- Email: [email protected]
FNB) for the diagnosis of solid pancreatic masses?
Abstracts / Pancreatology 15 (2015) e1ee17
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28.
30.
Association between morphological severity and the presence of exocrine pancreatic insufficiency (EPI) in chronic pancreatitis
Quantifying endoscopic ultrasound (EUS)-guided elastography for the differential diagnosis of solid pancreatic masses: Hue-histogram or strain ratio?
ndez-Cano, M.A. Romero-Ordon ~ ez, A. Perez Aisa, R. Rivera-Irigoin, F. Ferna nchez, A. Sa nchez-Yague, F. Rivas I. M endez-Sa Unidad de Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain Introduction: The EPI in the context of CP is an underdiagnosed entity, which secondarily involved maldigestion, malabsorption and malnutrition, remaining a diagnostic challenge. Objectives: Evaluate de association between severity and presence of EUS finding in CP. Material and methods: Transversal descriptive retrospective study including all patients with EUS criteria CP from 2001 to 2014 were correlated with the Computerized Medical Record to select those who met diagnostic CP. The presence of EPI was evaluated by means of C13 triglyceride breath test (TGT).A descriptive analysis with measures of central tendency and dispersion for quantitative variables and frequency distribution for qualitative took place. To compare subgroups (presence or absence of EPI) chi-square test for qualitative variables and test of Mann-Whitney was used for quantitative. Level of significance at p <0.05. Results: CP diagnosis in 85 patients with a mean age of 54.99 years, 19.2% women was established. 63 patients (74%) had done so much testing as EUS pancreatic and TGT. Of the 16 patients with mild EUS findings CP, 50% had EPI and 50% had not. Of the 47 patients with severe EUS findings CP, 70% had EPI and the rest not, without this would result in a statistically significant difference. Conclusions: In our series the degree of morphological severity by EUS does not correlate with the presence of EPI by TGT.
29. Correlation between the etiology of chronic pancreatitis and its morphological severity by EUS criteria
~ o Noia, J. Iglesias García, I. Abdulkader, J.E. Domínguez Mun ~ oz J. Larin n para la Hospital Clínico universitario de Santiago, Fundacio n en Enfermedades del Aparato Digestivo, Santiago de Investigacio Compostela, Spain Introduction: Quantitative EUS-elastography allows quantifying tissue stiffness during a standard EUS examination. Elastography result may be analyzed either by strain ratio (SR) or hue histogram analysis (HHA). Aims: was to evaluate the accuracy of SR and HHA for the differential diagnosis of solid pancreatic masses. Methods: A prospective, observational, comparative study was designed. 162 consecutive patients (mean age 63 years, range 17-89, 98 male), with a solid pancreatic mass at EUS were prospectively included. Elastography was performed with linear Pentax-EUS and Hitachi-Preirus. For HHA, the tumor area was selected and analyzed. The mass (area A) and a peripancreatic soft reference area (B) were selected for SR analysis (quotient B/A). Final diagnosis was based on surgical histopathology, or EUS-FNA/FNB and global clinical and radiological assessment at follow-up in non-operated cases. Data are shown as mean (95%CI) and analyzed by ANOVA. Diagnostic accuracy was calculated by drawing the corresponding ROC curves. Results: Size of masses was 35.0±17.8mm. Final diagnosis was pancreatic adenocarcinoma (n¼106), malignant neuroendocrine tumor (NET) (n¼9), benign NET (n¼4), pancreatic metastasis(n¼9), and inflammatory masses (n¼34). Results of HHA were 84.42 (76.4-92.45) in benign masses and 26.33 (24.7-28.0) in malignant tumors (p<0.001). SR was 8.73 (5.21-12.2) in benign masses and 43.90 (37.8-50.0) in malignanttumors (p<0.001). Sensitivity and specificity of SR for diagnosing malignancy were 100% and 92.1% (cut-off 9.74)(AUC¼0.942; 95%CI 0.88-1), and of HHA 92.1% and 100%, respectively (cut-off 62.0) (AUC¼0.961; 95%CI 0.91-1). Conclusion: Elastography is a very useful tool for the diagnosis of malignancy in solid pancreatic masses. SR and HHA are equivalent in this setting.
