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A report of Japanese familial pancreatic cancer
Abstracts / Pancreatology 16 (2016) S1eS192
Background/introduction: Education and support for pancreatic cancer patients and their families by the medical team “Suigan-Kyoshitsu: Pancreatic Cancer Patient's Classroom” was started from December 2012 at our institution. The member consists of six occupations: doctor (Dr), pharmacist (Ph), dietitian (D), nurse (Ns), medical social worker (MSW) and clinical psychologist (CP). Classroom activity (60 minutes) is composed of the lectures by each specialist and free talk within the class attendants. We evaluated the influence of Suigan-Kyoshitsu by questionnaire survey. Methods: The total of 213 participants answered to our questionnaire survey from December 2013 to December 2015. It included five questions: Q1; were you able to deepen information and knowledge? Q2; did you become able to face up to pancreatic cancer treatment? Q3; did you find that there were many medical team staff for pancreatic cancer treatment?. Q4; did you want to continue participating in Suigan-Kyoushitsu? Q5; did you have good conversation among participants? We compared feeling for pancreatic cancer treatment before and after participation in SuiganKyoushitsu by using face scale (five grading system). Results: An affirmative answer was obtained from Q1-4. Yes: All occupations; more than 80%. There was different result in Q5. Yes: Dr. 68%, Ph. 38%, D 41%, Ns. 92%, MSW 50%, and CP 94%. The changes of feeling after the participation were significantly improved from 3.0±0.5 points with 3.7±0.5 points (p<0.01). Conclusion: Pancreatic cancer patient's classroom activity supported by the medical team seems to improve the overall quality of care for patients with pancreatic cancer and to promote patient involvement through education. Our medical team should understand the special needs of pancreatic cancer patients and their families.
P-001. Exocrine pancreatic function in Japanese patients with cystic fibrosis Satoru Naruse 1, Shiho Kondo 2, Kotoyo Fujiki 3, Akiko Yamamoto 4, Miyuki Nakakuki 4, Toru Shimosegawa 5, Yoshifumi Takeyama 6, Hiroshi Ishiguro 4 1
Division of Gastroenterology, Miyoshi Municipal Hospital, Japan Department of Food Sciences and Nutrition, Nagoya Women's University, Japan 3 Department of Nutritional Sciences, Nagoya University of Art and Sciences, Japan 4 Department of Human Nutrition, Nagoya University Graduate School of Medicine, Japan 5 Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan 6 Department of Surgery, Kinki University Faculty of Medicine, Japan 2
Aim: Cystic fibrosis (CF) is an extremely rare disease in Japanese. The incidence is estimated to be one in 590,000 live births. We evaluated the exocrine pancreatic function in Japanese patients with CF with fecal elastase. Methods: The studies were conducted in 2013 (21 patients) and 2015 (18 patients). Fecal samples were obtained from 27 patients (16 males) aged 0.7-39 years. Fecal elastase-1 was measured with enzyme-linked immunosorbent assay (ScheBo) and levels less than 200 mg/g stool were considered pancreatic insufficient (PI). Χ2 test and F-test were used for statistical analysis with P<0.05 as level of significance. Results: Fecal elastase in 16 patients showed PI levels (median: 0.1; range: 0~39 mg/g), while 11 patients (513; 316~795 mg/g) were pancreatic sufficient (PS). The median age of PI patients (7.1; 0.7~25.3 years) was significantly (P<0.01) lower than that (27; 10~39 years) of PS patients. In 12 patients the measurements were repeated with the median interval of 1.75 (0.4~2.7) years. Ten PI patients in the first test (0.1~12.5 mg/g) remained PI in the second test (0~13.5mg/g) and elastase levels of two PS patients were similar between the two tests (280 vs. 320, 450 vs. 613 mg/g). Conclusion: Fecal elastase clearly and reproducibly differentiates between PI and PS in Japanese patients with CF. Approximately 60% of patients are PI and they are younger than PS patients.
S95
P-002. Surgical removal of the migrated biflanged metal stent following the EUS-guided transluminal drainage for pancreatic pseudocyst Yukitoshi Matsunami, Mitsuyoshi Honjo, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Shujiro Tsuji, Kentaro Kamada, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Mitsuru Fujita, Kenjiro Yamamoto Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan EUS-guided transluminal drainage (EUS-TD) has become a standard and safe treatment method for symptomatic pancreatic pseudocyst. The efficacy of EUS-TD using a dedicated biflanged metal stent (BFMS) has been reported as an alternative option. However, stent migration can occur following this procedure. We show a case that the migrated BFMS was trapped in the small intestine and the surgical removal was required. In a woman of the early 40s a cystic lesion located at the tail of the pancreas was detected. The distal pancreatectomy was undergone and the cystic lesion was diagnosed as mucinous cystic neoplasms. Four months later the pancreatic juice leak occurred and the pseudocyst was developed in the distal end of residual pancreas. EUS-TD using the BFMS (16mm in diameter, 30mm in length) was performed. The complete resolution of pseudocyst was achieved, but she complained lower abdominal pain two months after EUS-TD. An abnormal mass was palpable in the lower abdomen and a computed tomography scan showed the trapped BFMS in small intestine. The migrated stent removal using balloon-assisted enteroscope was attempted, but it failed. Finally, surgical stent removal was performed.
