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Does pancreatic stent type affect the incidence of pancreatic fistula? Results of a prospective randomized controlled trial
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Abstracts / Pancreatology 13 (2013) S1–S80
[O 17]. Clinical efficacy of pancrelipase delayed-release capsules on nonalcoholic fatty liver disease after pancreaticoduodenectomy Sohei Satoi 1, Masayuki Sho 2, Minako Nagai 2, Hideyoshi Toyokawa 1, Takahiro Akahori 2, Hiroaki Yanagimoto 1, Tomohisa Yamamoto 1, Syoichi Kinoshita 2, Satoshi Hirooka 1, So Yamaki 1, Hironori Ryota 1, Yoshiyuki Nakajima 2, A. Hon Kwon 1 1 2
[O 16]. Does pancreatic stent type affect the incidence of pancreatic fistula? Results of a prospective randomized controlled trial Masaji Tani, Manabu Kawai, Seiko Hirono, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Hiroki Yamaue Second Department of Surgery, Wakayama Medical University, Wakayama, Japan Background/aim: Complications of pancreaticoduodenectomy affect the postoperative course, and a stent is often placed across the pancreaticojejunostomy to reduce complications. However, no study has previously compared pancreatic stent types with regard to postoperative course. This study compared postoperative hospital stay and complications in patients with an external or internal drainage tube in pancreaticojejunostomy after pancreaticoduode-nectomy. Methods: We conducted a prospective randomized trial with 100 patients who underwent pancreaticoduodenectomy. We compared the effects of external and internal drainage tubes on postoperative course during the period from April 2005 to August 2007. This study has been registered at ClinicalTrials.gov using the Protocol Registration System (NCT00628186). Results: The median postoperative hospital stay was 21 days (range: 8–163 days) in the internal drainage group, significantly shorter than the median stay of 24 days (range: 21–88 days) in the external drainage group (P ¼ 0.016). The incidences of pancreatic fistula by International Study Group on Pancreatic Fistula criteria were 20% and 26% in the external and internal drainage groups, respectively. The incidence of pancreatic fistula classified as either grade B or grade C was 6% in both groups. The incidence of delayed gastric emptying was also similar in both groups. Conclusions: Internal drainage with pancreaticojejunostomy significantly shortened postoperative stay after pancreaticoduodenectomy and was associated with the same incidence of complications com pared with external drainage. Thus, internal drainage with pancreatico jejunostomy should be recommended for management after pan creaticoduodenectomy. Keywords: Pancreaticoduodenectomy, Pancreatic stent, Pancreatic fistula, Randomized controlled trial, Complication
Department of Surgery, Kansai Medical University, Osaka, Japan Department of Surgery, Nara Medical University, Nara, Japan
Background/aim: Postoperative nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has recently become recognized. However, the pathoetiology of postoperative NAFLD is largely unknown. Furthermore, the optimal treatment has not been established. The aim of this prospective study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse NAFLD. Methods: A collaborative clinical trial in two high-volume surgical centers has been conducted. A total of 30 patients who developed NAFLD after PD were prospectively treated with pancrelipase. NAFLD was defined and evaluated by the liver-to-spleen attenuation ratio on CT. Clinical symptoms and laboratory findings were also assessed. Results: The mean liver-to-spleen CT ratio before surgery in 30 patients was 1.233. It declined to 0.453 at diagnosis of NAFLD. It was significantly improved by the treatment and the CT ratios at 1, 3 and 6 months after treatment were 0.794, 0.958 and 0.944, respectively (versus pretreatment; P < 0.001). The mild liver dysfunction was also improved. Total protein levels at 3 and 6 months after treatment was significantly elevated compared with pretreatment (P ¼ 0.035 and P ¼ 0.027). Albumin at 3 and 6 months (P ¼ 0.039 and P ¼ 0.007) and total cholesterol at 1, 3 and 6 months levels (P ¼ 0.028, 0.004 and 0.030) were also improved after treatment. Importantly, relatively severe diarrhea seen in 11 patients was also ameliorated. Conclusions: Pancrelipase had a significant beneficial impact on NAFLD after PD. Maldigestion after pancreatic surgery may be a main cause for the development of postoperative NAFLD. Keywords: Fatty liver, Pancreaticoduodenectomy, Pancrelipase
[O 18]. The diagnostic value of abdominal drainage in the individual risk assessment for pancreatic fistula following pancreaticoduodenectomy €rd, John Blomberg, Marco Del Chiaro, Ralf Segersva Elena Rangelova, Christoph Ansorge Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Background/aim: Due to uncertain therapeutic value, the use of prophylactic abdominal drainage following pancreaticoduodenectomy (PD) is controversial. However, the diagnosis of postoperative pancreatic fistula (POPF), the predominate cause of PD-associated morbidity, is based on drain amylase levels. The aim was to assess the POPF-predictive value of drain pancreatic amylase (DPA), plasma pancreatic amylase (PPA) and serum C-reactive protein (CRP) in a POPF-risk stratified PD cohort. Methods: Prospective cohort study of 315 standardized PDs with prophylactic drainage 2008–2012. DPA, PPA and CRP were obtained daily. Differences between the study groups with clinically-relevant POPF (ISGPF-B/C) and without (non-POPF/ISGPF-A) were evaluated. ROC analyses were performed for the POPF-predictive values of DPA, PPA and CRP. Risk profiles for clinically-relevant POPF were constituted and related to the intraoperative pancreatic risk assessment.
