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Endoscopic ultrasonography in acute biliary pancreatitis: when to do it before ERCP
Abstracts / Pancreatology 17 (2017) S1eS142
endpoint differed significantly between the groups. Higher BMI, indigestion and major abdominal complications were significant risk factors for DGE. Conclusion: In this randomized conrolled trial, pylorus resection during PD did not reduce incidence or severity of DGE.The development of DGE seems to be multifactorial rather than attributable to pyloric dysfunction alone. Pylorus preservation should therefore remain the standard of care in PD.
Abstract ID: 1897. Mutation profiles in long-term survivors with pulmonary metastases from pancreatic ductal adenocarcinoma Masato Ono 1, Toru Namamura 1, Toshiaki Shichinohe 1, Keisuke Okamura 1, Takhiro Tsuchikawa 1, Soich Murakami 1, Ebihara Yuma 1, Yo Kurashima 1, Takehiro Noji 1, Yoshitsugu Nakanishi 1, Kimitaka Tanaka 1, Yusuke Mizukami 2, Satoshi Hirano 1 1
Gastroenterological Surgery II Hokkaido University, Japan Center for Clinical and Biomedical Reseach Sapporo Higashi Tokushukai Hospital, Japan 2
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal type of cancer. Genetic studies have demonstrated significant heterogeneity in PDACs, which may influence the outcome even in patient with metastatic disease. Aims: Here we report 2 patients of PDAC with long-term survival after surgical resections for pulmonary metastases following the pancreatectomy. Patients & methods: CASE 1; A 48-year-old man with PDAC in the head of the pancreas underwent pancreaticoduodenectomy (T3N0M0). Lung metastases were identified at 19, 42 and 148 months after, and the patient has survived over 15 years with no evidence of relapse following sequential pulmonary resections. Each tumor harbored identical KRASG12D and TP53R342X. CASE 2; A 63-year-old woman with PDAC in the body of the pancreas underwent distal pancreatectomy with en-bloc celiac axis resection (T3N1M0). The lung metastasis was identified 111 months after operation, she underwent partial resection of the right upper lobe. Right hilar lymphadenopathy was demonstrated 10 months after the intervention, and the patient is well on chemotherapy. Both the primary and lung met harbored a KRASG12D mutation, and an additional Smad4R445X mutation was evident in subset of tumor cells in the metastatic site. Results: Lung metastases from PDAC can be controlled by surgical intervention when there was no metastasis in extrapulmonary organs after resection of primary tumor. PDAC with isolated lung metastases might belong to a subgroup with different genetic backgrounds from others. Conclusion: Identifying such subtypes may be helpful to predict prognosis and select optimal treatment for these patients.
Abstract ID: 1908. Outcome of Surgical Resection after Neoadjuvant Peptide Receptor Radionuclide Therapy (PRRT) for Pancreatic Neuroendocrine Neoplasms: a case-matched analysis Francesca Muffatti 1, Stefano Partelli 1, Valentina Andreasi 1, Alessandra Piccioli 2, Emilio Bertani 3, Mirco Bartolomei 4, Maria Chiara Grana 5, Giuseppe Zamboni 6, Claudio Doglioni 7, Nicola Fazio 8, Massimo Falconi 1 1
Pancreatic Surgery Unit, San Raffaele Scientific Institute, Milan, Italy AUO Ospedali Riuniti, Ancona, Italy 3 Surgery Department, European Institute of Oncology, Milan, Italy 4 Nuclear Medicine Department, "M. Bufalini” Hospital, Cesena, Italy 2
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5 Nuclear Medicine Department, European Institute of Oncology, Milan, Italy 6 Pathology Department, "Sacro Cuore-Don Calabria” Hospital, Negrar, Italy 7 Pathology Department, San Raffaele Scientific Institute, Milan, Italy 8 Oncology Department, European Institute of Oncology, Milan, Italy
