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EUS-guided needle-based confocal laser endomicroscopy (nCLE) findings in cystic lesions of the pancreas (CLP)
Abstracts / Pancreatology 17 (2017) S1eS68
0309. Serum tissue factor/tissue factor pathway inhibitor ratio predicts non-mild acute pancreatitis
S61
months follow up, pancreas body cyst was completely disappeared on the CT scan. Conclusion: EUS-guided ethanol with paclitaxel ablation appears to be a safe, feasible and effective for a selected pancreas cystic lesion.
Jing Yang, Lu Lu Zhai, Wei Hu Hangzhou First People’s Hospital, Nanjing Medical University, China Aim: This study aimed to investigate the potential of serum TF, TFPI, and TF/TFPI ratio to predict non-mild AP. Background: Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are key regulators of external coagulation pathways. The imbalance of serum TF and TFPI levels is known to cause coagulation-fibrinolysis system disorders. And the coagulation-fibrinolysis disorders are significantly associated to the disease severity and organ dysfunction in acute pancreatitis (AP). Method: Eighty patients were prospectively included in the study, and were divided into mild and non-mild (moderately severe or severe) according to the revised Atlanta classification. Venous blood was collected within 24 hours when the patient was first diagnosed with AP. Serum TF and TFPI concentrations were measured by ELISA method in the patients. Receiver operating curves was employed to evaluate the capacity of serum TF, TFPI, and TF/TFPI for the prediction of non-mild AP. Results: Serum TF and TFPI levels in patients with non-mild AP were higher than that in mild AP (P <0.05), whereas serum TF/TFPI was lower in patients with non-mild AP than mild AP. High serum TF and TFPI were not available in distinguishing mild AP from non-mild AP, with an AUC of 0.516 (95% CI¼ 0.651-0.923) and 0.541 (95% CI¼ 0.621-0.932), respectively. Surprisingly, low TF/TFPI ratio was available in distinguishing mild AP from non-mild AP, with an AUC of 0.816 (95% CI¼ 0.654-0.856). The cut-off value of TF/TFPI was 1.8, with sensitivity 83%, specificity 74%, respectively. Excitingly, the combination of serum TF/TFPI and C-reactive protein, the AUC value was significantly higher than each of them individually (AUC¼ 0.912; 95% CI 0.853-0.972), suggesting TF/TFPI combine with C-reactive protein increase the ability to predict non-mild AP. Conclusion: We conclude that serum TF/TFPI has a clinical ability to distinguish mild from non-mild AP in the early stages of AP.
0313. Eus-guided ethanol with paclitaxel ablation for the pancreatic cyst Jung Sik Choi, Ju Il Yang Busan Paik Hospital, College Of Medicine, Inje University, Corea del Sur, South Korea Introduction: Pancreas cystic lesions are frequently detected incidentally but surgical resection of the pancreas still carries substantial morbidity, and sometimes mortality, especially when the cystic lesion is located in the head portion. Recently several centers have reported the results of endoscopic ultrasound (EUS)-guided ablation for the pancreas cystic lesions. Aim: This study was to evaluate the response after EUS-guided ethanol lavage with paclitaxel injection for the pancreas cystic lesion. Method: A 61eyear-old woman presented with an about 5 cm-sized asymptomatic cystic lesion located in the pancreas caused by the external compression of the stomach. The presumed diagnosis was suspected of a unilocular macrocystic serous cystadenoma which was assessed by CEA 2.56 ng/mL, amylase 142 U/L, no k-ras mutation and no malignant cells on the cystic fluid analysis by EUS-FNA. A curvilinear-array echoendoscope (GF-UCT 240-AL-5; Olympus) and a 22-gauge needle (Boston Scientific Corp.) were used for cystic fluid aspiration, 99% ethanol lavage for 5 minutes, and then 3 mg/mL paclitaxel. Results: A patient have no any side effects such as abdominal pain, pancreatitis, or bleeding. Five months later, pancreas body cyst was smaller to 3 cm-sized on the computerized tomography (CT) scan. On twelve
