- Email: [email protected]
Clinical characteristics of the patients with diabetes mellitus complicated with intraductal papillary mucinous neoplasm
S132
Abstracts / Pancreatology 16 (2016) S1eS192
may sometimes co-exist with a completely unrelated PDA. Thus far, there are no clear criteria distinguishing between IPMN-derived cancer and concomitant PDA. This is challenging particularly due to loss of borders between incipient invasive loci in IPMN and massive invasion. In addition, adjacent concomitant invasive lesions cannot be fully discriminated from classic PDA developed in geographically distant regions. In order to address these questions, we analyzed the genomic profiles of each component of the IPMN-related cancer together with satellite precursor lesions and traced the patterns of their development. Patients with IPMN-associated PDA from 2011 to February 2016 at Teine-Keijinkai Hospital were pathologically reviewed. Twenty-five cases were selected in this preliminary study (7 IPMN-derived cancers, 13 IPMN-concomitant cancers, and 5 indistinguishable PDAs, as designated by pathologic criteria). Based on the precise pathological mapping, areas of invasive cancer, IPMN, and small intraepithelial lesions were micro-dissected from formalin-fixed paraffin-embedded specimens. Targeted amplicon sequencing was performed on panel of 18 genes (including KRAS, TP53, SMAD4, CDKN2A as well as GNAS and RNF43). Tracing the genomic profile and associated molecule signature of the various patterns of the IPMN-related cancer will clarify the natural history of invasive PDA subtype and unveil relevant core pathways.
P-156. Impact of positive MUC 1 expression in cell block cytology specimen for the progression of branch-duct type and mixed type IPMN with worrisome features Ko Tomishima 1, Jin Kan Sai 1, Hiroaki Saito 1, Tomoyasu Ito 1, Shigeto Ishii 1, Ryo Kanazawa 1, Hiroko Miura 1, Koki Sato 1, Sumio Watanabe 1, Shuichiro Shiina 1, Yuki Fukumura 2 1 2
Departments of Gastroenterology, Juntendo University, Japan Departments of Human Pathology, Juntendo University, Japan
Objective: To investigate whether MUC1 expression in cell block cytology specimen is associated with progression of branch-duct and mixed type IPMN with worrisome features during follow-up. Methods: Between January 2010 and May 2014, 51 patients with branch-duct type IPMN having worrisome features were examined by pancreatic duct lavage cytology with cell block method followed by MUC 1, MUC 2, MUC 5AC, and MUC 6 staining. Among them, 15 patients with positive for MUC 1 and negative for MUC 2 (MUC 1 group) and 16 with negative for MUC 1 and MUC 2 (control group) were prospectively followed up and examined for change in diameter of the main and ectatic branch pancreatic duct, enlargement of mural nodule and appearance of invasive finding as solid mass by EUS/CT/MRCP every 3 to 6 months. Result: The size of the ectatic branch pancreatic duct increased in 8 patients (53%) in MUC 1 group and 1 (6.3%) in control group (p¼0.0059). The diameter of the main pancreatic duct increased in 8 patients (53.3%) in MUC 1 group and 1 (6.3%) in control group (p¼0.0059). The size of the mural nodule enlarged in 5 patients (40%) in MUC 1 group and 1 (6.3%) in control group (p＞0.05). Solid mass appeared in 6 patients (33.3%) in MUC 1 group during follow up, five patients were pathologically confirmed as invasive cancer by surgery, one patient was determined to be inoperable due to gastric invasion, while in none in control group (p＜0.05). Conclusion: Positive MUC1 expression in cell block cytology specimen may be associated with enlargement of the mural nodule, progressive dilation of the main and ecstatic branch pancreatic duct, and invasive nature in branchduct and mixed type IPMN with worrisome features during follow-up.
P-157. Clinical characteristics of the patients with diabetes mellitus complicated with intraductal papillary mucinous neoplasm Miyuki Yanagimachi 1, Yusuke Tando 2, Eri Sato 1, Atsufumi Matsumoto 1, Shinji Chikazawa 1, Yuki Matsuhashi 1, Makoto Daimon 1, Teruo Nakamura 3
1
Department of Endoclinology and Metabolism, Hirosaki University, Japan 2 Health Science, Hirosaki University, Japan 3 Medical Examination Center, Hirosaki Medical Association, Japan
Objective: The aim of this study is to investigate the clinical characteristics of the patients with diabetes mellitus (DM) complicated with intraductal papillary mucinous neoplasm (IPMN). Methods: We investigated 34 patients with DM complicated with IPMN. We investigated the following factors, the age of IPMN diagnosis, duration of DM at the time of IPMN diagnosis, opportunity of IPMN diagnosis, the history of weight loss, stage of diabetic complications, family history of DM and pancreatic disease. At the time of IPMN diagnosis, we measured body mass index (BMI), HbA1c, serum C-peptide (CPR), blood glucose, albumin, amylase, and CA19-9. We calculated C-peptide index (CPI¼serum C-peptide/blood glucose * 100). We diagnosed the patient with CPI under 0.8 was insulin dependent. Result: The age of IPMN diagnosis was 68.0±7.0 years old. The duration of DM at the time of IPMN diagnosis was 9.3±10.3 years. 14 patients were complicated with main-duct IPMN and 20 patients were complicated with branch-duct IPMN. 44 percent patients with main-duct IPMN were diagnosed on the examinations for the abdominal symptoms, 86.7 percent patients with branch-duct IPMN were diagnosed on the screening examination during DM treatment. 10 percent of patients had family history of pancreatic disease. 53 percent patients had the history of the weight loss. DM complications were mild. BMI was 21.3±2.5kg/m2, HbA1c was 10.1±3.1 percent, CPI was 0.84±0.76, albumin was 3.66±0.43g/dl, amylase was 68±25.9U/l, CA19-9 was 46.8±36.1U/l. About 60 percent patients were insulin dependent. In 44 percent patients, glycemic control was poor. Conclusion: When these signs including the history of weight loss, mild of diabetic complications, tendency of insulin dependent are found, an examination of the IPMN is necessary in patients with DM.