Introduction: Peptide receptor radionuclide therapy (PRRT) can be an option for advanced pancreatic neuroendocrine neoplasms (PNENs) to allow patients undergoing resection. Is not clearly established if neoadjuvant PRRT increases postoperative morbidity. Aims: To compare clinical and surgical outcomes in patients with initially metastatic and/or locally advanced PNENs, submitted to neoadjuvant PRRT (neoadjuvant group) or to upfront surgery (control group). Materials & methods: Retrospective monocentric case-match analysis. Patients were matched for tumor size, grading, staging, and intent of resection. Results: Twenty patients underwent sequential PRRT and pancreatic resection. Reasons for neoadjuvant PRRT were the presence of liver metastases (30%, 6 patients), organ/vascular infiltration (70%, 14 patients). After PRRT the median tumor size decreases from 59 to 50 mm (p¼0.047). Fifteen patients underwent distal pancreatectomy whereas the remaining 5 underwent pancreaticoduodenectomy. Curative resection rate’s was 65%. Histology revealed a PNEN-G1 in 10 cases, PNEN-G2 in 7, PNEC-G3 in 3. Neoadjuvant group patients’ had a lower risk of developing pancreatic fistula (25% versus 65%, P¼0.011) although the rate of overall complications was similar (45% versus 60%, P¼0.342). The two groups had similar distribution of tumor grading, T stage, TNM stage, R2 resection, microvascular invasion, perineural invasion, and necrosis. Control group patients’ had more lymph nodes metastases (80% versus 35%, P¼0.004). Twoyear progression free survival rate was 85% for the neoadjuvant group versus 59% in the control group (P¼0.302). Independent predictors of progression free survival were PNEC-G3 and stage IV tumor. Conclusion: Pancreatic resection for PNEN after neoadjuvant PRRT is safe and associated with a lower risk of developing pancreatic fistula.
Abstract ID: 1913. Endoscopic ultrasonography in acute biliary pancreatitis: when to do it before ERCP Santos Fernando, Germade Arantxa, Moreira Bruno, P erez Laura, Barcenilla Javier, Maestro Sergio, Madrigal Rosa Eva, P erez Antonio Gastroenterology Unit, Complejo Asistencial Universitario de Palencia, Spain Introduction: The most common cause of acute pancreatitis is stones in the gallblader and their pass througt the common bile duct (CBD). There are clinical guidelines in order to identify patients with "high risk" to have stones into the CBD, based on bilirrubin level or dilation of the CBD. Aims: Compare results of EUS and relationship with diameter of the CBD detected on transabdominal ultrasound (US) and bilirrubin level in patient with acute pancreatitis with suspected biliary etiology. Patients & methods: Retrospective study of patients with acute pancreatitis with suspected biliary etiology, who underwent endoscopic ultrasonography (EUS).We included patients with first pancreatitis episode, gallblader in situ, with an initial US, and without ERCP.We defined four groups of patients with low(<2mg/dL) or high (>2mg/dL) bilirrubin level and normal (<6mm) or dilated (>6mm) CBD on US Results: We perfomed an EUS in 98 patients. In 24 choledocholithiasis was identified and were performed an ERCP.Choledocholithiasis was confirmed in 23 (96%). We studied patients with choledocholithiasis on EUS and the relationship with bilirrubin level and dilatation of CBD on US. Choledocholithiasis Without choledocholithiasis 1.- Low bilirrubin level and normal CBD (36p) 2(5.5%) 34(94.5%) 2.- Low bilirrubin level and dilated CBD (17p) 5(29%) 12(71%) 3.- High bilirrubin level and normal CBD
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Abstracts / Pancreatology 17 (2017) S1eS142
(33p) 7(21%) 26(79%) 4.- High bilirrubin level and dilated CBD (12p) 10(83%) 21(17%) Conclusion: EUS is a very useful medical procedure to detect CL in acute biliary pancreatitis.In intermediate-risk patients in which CL can not be assessed with by the symptoms, analitic test or US, EUS allows a precise diagnosis of CL and avoid unnecesary ERCP.