A. Perez-Aisa 1, R. Rivera-Irigoin 1, F. Fernandez-Cano 1, M.A. Romero~ ez 1, A. Sanchez-Yague 1, F. Rivas 2, J.M. Navarro-Jarabo 1 Ordon 1
Unidad de Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain Unidad de Investigacion, Agencia Sanitaria Costa del Sol, Marbella, Spain 2
Introduction: Chronic Pancreatitis (CP) is an entity of difficult diagnosis of multiple etiologies are known to be toxic alcohol or smoking, the most common in our environment. Objectives: Descriptive study of patients diagnosed with CP in our area of influence. Evaluation of the existence of association between the etiology of pancreatitis severity of EUS findings. Material and methods: Transversal descriptive retrospective study that includes all cases with CP and EUS were reviewed from 2001 to 2014. It were correlated with the clinical history to select those who met diagnostic criteria for CP (Rosemont criteria). Descriptive analysis was performed with measures of central tendency and dispersion for quantitative variables and frequency distribution for qualitative. To compare subgroups (mild vs severe findings) the chi-square test for qualitative variables and the Mann-Whitney test was used for quantitative. It was established level of significance at p <0.05. Results: Of all the studies reviewed, we found the diagnosis of CP is established in 85 patients with a mean age of 54.99 years, 80.8% men. 76.7% were toxic etiology, 13.7% and 9.6% idiopathic to other causes. The toxic etiology had 32.6% of mild findings suggestive PC EUS against serious 67.4%, while the remaining (idiopatic etiology) 81.8% CP had serious findings, with no significant differences. Conclusions: In our SERIES screening according EUS criteria diagnose patients in more advanced stages of the disease. We found no differences in grade CP morphological severity (mild or severe) according to the etiology of this (Toxic versus the rest).
31. How safe is endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS-FNA/FNB) for the diagnosis of solid pancreatic masses? ~ o Noia, J. Iglesias García, D. De la Iglesia García, N. Vallejo Senra, I. J. Larin lez, J.E. Domínguez Mun ~ oz Abdulkader, L. Uribarri Gonza n para la Hospital Clínico Universitario de Santiago. Fundacio n en Enfermedades del Aparato Digestivo, Santiago de Investigacio Compostela, Spain EUS-FNA and FNB are considered as accurate and safe techniques for sampling solid appearance pancreatic lesions. However, safety data on large series of patients are lacking. Aim of our study was to determine the frequency and severity of complications after EUS-FNA/FNB of solid appearance pancreatic lesions in a large consecutive series of patients. Methods: 447 consecutive patients (mean age 66.4 years, range 17-92, 262 male), who underwent EUS-FNA/FNB for the evaluation of solid appearance pancreatic lesions over the last 4 years were identified from a prospectively collected endoscopy database, and included in the study. Early and late complications were also prospectively collected. EUS- FNA/ FNB was performed with standard cytology and ProcoreTM histology needles Records were reviewed for complications. Results: Mean size of solid pancreatic masses was 36.1±16.4 mm. 283 tumors were located in the head of the pancreas, 124 in the bdy and 40 in the tail. A total of 11 (2.4%) complications were documented. Five patients (1.1%) developed abdominal pain, 3 patients (0.7%) hematoma of the gastric (n¼2) or duodenal (n¼1) wall, 2 patients (0.4%) suffer from bleeding , and 1 patient (0.2%) suffered from acute pancreatitis. Only three (0.4%) patients required hospitalization after the procedure for 2-3 day.
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Abstracts / Pancreatology 15 (2015) e1ee17
There were no complications related to sedation, no cases requiring surgical intervention, and there was no mortality associated to the procedure. Conclusion: EUS-guided FNA/FNB of solid pancreatic lesions is a very safe technique. Severe complications requiring hospitalization develop in only 0.4% of the patients with no need for surgery and no mortality.
