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Fast-track pancreaticoduodenectomy: A cost analysis
Abstracts / Pancreatology 16 (2016) S1eS130
induced by systemic and local inflammatory mediators.So far,correlation with pancreatic cancer (PC) hasn’t been studied in the literature. Aims: To describe CL in PC patients and investigate their association. Patients & methods: Retrospective descriptive study involving 65 patients admitted to Intensive care unit of Emergency center from 2010 to 2015 with subsequent diagnosis of CL.PC was identified in 7 patients as etiological factor using exclusion criteria.We described CL characteristics in PC patients and investigated their relationship considering time of onset, biochemical pattern and biliary tract obstruction. Results: PC was etiological factor in 10% of CL patients.All PC patients were older than 50 years and had male to female ratio of 2.5:1.In 6 cases tumor was in the pancreatic head and 1 was located in the pancreatic body (86% versus 14%).CL was the first presenting symptom of PC in 5 patients who were also without ultrasound signs of biliary obstruction (prevalence of 71%, p<0.05).Biochemical pattern was distinguishing with discrepant elevation of gamma-glutamyl transferase (GGT) and bilirubin compared to aminotransferases in all cases (prevalence 100%, p<0.005). Conclusion: This is the first study evaluating CL and PC association. CL can be triggered with PC and be the first presenting symptom of PC. Cholestasis with discrepant elevation in GGT and bilirubin compared to aminotransferases without ultrasound signs of obstruction is characteristic. Further studies are necessary to better elucidate CL and PC relationship.
S97
Introduction: Apelin-36 is an adipocytokine, which can be considered as unifying link between metabolic disorders in the body and the development of pathological changes in the pancreas in patients with chronic pancreatitis (CP). Aims: The aim of this study was to explore the causative factors of progression of metabolic disorders in the tissues of the pancreas and their relationships in patients with CP. Patients & methods: The study was performed on 62 patients (22 males; mean aged 57.38±1.84) with CP; control group (n¼20). The survey plan included: BMI, fecal elastase -1, a-amilase, CRP, apelin-36, cholesterol, TG. Results: We found 1.7-fold increase in a-amilase serum level in patients (25.64±1.45) which was significant higher than in control (15.45±0.68) (p<0.05). Levels of elastase-1 were significantly lower in patients compare to control (131.4±5.4 vs 204.9±0.99, p<0.05). Level of CRP in patients was significantly higher compared to control (7.90±0.94 vs 0.25±0.18, p<0.05). We revealed 2.0-fold increase in serum apelin-36 level in patients which was significant higher than in control (349.97±12.77 vs 171.0±8.2, p<0.05). We found 1.8-fold and 1.7-fold increase in cholesterol and TG levels in patients (6.10±0.15 and 2.41±0.11) which was significant higher than in control (3.38±0.06 and 1.36±0.13; p<0.05). There were correlation between apelin-36 and BMI (r¼0.50; p<0.05), CRP (r¼0.72; p<0.05), elastase-1 (r¼-0.69; p<0.05), a-amilase (r¼-0.27; p<0.05), cholesterol (r¼0.38; p<0.05) and TG (r¼0.56; p<0.05). Conclusion: The results suggest the possible use of serum apelin-36 level as a new marker of progression of metabolic disorders in the pancreas on CP.
Abstract ID: 1625. Fast-track pancreaticoduodenectomy: A cost analysis Anna Murray
Abstract ID: 1629.
Queen Elizabeth Hospital Birmingham, United Kingdom
Correlation between the degree of pancreatic fibrosis and pancreatic secretion of bicarbonate in patients with early morphological changes of chronic pancreatitis
Introduction: Patients with obstructive jaundice secondary to pancreatic or periampullary tumours typically undergo pre-operative biliary drainage. However, data from randomized trials demonstrate higher complications rates and readmissions when patients are stented. A straight to surgery approach may be associated with reduced use and costs of healthcare compared to stented patients. Aims: To assess economic implications of a fast-track pancreaticoduodenectomy service Patients & methods: Retrospective analysis of a prospectively maintained patient database, from January 2015 to February 2016. Patients who were not jaundiced or required neoadjuvant chemotherapy were excluded on an intention to treat basis. Hospital Episode Statistics (HES) data and electronic patient records were used to identify all patient admissions from 30-days prior to the date of diagnosis and their date of surgery. Results: Sixty-seven patients were eligible for analysis. Twelve were fast tracked with a mean time to surgery of 18 days. Those on a standard pathway were divided into 3 groups; <60 days, 61-90 days and >90 days, with a mean time to surgery of 18, 42 and 103 days respectively. All patients who did not undergo the fast-track program were stented endoscopically or percutaneously, or both. The average total cost was significantly lower in the fast-track group (p < 0.05). The rate of complications increased with average time to surgery. Total length of hospital stay was greatest in the >90 days group (114 days) and lowest in the fast track group (25 days). Conclusion: Fast-track pancreatoduodenectomy is associated with a reduction in health care use and costs. This saving could be reinvested in a dedicated pancreatic nurse specialist to facilitate this pathway.