Abstract ID: 1914. Solid pseudopapillary tumor of pancreas with anomaly of hepatic portal vein in young female patient: case report Emilija Nikolovska 1, Darko Dzambaz 2, Viktorija Calovska 1, Rozalinda Popova-Jovanovska 1, Meri Trajkovska 1, Gjorgji Deriban 1 1 2
from January 2014 to January 2017. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, defined as near complete or complete resolution of the pseudocyst on imaging, adverse events and requirement of further intervention. Results: The search identified 183 studies, 6 studies with 592 (284 metal, 308 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 96.1% vs 87.5%, in the metal and plastic groups respectively, RR 1.08 [95% CI 1.01-1.15], I2 ¼38.1%. The rate of adverse events was 10.7% for metal stents vs 26.6% for plastic, RR 0.43 [95% CI 0.21-0.88], I2¼ 53.5%. Further intervention was required in 18.2% of patients in the metal stent group vs 27.3% RR 0.61 [95% CI 0.221.71], I2¼ 73.6%. Conclusion: Metal stent usage for drainage of peripancreatic fluid collections improves clinical outcomes and reduces adverse events.
University Clinic of Gastroenterhepatology, Macedonia University Clinic of Digestive Surgery, Macedonia
Introduction: Solid pseudopapillary tumor is rare tumor of the pancreas, with incidence around 3 % of all pancreatic neoplasms. The unknown etiopathogenesis still makes this tumor an enigma. They are usually found in young females between 30-40 years with nonspecific symptoms including abdominal discomfort, subtle abdominal pain or palpable abdominal mass. This tumor has a low malignant potential; however, it may be locally aggressive. In 70% of the cases it is presented with abdominal pain and 30% of cases it is asymptomatic with the diagnosis made incidentally on a routine medical examination. Aims: We present a rare case of a young female patient with solid pseudopapillary tumor of pancreas with anomaly of hepatic portal vein that lies on the anterior portion of duodenum. Patients & methods: Ultrasound, endoscopic ultrasound and computer tomography reveal tumor of the head of pancreas with solid and cystic components, well circumscribed. According to the imaging finding an operation was indicated. Results: Surgical resection of the tumor was done and solid pseudopapillary tumor of pancreas was histopathologically confirmed. During surgery anomaly of hepatic portal vein that lies on the anterior portion of duodenum was seen; this is a rare anomaly of portal tract that makes this case unique. The patient is in good general condition in the postoperative follow-up. Because of the potential for malignant alteration and local invasion of surrounding structurally, surgery is treatment of choice for patients with solid pancreatic tumor. Conclusion: We emphasize that early recognition of the lesion combined with surgery offers the best chances for definitive treatment.