P-158. Comparison of 6-hour and 24-hour Infusion of Nafamostat Mesilate for the Prevention of Post-ERCP Pancreatitis Woo Hyuk Choi, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam, Kong Jin Oh, Su Bum Park Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea Background and aims: Prolonged intravenous infusion of nafamostat mesilate is effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, the optimal duration of administration is yet to be revealed. We compared the efficacy of 24-hour versus 6-hour intravenous infusion of 20 mg nafamostat mesilate for post-ERCP pancreatitis (PEP) prevention. Methods: A total of 355 patients who underwent ERCP were randomly assigned to either 6-hour or 24-hour infusion group. Nafamostat mesilate (20 mg) infusion was initiated up to an hour before ERCP and continued for either 6-hours or 24-hours. Results: In both group, the overall incidence of pancreatitis was 2.5% (9/ 355). The rates of PEP following 6-hour and 24-hour infusion were 2.2% (4/ 182) and 2.8% (5/173), respectively (P¼0.652). No significant difference in the severity of pancreatitis was observed between the groups. On multivariate analysis, increasing pancreatic-duct cannulations (P¼0.030) was identified as a statistically significant risk factor. Conclusions: There was no difference between 6-hour and 24-hour nafamostat mesilate infusion group in the incidence of PEP. Therefore, 6hour infusion protocol may be effective and useful for the prevention of PEP in an outpatient setting.
Abstracts / Pancreatology 16 (2016) S1eS192
may sometimes co-exist with a completely unrelated PDA. Thus far, there are no clear criteria distinguishing between IPMN-derived cancer and concomitant PDA. This is challenging particularly due to loss of borders between incipient invasive loci in IPMN and massive invasion. In addition, adjacent concomitant invasive lesions cannot be fully discriminated from classic PDA developed in geographically distant regions. In order to address these questions, we analyzed the genomic profiles of each component of the IPMN-related cancer together with satellite precursor lesions and traced the patterns of their development. Patients with IPMN-associated PDA from 2011 to February 2016 at Teine-Keijinkai Hospital were pathologically reviewed. Twenty-five cases were selected in this preliminary study (7 IPMN-derived cancers, 13 IPMN-concomitant cancers, and 5 indistinguishable PDAs, as designated by pathologic criteria). Based on the precise pathological mapping, areas of invasive cancer, IPMN, and small intraepithelial lesions were micro-dissected from formalin-fixed paraffin-embedded specimens. Targeted amplicon sequencing was performed on panel of 18 genes (including KRAS, TP53, SMAD4, CDKN2A as well as GNAS and RNF43). Tracing the genomic profile and associated molecule signature of the various patterns of the IPMN-related cancer will clarify the natural history of invasive PDA subtype and unveil relevant core pathways.