P-003. A report of Japanese familial pancreatic cancer Yoshihiro Hamada 1, Kensei Maeshiro 2, Yoshifuku Nakayama 3 1
Department of Pathology, Fukuoka University, Japan Department of Surgery, St. Mary's Hospital, Japan 3 Department of Pathology, Murakami Memorial Hospital, Japan 2
Familial pancreatic cancer is defined as a diagnosis of pancreatic cancer in two or more first-degree relatives, who are not part of a familial cancer syndrome. Individuals with a family history of pancreatic cancer carry a 232 fold increased risk of developing the disease, depending on the number of affected family members. The identification of individuals with a family history of pancreatic cancer thus represents an opportunity to reduce the currently high mortality associated with this disease. Case 1. A 69-year-old woman visited the hospital because of continuous lumbago. Her serum CA19-9 was 263 U/ml and DUPAN-II was >1600 U/ml. A pancreatic tail mass was revealed by ultrasonography. The final diagnosis was well-differentiated tubular adenocarcinoma after surgical resection. The carcinoma had invaded the left adrenal gland and transverse colon, and metastasized in the regional lymph nodes. The patient died of peritonitis carcinomatosa 8 years after surgical resection. Case 2. The 80-year-old sister of Case 1 visited the hospital with lumbago. Her serum CA19-9 was 92 U/ml. Pancreatic carcinoma was diagnosed by endoscopic retrograde pancreatography. Distal pancreatectomy was performed. The final pathology revealed well-differentiated tubular adenocarcinoma. The patient died 2 years after surgical resection as a result of local recurrence. The mother of both patients had also died of pancreatic cancer.
P-004. The comparison of post-operative insulin secretion and glucose intolerance between pancreaticoduodenectomy and distal pancreatectomy Tsuguka Shiwa 1, Kenichiro Uemura 2, Naoya Nakagawa 2, Yoshiaki Murakami 2
Background/introduction: Education and support for pancreatic cancer patients and their families by the medical team “Suigan-Kyoshitsu: Pancreatic Cancer Patient's Classroom” was started from December 2012 at our institution. The member consists of six occupations: doctor (Dr), pharmacist (Ph), dietitian (D), nurse (Ns), medical social worker (MSW) and clinical psychologist (CP). Classroom activity (60 minutes) is composed of the lectures by each specialist and free talk within the class attendants. We evaluated the influence of Suigan-Kyoshitsu by questionnaire survey. Methods: The total of 213 participants answered to our questionnaire survey from December 2013 to December 2015. It included five questions: Q1; were you able to deepen information and knowledge? Q2; did you become able to face up to pancreatic cancer treatment? Q3; did you find that there were many medical team staff for pancreatic cancer treatment?. Q4; did you want to continue participating in Suigan-Kyoushitsu? Q5; did you have good conversation among participants? We compared feeling for pancreatic cancer treatment before and after participation in SuiganKyoushitsu by using face scale (five grading system). Results: An affirmative answer was obtained from Q1-4. Yes: All occupations; more than 80%. There was different result in Q5. Yes: Dr. 68%, Ph. 38%, D 41%, Ns. 92%, MSW 50%, and CP 94%. The changes of feeling after the participation were significantly improved from 3.0±0.5 points with 3.7±0.5 points (p<0.01). Conclusion: Pancreatic cancer patient's classroom activity supported by the medical team seems to improve the overall quality of care for patients with pancreatic cancer and to promote patient involvement through education. Our medical team should understand the special needs of pancreatic cancer patients and their families.