Abstract ID: 1916. Role of metal vs plastic stents for endoscopic ultrasound guided drainage of peri-pancreatic fluid collections: A systematic review and meta-analysis Rebecca Saunders, Jayapal Ramesh, Silvia Cicconi, Robert Sutton, John Neoptolemos, Chris Halloran
Abstract ID: 1918. Usage of transmural metal stents for endoscopic ultrasound guided drainage of pseudocysts may lead to lower reintervention rates Jayapal Ramesh, Rebecca Saunders, Jonathan Evans, Paula Ghaneh, Michael Raraty, Vincent Yip, Rukhsana Barkatali, Rebekah McCready, Faye Hughes, Silvia Cicconi, Robert Sutton, John Neoptolemos, Chris Halloran Royal Liverpool University Hospital, United Kingdom Introduction: Endoscopic ultrasound (EUS) guided drainage is now the first line treatment for drainage of symptomatic pancreatic pseudocysts. Aims: This study investigates the effects of metal vs. plastic transmural stents. The primary outcome measure was defined as rate of reintervention for pseudocyst following stent. Patients & methods: A prospectively maintained database from 20112016 was analysed. Fluid collections were characterised by CT imaging and EUS. All patients were discussed at multidisciplinary meeting prior to intervention. Results: 74 patients with pseudocysts were included in this analysis. There was no significant difference in patient demographics or indication for intervention between the groups. Metal stents were placed in 38 (51%) patients. Three patients (8%) with metal stents required further intervention compared to 11 patients (31%) with plastic stents (p¼0.037). Technical success was similar between groups; 100% for metal vs 97% for plastic stents. At 6 weeks following procedure, pseudocyst drainage was achieved in 33/35 patients using metal vs 27/36 of the plastic stent group (p¼0.046). 25 patients with metal stents achieved pseudocyst drainage at 6 months vs 23 (p¼0.25) who had plastic stents. Early adverse events were less common in the metal stent group (8%) vs 33% with plastic stents (p¼0.009). Conclusion: Use of metal transmural stents for drainage of pancreatic pseudocysts may reduce reintervention rates and causes fewer adverse events compared to plastic stents. Drainage with metal stents is most effective by 6 weeks, with little difference between metal vs. plastic stents by 6 months.
Royal Liverpool University Hospital, United Kingdom Introduction: The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents (LAMS) for transmural drainage of peri-pancreatic fluid collections has become widespread. Aims: A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore, a systematic review and meta-analysis was performed. Patients & methods: We conducted a Pubmed search for English language original comparative studies between plastic and metal stents
Abstract ID: 1921. Encouraging observed 5-year survival with upfront resection and adjuvant therapy for pancreatic ductal adenocarcinoma in a large contemporary series Oliver Strobel 1, Philipp Lorenz 1, Ulf Hinz 1, Matthias Gaida 2, AnnaKatharina Stadler 1, Thomas Hank 1, Willem Niesen 1, Frank Bergmann 2, Thilo Hackert 1, Markus Büchler 1 1
General Surgery, Heidelberg University Hospital, Germany
endpoint differed significantly between the groups. Higher BMI, indigestion and major abdominal complications were significant risk factors for DGE. Conclusion: In this randomized conrolled trial, pylorus resection during PD did not reduce incidence or severity of DGE.The development of DGE seems to be multifactorial rather than attributable to pyloric dysfunction alone. Pylorus preservation should therefore remain the standard of care in PD.
Abstract ID: 1897. Mutation profiles in long-term survivors with pulmonary metastases from pancreatic ductal adenocarcinoma Masato Ono 1, Toru Namamura 1, Toshiaki Shichinohe 1, Keisuke Okamura 1, Takhiro Tsuchikawa 1, Soich Murakami 1, Ebihara Yuma 1, Yo Kurashima 1, Takehiro Noji 1, Yoshitsugu Nakanishi 1, Kimitaka Tanaka 1, Yusuke Mizukami 2, Satoshi Hirano 1 1
Gastroenterological Surgery II Hokkaido University, Japan Center for Clinical and Biomedical Reseach Sapporo Higashi Tokushukai Hospital, Japan 2
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal type of cancer. Genetic studies have demonstrated significant heterogeneity in PDACs, which may influence the outcome even in patient with metastatic disease. Aims: Here we report 2 patients of PDAC with long-term survival after surgical resections for pulmonary metastases following the pancreatectomy. Patients & methods: CASE 1; A 48-year-old man with PDAC in the head of the pancreas underwent pancreaticoduodenectomy (T3N0M0). Lung metastases were identified at 19, 42 and 148 months after, and the patient has survived over 15 years with no evidence of relapse following sequential pulmonary resections. Each tumor harbored identical KRASG12D and TP53R342X. CASE 2; A 63-year-old woman with PDAC in the body of the pancreas underwent distal pancreatectomy with en-bloc celiac axis resection (T3N1M0). The lung metastasis was identified 111 months after operation, she underwent partial resection of the right upper lobe. Right hilar lymphadenopathy was demonstrated 10 months after the intervention, and the patient is well on chemotherapy. Both the primary and lung met harbored a KRASG12D mutation, and an additional Smad4R445X mutation was evident in subset of tumor cells in the metastatic site. Results: Lung metastases from PDAC can be controlled by surgical intervention when there was no metastasis in extrapulmonary organs after resection of primary tumor. PDAC with isolated lung metastases might belong to a subgroup with different genetic backgrounds from others. Conclusion: Identifying such subtypes may be helpful to predict prognosis and select optimal treatment for these patients.