0316. EUS-guided needle-based confocal laser endomicroscopy (nCLE) findings in cystic lesions of the pancreas (CLP) María Del Carmen Manzano, Jos e Guillermo de la Mora Levy, Cesar Ricardo Ortega Espinoza, Melissa Morales Jimenez, J. Octavio Alonso nchez del Monte, Mauro E. Ramirez Solis, Ang Larraga, Julio Sa elica ndez Guerrero Herna Instituto Nacional de Cancerologia, Mexico Introduction: Diagnosis of cystic tumors of the pancreas is challenging. nCLE enables real time images of the cyst during EUS/FNA that suggest mucinous lesions. Recent reports suggest that nCLE can separate mucinous from other neoplasia. Aim: Describe EUS-guided nCLE findings of CLP Background: Diagnosis of cystic tumors of the pancreas is challenging. nCLE enables real time images of the cyst during EUS/FNA that suggest mucinous lesions. Recent reports suggest that nCLE can separate mucinous from other neoplasia. Aim: Describe EUS-guided nCLE findings of CLP Method: All patients with a cystic lesion sent for EUS were considered for enrollment prospectively during a 3 month period. FNA was performed using a Cellvizio AQFlex probe (Mauna Kea) through a 19 gauge needle. Cytology and fluid analysis were also performed. The images were classified according to criteria for mucinous neoplasia by Konda (ultrathin straight bright bands, finger-like papillary projections, dark ring with white core, gland-like or crypt-like structures). nCLE findings were compared to cytology. Results: One-hundred-thirty-six EUS were performed. Nine CLP were found and 5 were included. All cysts measured more than 30mm. Cyst were located in tail (2), uncinate (1), body & tail (1), and head & body (1). EUS showed mostly anechoic/hypoechoic, heterogeneous and well defined tumors. Intramural nodules were presented in one patient and only one case had predominant solid component. Cytology showed adenocarcinoma in four patients. CEA was increased in 2 of four patients. All patients had images suggestive of mucinous neoplasia during nCLE, and four of them had positive cytology for adenocarcinoma. No complications were present Discussion: The presence of villous and epithelial structures during nCLE for the evaluation of cystic tumors of the pancreas supports the diagnosis of mucinous neoplasia. Conclusion: nCLE for the evaluation of cystic tumors of the pancreas supports the diagnosis of mucinous neoplasia.
0318. The yeld of the Fukuoka's criteria to detect cancer in patients with branch duct intraductal papillary mucinous neoplasia Lara Koyanagi, Katherina Yuriko Mizumura, Jos e Celso Ardengh, Otavio Micelli Neto, Eloy Taglieri, Raquelli Marçal Barbosa, Aline Duarte Silveira, Giovanna Riccitelli do Couto Hospital, 9 de Julho, Brazil Introduction: Intraductal papillary mucinous neoplasia is a preneoplastic lesion and according to the Fukuoka's criteria there were changes in its management. Nowadays people are debating how to proceed after identifying an asymptomatic pancreatic cyst. The endoscopic ultrasonography with a fine needle puncture is an effective tool to distinguish benign from malignant pancreatic lesions.
0309. Serum tissue factor/tissue factor pathway inhibitor ratio predicts non-mild acute pancreatitis
S61
months follow up, pancreas body cyst was completely disappeared on the CT scan. Conclusion: EUS-guided ethanol with paclitaxel ablation appears to be a safe, feasible and effective for a selected pancreas cystic lesion.
Jing Yang, Lu Lu Zhai, Wei Hu Hangzhou First People’s Hospital, Nanjing Medical University, China Aim: This study aimed to investigate the potential of serum TF, TFPI, and TF/TFPI ratio to predict non-mild AP. Background: Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are key regulators of external coagulation pathways. The imbalance of serum TF and TFPI levels is known to cause coagulation-fibrinolysis system disorders. And the coagulation-fibrinolysis disorders are significantly associated to the disease severity and organ dysfunction in acute pancreatitis (AP). Method: Eighty patients were prospectively included in the study, and were divided into mild and non-mild (moderately severe or severe) according to the revised Atlanta classification. Venous blood was collected within 24 hours when the patient was first diagnosed with AP. Serum TF and TFPI concentrations were measured by ELISA method in the patients. Receiver operating curves was employed to evaluate the capacity of serum TF, TFPI, and TF/TFPI for the prediction of non-mild AP. Results: Serum TF and TFPI levels in patients with non-mild AP were higher than that in mild AP (P <0.05), whereas serum TF/TFPI was lower in patients with non-mild AP than mild AP. High serum TF and TFPI were not available in distinguishing mild AP from non-mild AP, with an AUC of 0.516 (95% CI¼ 0.651-0.923) and 0.541 (95% CI¼ 0.621-0.932), respectively. Surprisingly, low TF/TFPI ratio was available in distinguishing mild AP from non-mild AP, with an AUC of 0.816 (95% CI¼ 0.654-0.856). The cut-off value of TF/TFPI was 1.8, with sensitivity 83%, specificity 74%, respectively. Excitingly, the combination of serum TF/TFPI and C-reactive protein, the AUC value was significantly higher than each of them individually (AUC¼ 0.912; 95% CI 0.853-0.972), suggesting TF/TFPI combine with C-reactive protein increase the ability to predict non-mild AP. Conclusion: We conclude that serum TF/TFPI has a clinical ability to distinguish mild from non-mild AP in the early stages of AP.