P-156. Impact of positive MUC 1 expression in cell block cytology specimen for the progression of branch-duct type and mixed type IPMN with worrisome features Ko Tomishima 1, Jin Kan Sai 1, Hiroaki Saito 1, Tomoyasu Ito 1, Shigeto Ishii 1, Ryo Kanazawa 1, Hiroko Miura 1, Koki Sato 1, Sumio Watanabe 1, Shuichiro Shiina 1, Yuki Fukumura 2 1 2
Departments of Gastroenterology, Juntendo University, Japan Departments of Human Pathology, Juntendo University, Japan
Objective: To investigate whether MUC1 expression in cell block cytology specimen is associated with progression of branch-duct and mixed type IPMN with worrisome features during follow-up. Methods: Between January 2010 and May 2014, 51 patients with branch-duct type IPMN having worrisome features were examined by pancreatic duct lavage cytology with cell block method followed by MUC 1, MUC 2, MUC 5AC, and MUC 6 staining. Among them, 15 patients with positive for MUC 1 and negative for MUC 2 (MUC 1 group) and 16 with negative for MUC 1 and MUC 2 (control group) were prospectively followed up and examined for change in diameter of the main and ectatic branch pancreatic duct, enlargement of mural nodule and appearance of invasive finding as solid mass by EUS/CT/MRCP every 3 to 6 months. Result: The size of the ectatic branch pancreatic duct increased in 8 patients (53%) in MUC 1 group and 1 (6.3%) in control group (p¼0.0059). The diameter of the main pancreatic duct increased in 8 patients (53.3%) in MUC 1 group and 1 (6.3%) in control group (p¼0.0059). The size of the mural nodule enlarged in 5 patients (40%) in MUC 1 group and 1 (6.3%) in control group (p＞0.05). Solid mass appeared in 6 patients (33.3%) in MUC 1 group during follow up, five patients were pathologically confirmed as invasive cancer by surgery, one patient was determined to be inoperable due to gastric invasion, while in none in control group (p＜0.05). Conclusion: Positive MUC1 expression in cell block cytology specimen may be associated with enlargement of the mural nodule, progressive dilation of the main and ecstatic branch pancreatic duct, and invasive nature in branchduct and mixed type IPMN with worrisome features during follow-up.
P-157. Clinical characteristics of the patients with diabetes mellitus complicated with intraductal papillary mucinous neoplasm Miyuki Yanagimachi 1, Yusuke Tando 2, Eri Sato 1, Atsufumi Matsumoto 1, Shinji Chikazawa 1, Yuki Matsuhashi 1, Makoto Daimon 1, Teruo Nakamura 3
1
Department of Endoclinology and Metabolism, Hirosaki University, Japan 2 Health Science, Hirosaki University, Japan 3 Medical Examination Center, Hirosaki Medical Association, Japan
Objective: The aim of this study is to investigate the clinical characteristics of the patients with diabetes mellitus (DM) complicated with intraductal papillary mucinous neoplasm (IPMN). Methods: We investigated 34 patients with DM complicated with IPMN. We investigated the following factors, the age of IPMN diagnosis, duration of DM at the time of IPMN diagnosis, opportunity of IPMN diagnosis, the history of weight loss, stage of diabetic complications, family history of DM and pancreatic disease. At the time of IPMN diagnosis, we measured body mass index (BMI), HbA1c, serum C-peptide (CPR), blood glucose, albumin, amylase, and CA19-9. We calculated C-peptide index (CPI¼serum C-peptide/blood glucose * 100). We diagnosed the patient with CPI under 0.8 was insulin dependent. Result: The age of IPMN diagnosis was 68.0±7.0 years old. The duration of DM at the time of IPMN diagnosis was 9.3±10.3 years. 14 patients were complicated with main-duct IPMN and 20 patients were complicated with branch-duct IPMN. 44 percent patients with main-duct IPMN were diagnosed on the examinations for the abdominal symptoms, 86.7 percent patients with branch-duct IPMN were diagnosed on the screening examination during DM treatment. 10 percent of patients had family history of pancreatic disease. 53 percent patients had the history of the weight loss. DM complications were mild. BMI was 21.3±2.5kg/m2, HbA1c was 10.1±3.1 percent, CPI was 0.84±0.76, albumin was 3.66±0.43g/dl, amylase was 68±25.9U/l, CA19-9 was 46.8±36.1U/l. About 60 percent patients were insulin dependent. In 44 percent patients, glycemic control was poor. Conclusion: When these signs including the history of weight loss, mild of diabetic complications, tendency of insulin dependent are found, an examination of the IPMN is necessary in patients with DM.
P-158. Comparison of 6-hour and 24-hour Infusion of Nafamostat Mesilate for the Prevention of Post-ERCP Pancreatitis Woo Hyuk Choi, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam, Kong Jin Oh, Su Bum Park Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea Background and aims: Prolonged intravenous infusion of nafamostat mesilate is effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, the optimal duration of administration is yet to be revealed. We compared the efficacy of 24-hour versus 6-hour intravenous infusion of 20 mg nafamostat mesilate for post-ERCP pancreatitis (PEP) prevention. Methods: A total of 355 patients who underwent ERCP were randomly assigned to either 6-hour or 24-hour infusion group. Nafamostat mesilate (20 mg) infusion was initiated up to an hour before ERCP and continued for either 6-hours or 24-hours. Results: In both group, the overall incidence of pancreatitis was 2.5% (9/ 355). The rates of PEP following 6-hour and 24-hour infusion were 2.2% (4/ 182) and 2.8% (5/173), respectively (P¼0.652). No significant difference in the severity of pancreatitis was observed between the groups. On multivariate analysis, increasing pancreatic-duct cannulations (P¼0.030) was identified as a statistically significant risk factor. Conclusions: There was no difference between 6-hour and 24-hour nafamostat mesilate infusion group in the incidence of PEP. Therefore, 6hour infusion protocol may be effective and useful for the prevention of PEP in an outpatient setting.