Abstract ID: 1908. Outcome of Surgical Resection after Neoadjuvant Peptide Receptor Radionuclide Therapy (PRRT) for Pancreatic Neuroendocrine Neoplasms: a case-matched analysis Francesca Muffatti 1, Stefano Partelli 1, Valentina Andreasi 1, Alessandra Piccioli 2, Emilio Bertani 3, Mirco Bartolomei 4, Maria Chiara Grana 5, Giuseppe Zamboni 6, Claudio Doglioni 7, Nicola Fazio 8, Massimo Falconi 1 1
Pancreatic Surgery Unit, San Raffaele Scientific Institute, Milan, Italy AUO Ospedali Riuniti, Ancona, Italy 3 Surgery Department, European Institute of Oncology, Milan, Italy 4 Nuclear Medicine Department, "M. Bufalini” Hospital, Cesena, Italy 2
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5 Nuclear Medicine Department, European Institute of Oncology, Milan, Italy 6 Pathology Department, "Sacro Cuore-Don Calabria” Hospital, Negrar, Italy 7 Pathology Department, San Raffaele Scientific Institute, Milan, Italy 8 Oncology Department, European Institute of Oncology, Milan, Italy
Introduction: Peptide receptor radionuclide therapy (PRRT) can be an option for advanced pancreatic neuroendocrine neoplasms (PNENs) to allow patients undergoing resection. Is not clearly established if neoadjuvant PRRT increases postoperative morbidity. Aims: To compare clinical and surgical outcomes in patients with initially metastatic and/or locally advanced PNENs, submitted to neoadjuvant PRRT (neoadjuvant group) or to upfront surgery (control group). Materials & methods: Retrospective monocentric case-match analysis. Patients were matched for tumor size, grading, staging, and intent of resection. Results: Twenty patients underwent sequential PRRT and pancreatic resection. Reasons for neoadjuvant PRRT were the presence of liver metastases (30%, 6 patients), organ/vascular infiltration (70%, 14 patients). After PRRT the median tumor size decreases from 59 to 50 mm (p¼0.047). Fifteen patients underwent distal pancreatectomy whereas the remaining 5 underwent pancreaticoduodenectomy. Curative resection rate’s was 65%. Histology revealed a PNEN-G1 in 10 cases, PNEN-G2 in 7, PNEC-G3 in 3. Neoadjuvant group patients’ had a lower risk of developing pancreatic fistula (25% versus 65%, P¼0.011) although the rate of overall complications was similar (45% versus 60%, P¼0.342). The two groups had similar distribution of tumor grading, T stage, TNM stage, R2 resection, microvascular invasion, perineural invasion, and necrosis. Control group patients’ had more lymph nodes metastases (80% versus 35%, P¼0.004). Twoyear progression free survival rate was 85% for the neoadjuvant group versus 59% in the control group (P¼0.302). Independent predictors of progression free survival were PNEC-G3 and stage IV tumor. Conclusion: Pancreatic resection for PNEN after neoadjuvant PRRT is safe and associated with a lower risk of developing pancreatic fistula.