32. Pancreatic collection including an arterial bypass: Contraindication for EUS- guided drainage? lez de la Higuera, F. Bolado, J.J. Vila M.A. Casi, D. Ruiz-Clavijo, B. Gonza Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: The endoscopic approach of symptomatic pancreatic collections are considered first-line treatment. The development of endoscopic ultrasound (EUS) has resulted in greater applicability and effectiveness of transluminal drainage.Within the current indications for endoscopic treatment of pancreatic collections highlights the compression of vascular structures. We present a case of endoscopic drainage of peripancreatic collection with an arterial bypass inside the collection. Case report: A male, 63 years old with aortic dissection and thrombosis of the superior mesenteric artery (SMA) in May / 2013. Iliac Bypass urgent AMS. After that, he had a postoperative mesenteric ischemia, an acute pancreatitis and an important bleeding that required two reoperations. Furthermore he suffered a pancreaticutaneous fistula and abdominal sepsis. Good outcome, he was discharged in September / 2013. He was to reentering because of fever the day after, observing a nine centimeters collection surrounding the bypass. Antibiotic treatment was started, and percutaneous drainage of the collection that shows infection by Pseudomonas and Serratia bypass was performed. Repeated bacteremia requiring performs four sets of three weeks of home intravenous treatment with different antibiotics between October and April / 2014. A four centimeters, peripancreatic collection surrounding the infected bypass returned again.Because an unaffordable risk of replacement bypass, endoscopic drainage of the collection was decided. Technique: In ERCP residual ductal disruption was discarded. By ultrasound endoscopy, a 2,5x2,5x7 cm collection was identified with a vascular bypass floating. A fistula between the collection and the stomach, introducing a 19 G needle was created, avoiding the bypass. The fistula was dilated. A double pigtail (10F and 5 cm) stent is placed and then a nasocystic catheter was inserted. Daily collection aspiration and washings was performed through the nasocystic drainage for a week and the patient was discharged. After confirming resolution of the collection, the pigtail was removed after four weeks. Subsequently the patient continued asymptomatic except febrile episode that subsided with conservative management without recurrence of the collection. Conclusions: Endoscopic drainage may be feasible and effective in selected patients with vascular structures inside the collection.
33. Pancreatic stent related complications: Endoscopic management and outcomes lez de la M.A. Casi, C. Prieto, F. Bolado, J. Urman, D. Ruiz-Clavijo, B. Gonza Higuera, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: Expansion of indications has increased pancreatic stent placement during an ERCP. Therefore, complications related with pancreatic stents have also increased. Aim: To analyze the incidence and management of pancreatic stent related complications.
Materials and methods: Retrospective analysis of a prospectively filled database including patients who underwent ERCP (endoscopic retrograde cholangiopancreatography) with pancreatic stent placement between january/2009 and september/2014. Variables included: sex, indication for stent placement (therapeutic or prophylactic), pancreatic stent related complications and treatment (endoscopy or surgery). Post-ERCP pancreatitis was not considered a pancreatic stent related complication. Results: During the study period 205 therapeutic pancreatic stents and 121 prophylactic stents were placed. Pancreatic stent related complications occurred in 16 patients (2 women): external migration (1 patient), internal migration (8 patients although 2 of them were referred from other hospitals to retrieve the migrated stent), pancreatic-type pain for excessive duct distention (4 patients), pancreatic stent rupture (2 patients) and pancreatic perforation related to stent intraductal rectification (1 patient). Two internal migrations occurred after prophylactic stent placement; the rest of complications were related to therapeutic stents. All complications were managed endoscopically: new stent placement after external migration, stent retrieval after internal migration (Lasso technique in 4 patients, Dormia basket in 2 patients and Fogarty balloon in 2 patients), stent retrieval after rupture since it resembles internal migration (Lasso technique), pancreatic type pain was resolved by extraction of one of the previously placed stents. Stent related pancreatic perforation caused complete duct dysruption and was resolved by bridging with a softer stent. Conclusions: Pancreatic stent related complications ocurred in 4.3% of patients. All complications were resolved endoscopically.