0313. Eus-guided ethanol with paclitaxel ablation for the pancreatic cyst Jung Sik Choi, Ju Il Yang Busan Paik Hospital, College Of Medicine, Inje University, Corea del Sur, South Korea Introduction: Pancreas cystic lesions are frequently detected incidentally but surgical resection of the pancreas still carries substantial morbidity, and sometimes mortality, especially when the cystic lesion is located in the head portion. Recently several centers have reported the results of endoscopic ultrasound (EUS)-guided ablation for the pancreas cystic lesions. Aim: This study was to evaluate the response after EUS-guided ethanol lavage with paclitaxel injection for the pancreas cystic lesion. Method: A 61eyear-old woman presented with an about 5 cm-sized asymptomatic cystic lesion located in the pancreas caused by the external compression of the stomach. The presumed diagnosis was suspected of a unilocular macrocystic serous cystadenoma which was assessed by CEA 2.56 ng/mL, amylase 142 U/L, no k-ras mutation and no malignant cells on the cystic fluid analysis by EUS-FNA. A curvilinear-array echoendoscope (GF-UCT 240-AL-5; Olympus) and a 22-gauge needle (Boston Scientific Corp.) were used for cystic fluid aspiration, 99% ethanol lavage for 5 minutes, and then 3 mg/mL paclitaxel. Results: A patient have no any side effects such as abdominal pain, pancreatitis, or bleeding. Five months later, pancreas body cyst was smaller to 3 cm-sized on the computerized tomography (CT) scan. On twelve
0316. EUS-guided needle-based confocal laser endomicroscopy (nCLE) findings in cystic lesions of the pancreas (CLP) María Del Carmen Manzano, Jos e Guillermo de la Mora Levy, Cesar Ricardo Ortega Espinoza, Melissa Morales Jimenez, J. Octavio Alonso nchez del Monte, Mauro E. Ramirez Solis, Ang Larraga, Julio Sa elica ndez Guerrero Herna Instituto Nacional de Cancerologia, Mexico Introduction: Diagnosis of cystic tumors of the pancreas is challenging. nCLE enables real time images of the cyst during EUS/FNA that suggest mucinous lesions. Recent reports suggest that nCLE can separate mucinous from other neoplasia. Aim: Describe EUS-guided nCLE findings of CLP Background: Diagnosis of cystic tumors of the pancreas is challenging. nCLE enables real time images of the cyst during EUS/FNA that suggest mucinous lesions. Recent reports suggest that nCLE can separate mucinous from other neoplasia. Aim: Describe EUS-guided nCLE findings of CLP Method: All patients with a cystic lesion sent for EUS were considered for enrollment prospectively during a 3 month period. FNA was performed using a Cellvizio AQFlex probe (Mauna Kea) through a 19 gauge needle. Cytology and fluid analysis were also performed. The images were classified according to criteria for mucinous neoplasia by Konda (ultrathin straight bright bands, finger-like papillary projections, dark ring with white core, gland-like or crypt-like structures). nCLE findings were compared to cytology. Results: One-hundred-thirty-six EUS were performed. Nine CLP were found and 5 were included. All cysts measured more than 30mm. Cyst were located in tail (2), uncinate (1), body & tail (1), and head & body (1). EUS showed mostly anechoic/hypoechoic, heterogeneous and well defined tumors. Intramural nodules were presented in one patient and only one case had predominant solid component. Cytology showed adenocarcinoma in four patients. CEA was increased in 2 of four patients. All patients had images suggestive of mucinous neoplasia during nCLE, and four of them had positive cytology for adenocarcinoma. No complications were present Discussion: The presence of villous and epithelial structures during nCLE for the evaluation of cystic tumors of the pancreas supports the diagnosis of mucinous neoplasia. Conclusion: nCLE for the evaluation of cystic tumors of the pancreas supports the diagnosis of mucinous neoplasia.
0318. The yeld of the Fukuoka's criteria to detect cancer in patients with branch duct intraductal papillary mucinous neoplasia Lara Koyanagi, Katherina Yuriko Mizumura, Jos e Celso Ardengh, Otavio Micelli Neto, Eloy Taglieri, Raquelli Marçal Barbosa, Aline Duarte Silveira, Giovanna Riccitelli do Couto Hospital, 9 de Julho, Brazil Introduction: Intraductal papillary mucinous neoplasia is a preneoplastic lesion and according to the Fukuoka's criteria there were changes in its management. Nowadays people are debating how to proceed after identifying an asymptomatic pancreatic cyst. The endoscopic ultrasonography with a fine needle puncture is an effective tool to distinguish benign from malignant pancreatic lesions.