Abstract ID: 1626. Apelin-36 e New marker of progression of metabolic disorders in the pancreas in patients with chronic pancreatitis Yuliia Shekhovtsova, Larysa Zhuravlyova Kharkiv national medical university, Ukraine
o-Noia 1, Laura Nieto-Garcia 1, Santiago Julio Iglesias-Garcia 1, Jos e Larin oz 1 Lojo 2, J. Enrique Domínguez-Mun 1 Deparment of Gastroenterology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago, Spain 2 Department of Clinical Chemistry, University Hospital of Santiago, Spain
Introduction: Diagnosis of chronic pancreatitis (CP) is based on morphological and functional evaluation of the pancreas. Correlation between morphological and functional changes is poor at early stages of the disease. We have previously shown that the degree of pancreatic fibrosis in CP can be quantified by endoscopic ultrasound elastography (EUS-E), whereas pancreatic secretion can be accurately evaluated by the endoscopic pancreatic function test (ePFT). Aims: Aim of the present study was to evaluate the correlation between the degree of pancreatic fibrosis and pancreatic secretion in early CP. Materials & methods: Prospective, cross sectional study. Patients with clinical suspicion of CP and 3-4 EUS criteria of the disease were included. Elastographic strain ratio (SR) was evaluated as the mean SR at the head, body and tail of the pancreas. After that, 0.2 mg/kg secretin was intravenously administered and bicarbonate concentration was measured in samples of duodenal juice collected after 15, 30 and 45 minutes. Data are shown as mean ± SD and percentages. Correlation between SR and bicarbonate peak was calculated by linear regression analysis. Results: 43 patients were included (mean age 39.9 years, range 18e66). Peak bicarbonate concentration was 66.1 ± 27.7 mEq/L, and it was abnormally low in 33 (76.7%) patients. SR was 3.55 ± 1.01 and it was abnormally high in all patients. Correlation between SR and bicarbonate secretion was highly significant (r ¼ 0.768; p < 0.0001). Conclusion: There is a strong correlation between the degree of pancreatic fibrosis as evaluated by EUS-elastography and pancreatic secretion of bicarbonate. These results support the use of EUS-E for the early diagnosis of CP.
induced by systemic and local inflammatory mediators.So far,correlation with pancreatic cancer (PC) hasn’t been studied in the literature. Aims: To describe CL in PC patients and investigate their association. Patients & methods: Retrospective descriptive study involving 65 patients admitted to Intensive care unit of Emergency center from 2010 to 2015 with subsequent diagnosis of CL.PC was identified in 7 patients as etiological factor using exclusion criteria.We described CL characteristics in PC patients and investigated their relationship considering time of onset, biochemical pattern and biliary tract obstruction. Results: PC was etiological factor in 10% of CL patients.All PC patients were older than 50 years and had male to female ratio of 2.5:1.In 6 cases tumor was in the pancreatic head and 1 was located in the pancreatic body (86% versus 14%).CL was the first presenting symptom of PC in 5 patients who were also without ultrasound signs of biliary obstruction (prevalence of 71%, p<0.05).Biochemical pattern was distinguishing with discrepant elevation of gamma-glutamyl transferase (GGT) and bilirubin compared to aminotransferases in all cases (prevalence 100%, p<0.005). Conclusion: This is the first study evaluating CL and PC association. CL can be triggered with PC and be the first presenting symptom of PC. Cholestasis with discrepant elevation in GGT and bilirubin compared to aminotransferases without ultrasound signs of obstruction is characteristic. Further studies are necessary to better elucidate CL and PC relationship.
S97
Introduction: Apelin-36 is an adipocytokine, which can be considered as unifying link between metabolic disorders in the body and the development of pathological changes in the pancreas in patients with chronic pancreatitis (CP). Aims: The aim of this study was to explore the causative factors of progression of metabolic disorders in the tissues of the pancreas and their relationships in patients with CP. Patients & methods: The study was performed on 62 patients (22 males; mean aged 57.38±1.84) with CP; control group (n¼20). The survey plan included: BMI, fecal elastase -1, a-amilase, CRP, apelin-36, cholesterol, TG. Results: We found 1.7-fold increase in a-amilase serum level in patients (25.64±1.45) which was significant higher than in control (15.45±0.68) (p<0.05). Levels of elastase-1 were significantly lower in patients compare to control (131.4±5.4 vs 204.9±0.99, p<0.05). Level of CRP in patients was significantly higher compared to control (7.90±0.94 vs 0.25±0.18, p<0.05). We revealed 2.0-fold increase in serum apelin-36 level in patients which was significant higher than in control (349.97±12.77 vs 171.0±8.2, p<0.05). We found 1.8-fold and 1.7-fold increase in cholesterol and TG levels in patients (6.10±0.15 and 2.41±0.11) which was significant higher than in control (3.38±0.06 and 1.36±0.13; p<0.05). There were correlation between apelin-36 and BMI (r¼0.50; p<0.05), CRP (r¼0.72; p<0.05), elastase-1 (r¼-0.69; p<0.05), a-amilase (r¼-0.27; p<0.05), cholesterol (r¼0.38; p<0.05) and TG (r¼0.56; p<0.05). Conclusion: The results suggest the possible use of serum apelin-36 level as a new marker of progression of metabolic disorders in the pancreas on CP.