34. Analysis of the relationship between pancreatic duct fusion anomalies and risk for development of post-ERCP pancreatitis lez de la Higuera, J.M. Urman, F. Bolado, C. Prieto, M. Casi, B. Gonza D. Ruiz-Clavijo, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: Pancreatic ductal fusion anomalies have been possibly linked with pancreatic ductal morphology and the occurrence of postERCP pancreatitis. Objective: Our aim was to evaluate the possible association between abnormal fusion of the pancreatic duct and the development of post- ERCP pancreatitis. Material and methods: We reviewed the pancreatic ERCPs (PERCP) performed in our center from June 2009 to June 2013. The wirsungrafies were blindly reviewed by one ERCPist who classified the pancreatic ductal fusion unaware of the identity and evolution of patients after PERCP. The ductal fusion was classified into four groups: Normal (Group I); “Ansa Pancreatica” (Group II); Pancreatic Loop (Group III) and Pancreas Divisum (Group IV). Incomplete wirsungrafies were considered indeterminate and not analyzed. Groups II, III and IV were considered together as Fusion Anomalies (FA) Group. We compared the incidence of post-ERCP pancreatitis in each of the groups with respect to the rest and the AF group with Group I. Results: We performed 134 PERCPs in 68 patients during the inclusion period. We were able to determine with certainty the type of ductal fusion in 56 patients (40 men). Twenty-seven patients suffered a previous acute pancreatitis and 28 had chronic pancreatitis. Women had significantly more FA (69% vs 37%, p ¼ 0.04). Thirty patients were included in Group I; 10 in Group II; 3 in Group III and 13 in Group IV. Complications occurred in 8 patients (14%), pancreatitis in 5 of them (8,9%). Only Group III was significantly associated with a higher rate of post-ERCP pancreatitis (67% vs 11.3%, p¼0.019). The incidence of post-ERCP pancreatitis in Group II and IV was 10% and 15,4% respectively. FA Group showed a significantly higher incidence of post-ERCP pancreatitis compared with Group I (19,2% vs 0%, p¼0.017) and this comparison remained significant after adjusting for sex (p¼0.017). Conclusion: Pancreatic ductal fusion anomalies are a risk factor for development of post-ERCP pancreatitis. This association should be confirmed by means of prospective comparative studies.
e11
28.
30.
Association between morphological severity and the presence of exocrine pancreatic insufficiency (EPI) in chronic pancreatitis
Quantifying endoscopic ultrasound (EUS)-guided elastography for the differential diagnosis of solid pancreatic masses: Hue-histogram or strain ratio?
ndez-Cano, M.A. Romero-Ordon ~ ez, A. Perez Aisa, R. Rivera-Irigoin, F. Ferna nchez, A. Sa nchez-Yague, F. Rivas I. M endez-Sa Unidad de Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain Introduction: The EPI in the context of CP is an underdiagnosed entity, which secondarily involved maldigestion, malabsorption and malnutrition, remaining a diagnostic challenge. Objectives: Evaluate de association between severity and presence of EUS finding in CP. Material and methods: Transversal descriptive retrospective study including all patients with EUS criteria CP from 2001 to 2014 were correlated with the Computerized Medical Record to select those who met diagnostic CP. The presence of EPI was evaluated by means of C13 triglyceride breath test (TGT).A descriptive analysis with measures of central tendency and dispersion for quantitative variables and frequency distribution for qualitative took place. To compare subgroups (presence or absence of EPI) chi-square test for qualitative variables and test of Mann-Whitney was used for quantitative. Level of significance at p <0.05. Results: CP diagnosis in 85 patients with a mean age of 54.99 years, 19.2% women was established. 63 patients (74%) had done so much testing as EUS pancreatic and TGT. Of the 16 patients with mild EUS findings CP, 50% had EPI and 50% had not. Of the 47 patients with severe EUS findings CP, 70% had EPI and the rest not, without this would result in a statistically significant difference. Conclusions: In our series the degree of morphological severity by EUS does not correlate with the presence of EPI by TGT.
29. Correlation between the etiology of chronic pancreatitis and its morphological severity by EUS criteria
~ o Noia, J. Iglesias García, I. Abdulkader, J.E. Domínguez Mun ~ oz J. Larin n para la Hospital Clínico universitario de Santiago, Fundacio n en Enfermedades del Aparato Digestivo, Santiago de Investigacio Compostela, Spain Introduction: Quantitative EUS-elastography allows quantifying tissue stiffness during a standard EUS examination. Elastography result may be analyzed either by strain ratio (SR) or hue histogram analysis (HHA). Aims: was to evaluate the accuracy of SR and HHA for the differential diagnosis of solid pancreatic masses. Methods: A prospective, observational, comparative study was designed. 162 consecutive patients (mean age 63 years, range 17-89, 98 male), with a solid pancreatic mass at EUS were prospectively included. Elastography was performed with linear Pentax-EUS and Hitachi-Preirus. For HHA, the tumor area was selected and analyzed. The mass (area A) and a peripancreatic soft reference area (B) were selected for SR analysis (quotient B/A). Final diagnosis was based on surgical histopathology, or EUS-FNA/FNB and global clinical and radiological assessment at follow-up in non-operated cases. Data are shown as mean (95%CI) and analyzed by ANOVA. Diagnostic accuracy was calculated by drawing the corresponding ROC curves. Results: Size of masses was 35.0±17.8mm. Final diagnosis was pancreatic adenocarcinoma (n¼106), malignant neuroendocrine tumor (NET) (n¼9), benign NET (n¼4), pancreatic metastasis(n¼9), and inflammatory masses (n¼34). Results of HHA were 84.42 (76.4-92.45) in benign masses and 26.33 (24.7-28.0) in malignant tumors (p<0.001). SR was 8.73 (5.21-12.2) in benign masses and 43.90 (37.8-50.0) in malignanttumors (p<0.001). Sensitivity and specificity of SR for diagnosing malignancy were 100% and 92.1% (cut-off 9.74)(AUC¼0.942; 95%CI 0.88-1), and of HHA 92.1% and 100%, respectively (cut-off 62.0) (AUC¼0.961; 95%CI 0.91-1). Conclusion: Elastography is a very useful tool for the diagnosis of malignancy in solid pancreatic masses. SR and HHA are equivalent in this setting.