P-001. Exocrine pancreatic function in Japanese patients with cystic fibrosis Satoru Naruse 1, Shiho Kondo 2, Kotoyo Fujiki 3, Akiko Yamamoto 4, Miyuki Nakakuki 4, Toru Shimosegawa 5, Yoshifumi Takeyama 6, Hiroshi Ishiguro 4 1
Division of Gastroenterology, Miyoshi Municipal Hospital, Japan Department of Food Sciences and Nutrition, Nagoya Women's University, Japan 3 Department of Nutritional Sciences, Nagoya University of Art and Sciences, Japan 4 Department of Human Nutrition, Nagoya University Graduate School of Medicine, Japan 5 Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan 6 Department of Surgery, Kinki University Faculty of Medicine, Japan 2
Aim: Cystic fibrosis (CF) is an extremely rare disease in Japanese. The incidence is estimated to be one in 590,000 live births. We evaluated the exocrine pancreatic function in Japanese patients with CF with fecal elastase. Methods: The studies were conducted in 2013 (21 patients) and 2015 (18 patients). Fecal samples were obtained from 27 patients (16 males) aged 0.7-39 years. Fecal elastase-1 was measured with enzyme-linked immunosorbent assay (ScheBo) and levels less than 200 mg/g stool were considered pancreatic insufficient (PI). Χ2 test and F-test were used for statistical analysis with P<0.05 as level of significance. Results: Fecal elastase in 16 patients showed PI levels (median: 0.1; range: 0~39 mg/g), while 11 patients (513; 316~795 mg/g) were pancreatic sufficient (PS). The median age of PI patients (7.1; 0.7~25.3 years) was significantly (P<0.01) lower than that (27; 10~39 years) of PS patients. In 12 patients the measurements were repeated with the median interval of 1.75 (0.4~2.7) years. Ten PI patients in the first test (0.1~12.5 mg/g) remained PI in the second test (0~13.5mg/g) and elastase levels of two PS patients were similar between the two tests (280 vs. 320, 450 vs. 613 mg/g). Conclusion: Fecal elastase clearly and reproducibly differentiates between PI and PS in Japanese patients with CF. Approximately 60% of patients are PI and they are younger than PS patients.
S95
P-002. Surgical removal of the migrated biflanged metal stent following the EUS-guided transluminal drainage for pancreatic pseudocyst Yukitoshi Matsunami, Mitsuyoshi Honjo, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Shujiro Tsuji, Kentaro Kamada, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Mitsuru Fujita, Kenjiro Yamamoto Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan EUS-guided transluminal drainage (EUS-TD) has become a standard and safe treatment method for symptomatic pancreatic pseudocyst. The efficacy of EUS-TD using a dedicated biflanged metal stent (BFMS) has been reported as an alternative option. However, stent migration can occur following this procedure. We show a case that the migrated BFMS was trapped in the small intestine and the surgical removal was required. In a woman of the early 40s a cystic lesion located at the tail of the pancreas was detected. The distal pancreatectomy was undergone and the cystic lesion was diagnosed as mucinous cystic neoplasms. Four months later the pancreatic juice leak occurred and the pseudocyst was developed in the distal end of residual pancreas. EUS-TD using the BFMS (16mm in diameter, 30mm in length) was performed. The complete resolution of pseudocyst was achieved, but she complained lower abdominal pain two months after EUS-TD. An abnormal mass was palpable in the lower abdomen and a computed tomography scan showed the trapped BFMS in small intestine. The migrated stent removal using balloon-assisted enteroscope was attempted, but it failed. Finally, surgical stent removal was performed.
P-003. A report of Japanese familial pancreatic cancer Yoshihiro Hamada 1, Kensei Maeshiro 2, Yoshifuku Nakayama 3 1
Department of Pathology, Fukuoka University, Japan Department of Surgery, St. Mary's Hospital, Japan 3 Department of Pathology, Murakami Memorial Hospital, Japan 2
Familial pancreatic cancer is defined as a diagnosis of pancreatic cancer in two or more first-degree relatives, who are not part of a familial cancer syndrome. Individuals with a family history of pancreatic cancer carry a 232 fold increased risk of developing the disease, depending on the number of affected family members. The identification of individuals with a family history of pancreatic cancer thus represents an opportunity to reduce the currently high mortality associated with this disease. Case 1. A 69-year-old woman visited the hospital because of continuous lumbago. Her serum CA19-9 was 263 U/ml and DUPAN-II was >1600 U/ml. A pancreatic tail mass was revealed by ultrasonography. The final diagnosis was well-differentiated tubular adenocarcinoma after surgical resection. The carcinoma had invaded the left adrenal gland and transverse colon, and metastasized in the regional lymph nodes. The patient died of peritonitis carcinomatosa 8 years after surgical resection. Case 2. The 80-year-old sister of Case 1 visited the hospital with lumbago. Her serum CA19-9 was 92 U/ml. Pancreatic carcinoma was diagnosed by endoscopic retrograde pancreatography. Distal pancreatectomy was performed. The final pathology revealed well-differentiated tubular adenocarcinoma. The patient died 2 years after surgical resection as a result of local recurrence. The mother of both patients had also died of pancreatic cancer.
P-004. The comparison of post-operative insulin secretion and glucose intolerance between pancreaticoduodenectomy and distal pancreatectomy Tsuguka Shiwa 1, Kenichiro Uemura 2, Naoya Nakagawa 2, Yoshiaki Murakami 2