Abstract ID: 1913. Endoscopic ultrasonography in acute biliary pancreatitis: when to do it before ERCP Santos Fernando, Germade Arantxa, Moreira Bruno, P erez Laura, Barcenilla Javier, Maestro Sergio, Madrigal Rosa Eva, P erez Antonio Gastroenterology Unit, Complejo Asistencial Universitario de Palencia, Spain Introduction: The most common cause of acute pancreatitis is stones in the gallblader and their pass througt the common bile duct (CBD). There are clinical guidelines in order to identify patients with "high risk" to have stones into the CBD, based on bilirrubin level or dilation of the CBD. Aims: Compare results of EUS and relationship with diameter of the CBD detected on transabdominal ultrasound (US) and bilirrubin level in patient with acute pancreatitis with suspected biliary etiology. Patients & methods: Retrospective study of patients with acute pancreatitis with suspected biliary etiology, who underwent endoscopic ultrasonography (EUS).We included patients with first pancreatitis episode, gallblader in situ, with an initial US, and without ERCP.We defined four groups of patients with low(<2mg/dL) or high (>2mg/dL) bilirrubin level and normal (<6mm) or dilated (>6mm) CBD on US Results: We perfomed an EUS in 98 patients. In 24 choledocholithiasis was identified and were performed an ERCP.Choledocholithiasis was confirmed in 23 (96%). We studied patients with choledocholithiasis on EUS and the relationship with bilirrubin level and dilatation of CBD on US. Choledocholithiasis Without choledocholithiasis 1.- Low bilirrubin level and normal CBD (36p) 2(5.5%) 34(94.5%) 2.- Low bilirrubin level and dilated CBD (17p) 5(29%) 12(71%) 3.- High bilirrubin level and normal CBD
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Abstracts / Pancreatology 17 (2017) S1eS142
(33p) 7(21%) 26(79%) 4.- High bilirrubin level and dilated CBD (12p) 10(83%) 21(17%) Conclusion: EUS is a very useful medical procedure to detect CL in acute biliary pancreatitis.In intermediate-risk patients in which CL can not be assessed with by the symptoms, analitic test or US, EUS allows a precise diagnosis of CL and avoid unnecesary ERCP.
Abstract ID: 1914. Solid pseudopapillary tumor of pancreas with anomaly of hepatic portal vein in young female patient: case report Emilija Nikolovska 1, Darko Dzambaz 2, Viktorija Calovska 1, Rozalinda Popova-Jovanovska 1, Meri Trajkovska 1, Gjorgji Deriban 1 1 2
from January 2014 to January 2017. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, defined as near complete or complete resolution of the pseudocyst on imaging, adverse events and requirement of further intervention. Results: The search identified 183 studies, 6 studies with 592 (284 metal, 308 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 96.1% vs 87.5%, in the metal and plastic groups respectively, RR 1.08 [95% CI 1.01-1.15], I2 ¼38.1%. The rate of adverse events was 10.7% for metal stents vs 26.6% for plastic, RR 0.43 [95% CI 0.21-0.88], I2¼ 53.5%. Further intervention was required in 18.2% of patients in the metal stent group vs 27.3% RR 0.61 [95% CI 0.221.71], I2¼ 73.6%. Conclusion: Metal stent usage for drainage of peripancreatic fluid collections improves clinical outcomes and reduces adverse events.