Abstract ID: 1625. Fast-track pancreaticoduodenectomy: A cost analysis Anna Murray
Abstract ID: 1629.
Queen Elizabeth Hospital Birmingham, United Kingdom
Correlation between the degree of pancreatic fibrosis and pancreatic secretion of bicarbonate in patients with early morphological changes of chronic pancreatitis
Introduction: Patients with obstructive jaundice secondary to pancreatic or periampullary tumours typically undergo pre-operative biliary drainage. However, data from randomized trials demonstrate higher complications rates and readmissions when patients are stented. A straight to surgery approach may be associated with reduced use and costs of healthcare compared to stented patients. Aims: To assess economic implications of a fast-track pancreaticoduodenectomy service Patients & methods: Retrospective analysis of a prospectively maintained patient database, from January 2015 to February 2016. Patients who were not jaundiced or required neoadjuvant chemotherapy were excluded on an intention to treat basis. Hospital Episode Statistics (HES) data and electronic patient records were used to identify all patient admissions from 30-days prior to the date of diagnosis and their date of surgery. Results: Sixty-seven patients were eligible for analysis. Twelve were fast tracked with a mean time to surgery of 18 days. Those on a standard pathway were divided into 3 groups; <60 days, 61-90 days and >90 days, with a mean time to surgery of 18, 42 and 103 days respectively. All patients who did not undergo the fast-track program were stented endoscopically or percutaneously, or both. The average total cost was significantly lower in the fast-track group (p < 0.05). The rate of complications increased with average time to surgery. Total length of hospital stay was greatest in the >90 days group (114 days) and lowest in the fast track group (25 days). Conclusion: Fast-track pancreatoduodenectomy is associated with a reduction in health care use and costs. This saving could be reinvested in a dedicated pancreatic nurse specialist to facilitate this pathway.
Abstract ID: 1626. Apelin-36 e New marker of progression of metabolic disorders in the pancreas in patients with chronic pancreatitis Yuliia Shekhovtsova, Larysa Zhuravlyova Kharkiv national medical university, Ukraine
o-Noia 1, Laura Nieto-Garcia 1, Santiago Julio Iglesias-Garcia 1, Jos e Larin oz 1 Lojo 2, J. Enrique Domínguez-Mun 1 Deparment of Gastroenterology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago, Spain 2 Department of Clinical Chemistry, University Hospital of Santiago, Spain
Introduction: Diagnosis of chronic pancreatitis (CP) is based on morphological and functional evaluation of the pancreas. Correlation between morphological and functional changes is poor at early stages of the disease. We have previously shown that the degree of pancreatic fibrosis in CP can be quantified by endoscopic ultrasound elastography (EUS-E), whereas pancreatic secretion can be accurately evaluated by the endoscopic pancreatic function test (ePFT). Aims: Aim of the present study was to evaluate the correlation between the degree of pancreatic fibrosis and pancreatic secretion in early CP. Materials & methods: Prospective, cross sectional study. Patients with clinical suspicion of CP and 3-4 EUS criteria of the disease were included. Elastographic strain ratio (SR) was evaluated as the mean SR at the head, body and tail of the pancreas. After that, 0.2 mg/kg secretin was intravenously administered and bicarbonate concentration was measured in samples of duodenal juice collected after 15, 30 and 45 minutes. Data are shown as mean ± SD and percentages. Correlation between SR and bicarbonate peak was calculated by linear regression analysis. Results: 43 patients were included (mean age 39.9 years, range 18e66). Peak bicarbonate concentration was 66.1 ± 27.7 mEq/L, and it was abnormally low in 33 (76.7%) patients. SR was 3.55 ± 1.01 and it was abnormally high in all patients. Correlation between SR and bicarbonate secretion was highly significant (r ¼ 0.768; p < 0.0001). Conclusion: There is a strong correlation between the degree of pancreatic fibrosis as evaluated by EUS-elastography and pancreatic secretion of bicarbonate. These results support the use of EUS-E for the early diagnosis of CP.