Abstracts / Pancreatology 13 (2013) S1–S80
[O 17]. Clinical efficacy of pancrelipase delayed-release capsules on nonalcoholic fatty liver disease after pancreaticoduodenectomy Sohei Satoi 1, Masayuki Sho 2, Minako Nagai 2, Hideyoshi Toyokawa 1, Takahiro Akahori 2, Hiroaki Yanagimoto 1, Tomohisa Yamamoto 1, Syoichi Kinoshita 2, Satoshi Hirooka 1, So Yamaki 1, Hironori Ryota 1, Yoshiyuki Nakajima 2, A. Hon Kwon 1 1 2
[O 16]. Does pancreatic stent type affect the incidence of pancreatic fistula? Results of a prospective randomized controlled trial Masaji Tani, Manabu Kawai, Seiko Hirono, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Hiroki Yamaue Second Department of Surgery, Wakayama Medical University, Wakayama, Japan Background/aim: Complications of pancreaticoduodenectomy affect the postoperative course, and a stent is often placed across the pancreaticojejunostomy to reduce complications. However, no study has previously compared pancreatic stent types with regard to postoperative course. This study compared postoperative hospital stay and complications in patients with an external or internal drainage tube in pancreaticojejunostomy after pancreaticoduode-nectomy. Methods: We conducted a prospective randomized trial with 100 patients who underwent pancreaticoduodenectomy. We compared the effects of external and internal drainage tubes on postoperative course during the period from April 2005 to August 2007. This study has been registered at ClinicalTrials.gov using the Protocol Registration System (NCT00628186). Results: The median postoperative hospital stay was 21 days (range: 8–163 days) in the internal drainage group, significantly shorter than the median stay of 24 days (range: 21–88 days) in the external drainage group (P ¼ 0.016). The incidences of pancreatic fistula by International Study Group on Pancreatic Fistula criteria were 20% and 26% in the external and internal drainage groups, respectively. The incidence of pancreatic fistula classified as either grade B or grade C was 6% in both groups. The incidence of delayed gastric emptying was also similar in both groups. Conclusions: Internal drainage with pancreaticojejunostomy significantly shortened postoperative stay after pancreaticoduodenectomy and was associated with the same incidence of complications com pared with external drainage. Thus, internal drainage with pancreatico jejunostomy should be recommended for management after pan creaticoduodenectomy. Keywords: Pancreaticoduodenectomy, Pancreatic stent, Pancreatic fistula, Randomized controlled trial, Complication
Department of Surgery, Kansai Medical University, Osaka, Japan Department of Surgery, Nara Medical University, Nara, Japan
Background/aim: Postoperative nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has recently become recognized. However, the pathoetiology of postoperative NAFLD is largely unknown. Furthermore, the optimal treatment has not been established. The aim of this prospective study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse NAFLD. Methods: A collaborative clinical trial in two high-volume surgical centers has been conducted. A total of 30 patients who developed NAFLD after PD were prospectively treated with pancrelipase. NAFLD was defined and evaluated by the liver-to-spleen attenuation ratio on CT. Clinical symptoms and laboratory findings were also assessed. Results: The mean liver-to-spleen CT ratio before surgery in 30 patients was 1.233. It declined to 0.453 at diagnosis of NAFLD. It was significantly improved by the treatment and the CT ratios at 1, 3 and 6 months after treatment were 0.794, 0.958 and 0.944, respectively (versus pretreatment; P < 0.001). The mild liver dysfunction was also improved. Total protein levels at 3 and 6 months after treatment was significantly elevated compared with pretreatment (P ¼ 0.035 and P ¼ 0.027). Albumin at 3 and 6 months (P ¼ 0.039 and P ¼ 0.007) and total cholesterol at 1, 3 and 6 months levels (P ¼ 0.028, 0.004 and 0.030) were also improved after treatment. Importantly, relatively severe diarrhea seen in 11 patients was also ameliorated. Conclusions: Pancrelipase had a significant beneficial impact on NAFLD after PD. Maldigestion after pancreatic surgery may be a main cause for the development of postoperative NAFLD. Keywords: Fatty liver, Pancreaticoduodenectomy, Pancrelipase
[O 18]. The diagnostic value of abdominal drainage in the individual risk assessment for pancreatic fistula following pancreaticoduodenectomy €rd, John Blomberg, Marco Del Chiaro, Ralf Segersva Elena Rangelova, Christoph Ansorge Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Background/aim: Due to uncertain therapeutic value, the use of prophylactic abdominal drainage following pancreaticoduodenectomy (PD) is controversial. However, the diagnosis of postoperative pancreatic fistula (POPF), the predominate cause of PD-associated morbidity, is based on drain amylase levels. The aim was to assess the POPF-predictive value of drain pancreatic amylase (DPA), plasma pancreatic amylase (PPA) and serum C-reactive protein (CRP) in a POPF-risk stratified PD cohort. Methods: Prospective cohort study of 315 standardized PDs with prophylactic drainage 2008–2012. DPA, PPA and CRP were obtained daily. Differences between the study groups with clinically-relevant POPF (ISGPF-B/C) and without (non-POPF/ISGPF-A) were evaluated. ROC analyses were performed for the POPF-predictive values of DPA, PPA and CRP. Risk profiles for clinically-relevant POPF were constituted and related to the intraoperative pancreatic risk assessment.