University Clinic of Gastroenterhepatology, Macedonia University Clinic of Digestive Surgery, Macedonia
Introduction: Solid pseudopapillary tumor is rare tumor of the pancreas, with incidence around 3 % of all pancreatic neoplasms. The unknown etiopathogenesis still makes this tumor an enigma. They are usually found in young females between 30-40 years with nonspecific symptoms including abdominal discomfort, subtle abdominal pain or palpable abdominal mass. This tumor has a low malignant potential; however, it may be locally aggressive. In 70% of the cases it is presented with abdominal pain and 30% of cases it is asymptomatic with the diagnosis made incidentally on a routine medical examination. Aims: We present a rare case of a young female patient with solid pseudopapillary tumor of pancreas with anomaly of hepatic portal vein that lies on the anterior portion of duodenum. Patients & methods: Ultrasound, endoscopic ultrasound and computer tomography reveal tumor of the head of pancreas with solid and cystic components, well circumscribed. According to the imaging finding an operation was indicated. Results: Surgical resection of the tumor was done and solid pseudopapillary tumor of pancreas was histopathologically confirmed. During surgery anomaly of hepatic portal vein that lies on the anterior portion of duodenum was seen; this is a rare anomaly of portal tract that makes this case unique. The patient is in good general condition in the postoperative follow-up. Because of the potential for malignant alteration and local invasion of surrounding structurally, surgery is treatment of choice for patients with solid pancreatic tumor. Conclusion: We emphasize that early recognition of the lesion combined with surgery offers the best chances for definitive treatment.
Abstract ID: 1916. Role of metal vs plastic stents for endoscopic ultrasound guided drainage of peri-pancreatic fluid collections: A systematic review and meta-analysis Rebecca Saunders, Jayapal Ramesh, Silvia Cicconi, Robert Sutton, John Neoptolemos, Chris Halloran
Abstract ID: 1918. Usage of transmural metal stents for endoscopic ultrasound guided drainage of pseudocysts may lead to lower reintervention rates Jayapal Ramesh, Rebecca Saunders, Jonathan Evans, Paula Ghaneh, Michael Raraty, Vincent Yip, Rukhsana Barkatali, Rebekah McCready, Faye Hughes, Silvia Cicconi, Robert Sutton, John Neoptolemos, Chris Halloran Royal Liverpool University Hospital, United Kingdom Introduction: Endoscopic ultrasound (EUS) guided drainage is now the first line treatment for drainage of symptomatic pancreatic pseudocysts. Aims: This study investigates the effects of metal vs. plastic transmural stents. The primary outcome measure was defined as rate of reintervention for pseudocyst following stent. Patients & methods: A prospectively maintained database from 20112016 was analysed. Fluid collections were characterised by CT imaging and EUS. All patients were discussed at multidisciplinary meeting prior to intervention. Results: 74 patients with pseudocysts were included in this analysis. There was no significant difference in patient demographics or indication for intervention between the groups. Metal stents were placed in 38 (51%) patients. Three patients (8%) with metal stents required further intervention compared to 11 patients (31%) with plastic stents (p¼0.037). Technical success was similar between groups; 100% for metal vs 97% for plastic stents. At 6 weeks following procedure, pseudocyst drainage was achieved in 33/35 patients using metal vs 27/36 of the plastic stent group (p¼0.046). 25 patients with metal stents achieved pseudocyst drainage at 6 months vs 23 (p¼0.25) who had plastic stents. Early adverse events were less common in the metal stent group (8%) vs 33% with plastic stents (p¼0.009). Conclusion: Use of metal transmural stents for drainage of pancreatic pseudocysts may reduce reintervention rates and causes fewer adverse events compared to plastic stents. Drainage with metal stents is most effective by 6 weeks, with little difference between metal vs. plastic stents by 6 months.
Royal Liverpool University Hospital, United Kingdom Introduction: The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents (LAMS) for transmural drainage of peri-pancreatic fluid collections has become widespread. Aims: A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore, a systematic review and meta-analysis was performed. Patients & methods: We conducted a Pubmed search for English language original comparative studies between plastic and metal stents
Abstract ID: 1921. Encouraging observed 5-year survival with upfront resection and adjuvant therapy for pancreatic ductal adenocarcinoma in a large contemporary series Oliver Strobel 1, Philipp Lorenz 1, Ulf Hinz 1, Matthias Gaida 2, AnnaKatharina Stadler 1, Thomas Hank 1, Willem Niesen 1, Frank Bergmann 2, Thilo Hackert 1, Markus Büchler 1 1
General Surgery, Heidelberg University Hospital, Germany