysis was performed to evaluate the microbiological factors associated with mortality. Results: 198 patients met inclusion criteria. A total 73.7% of patients had organ failure, 52.5% of patients had POF and 15.6% of patients died during admission. Mortality rate decreased per unit time (week) as both the length from admission to diagnosis of IPN (HR:0.89, 95% CI:0.800.99,p¼0.04) and the time from admission to surgery increased (HR:0.90,95%CI:0.81-0.99,p¼0.48). POF (HR:7.97, 95% CI:1.0759.04,p¼0.04) but not TOF (HR:2.39, 95%CI:0.26-21.77, p¼0.44) was associated with increased mortality. On multivariate cox proportional hazard analysis evaluating the association between microorganism and mortality, anaerobic (HR:2.55,95%CI:0.93-6.96, p¼0.07), gram negative (HR:1.55, 95%CI:0.67-3.57, p¼0.31), gram positive (HR:1.05, 95%CI:0.452.47, p¼0.91), polymicrobial (HR:1.41, 95%CI:0.45-4.41, p¼0.26) and fungal (HR:1.57, 95%CI: 0.65-3.83, p¼0.32) infections of PN were not associated with mortality. In addition, bacteremia (HR:2.63, 95%CI:0.79-8.79, p¼0.12), the number of episodes of bacteremia (HR:0.86, 95%CI:0.56-1.33, p¼0.51) and fungemia (HR:1.97, 95%CI: 0.56-6.89, p¼0.29) were not associated with mortality when individually evaluated on cox proportional hazard analysis. Conclusion: POF, the time to diagnosis of IPN and the timing of necrosectomy remain the key factors associated with mortality in patients with IPN. The microbial spectrum of IPN does not appear to influence mortality.
Abstract ID: 1657. Results of non-operative management for intraductal papillary mucinous neoplasms with an indication for surgery: A meta-analysis Giuseppe Vanella 1, Gabriele Capurso 1, Gianfranco Delle Fave 1, Massimo Falconi 2, Stefano Crippa 2 1
Digestive and Liver Disease Unit, Sant-Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy 2 Vita-Salute, San Raffaele Division of Pancreatic Surgery, Universita Scientific Institute, Milan, Italy Introduction: Guidelines suggest surgery for Main Duct (MD) and Branch Duct (BD) IPMN patients with high-risk stigmata. Recent studies suggested that a non-operative strategy in elderly patients with elevated surgical risk might be considered. However, the safety of such approach is based on heterogeneous data often obtained in small subgroups and is therefore debatable. Aims: To perform a systematic review and meta-analysis to determine the risk of death in IPMN patients with an indication for surgery undergoing non-operative management. Patients & methods: A MEDLINE search was performed until January 2016, and methodology based on PRISMA statement. Incidence rate of IPMN-related deaths was calculated by dividing number of events by number of person-years (pyrs) of follow-up. Subgroup analyses were performed for MD and BD-IPMNs. Heterogeneity determined by I2statistic. Results: 13 studies were included in the qualitative analysis (750 patients). 6 studies reported data on mortality for 483 patients during a follow-up ranging 24.9-56.4 months. Pooled rates of overall and IPMNrelated mortality were 30.9% (95%CI 20-45%) and 14.2% (95%CI 11-18%) respectively with considerable heterogeneity for both (I2¼82.5 and 81.3%). The pooled estimate rate of overall mortality was 78/1000pyrs (I2¼79.5%), while for IPMN-related mortality it was 35/1000pyrs (I2¼70.8%). The rate was 7/1000pyrs in BD and 39/1000pyrs in MD-IPMNs. Conclusion: Non-operative management of IPMN patients with an indication for surgery might be safe, with a relatively low risk of IPMNrelated death, as 86% don't die of IPMN. The reported 3.5/100pyrs rate of IPMN-related mortality should be carefully balanced with the high mortality of pancreatic surgery for elderly/comorbid patients in this setting.
Abstract ID: 1659. Short-term outcomes after distal pancreatectomy: Experience from Clinical Center of Serbia Nemanja Bidzic, Vladimir Djordjevic, Aleksandar Bogdanovic, Nemanja Zaric, Djordje Knezevic, Danijel Galun, Dragan Basaric, Zoran Kujacic, Predrag Bulajic, Srbislav Knezevic Clinical Center of Serbia, Serbia Introduction: Distal pancreatectomy is standard procedure for lesions of the body and tail of the pancreas. Recent advances in surgical technique and perioperative management has reduced mortality rate but morbidity is still high. Postoperative pancreatic fistula (POPF) is the most frequent complication and also underlying problem for other morbidities, such as abdominal abscess, sepsis, postpancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). Aims: The aim of this study was to evaluate rate of morbidity after distal pancreatectomy in our institution and to compare it to published data. Patients & methods: We performed retrospective study. Between May 2010 and September 2015 there were 55 patients undergoing open distal splenopancreatectomy for malignant neoplasms. In all cases we used oversewn technique. All complications are defined according to International Study Group of Pancreatic Fistula and International Study Group of Pancreatic Surgery.