A. Perez-Aisa 1, R. Rivera-Irigoin 1, F. Fernandez-Cano 1, M.A. Romero~ ez 1, A. Sanchez-Yague 1, F. Rivas 2, J.M. Navarro-Jarabo 1 Ordon 1
Unidad de Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain Unidad de Investigacion, Agencia Sanitaria Costa del Sol, Marbella, Spain 2
Introduction: Chronic Pancreatitis (CP) is an entity of difficult diagnosis of multiple etiologies are known to be toxic alcohol or smoking, the most common in our environment. Objectives: Descriptive study of patients diagnosed with CP in our area of influence. Evaluation of the existence of association between the etiology of pancreatitis severity of EUS findings. Material and methods: Transversal descriptive retrospective study that includes all cases with CP and EUS were reviewed from 2001 to 2014. It were correlated with the clinical history to select those who met diagnostic criteria for CP (Rosemont criteria). Descriptive analysis was performed with measures of central tendency and dispersion for quantitative variables and frequency distribution for qualitative. To compare subgroups (mild vs severe findings) the chi-square test for qualitative variables and the Mann-Whitney test was used for quantitative. It was established level of significance at p <0.05. Results: Of all the studies reviewed, we found the diagnosis of CP is established in 85 patients with a mean age of 54.99 years, 80.8% men. 76.7% were toxic etiology, 13.7% and 9.6% idiopathic to other causes. The toxic etiology had 32.6% of mild findings suggestive PC EUS against serious 67.4%, while the remaining (idiopatic etiology) 81.8% CP had serious findings, with no significant differences. Conclusions: In our SERIES screening according EUS criteria diagnose patients in more advanced stages of the disease. We found no differences in grade CP morphological severity (mild or severe) according to the etiology of this (Toxic versus the rest).
31. How safe is endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS-FNA/FNB) for the diagnosis of solid pancreatic masses? ~ o Noia, J. Iglesias García, D. De la Iglesia García, N. Vallejo Senra, I. J. Larin lez, J.E. Domínguez Mun ~ oz Abdulkader, L. Uribarri Gonza n para la Hospital Clínico Universitario de Santiago. Fundacio n en Enfermedades del Aparato Digestivo, Santiago de Investigacio Compostela, Spain EUS-FNA and FNB are considered as accurate and safe techniques for sampling solid appearance pancreatic lesions. However, safety data on large series of patients are lacking. Aim of our study was to determine the frequency and severity of complications after EUS-FNA/FNB of solid appearance pancreatic lesions in a large consecutive series of patients. Methods: 447 consecutive patients (mean age 66.4 years, range 17-92, 262 male), who underwent EUS-FNA/FNB for the evaluation of solid appearance pancreatic lesions over the last 4 years were identified from a prospectively collected endoscopy database, and included in the study. Early and late complications were also prospectively collected. EUS- FNA/ FNB was performed with standard cytology and ProcoreTM histology needles Records were reviewed for complications. Results: Mean size of solid pancreatic masses was 36.1±16.4 mm. 283 tumors were located in the head of the pancreas, 124 in the bdy and 40 in the tail. A total of 11 (2.4%) complications were documented. Five patients (1.1%) developed abdominal pain, 3 patients (0.7%) hematoma of the gastric (n¼2) or duodenal (n¼1) wall, 2 patients (0.4%) suffer from bleeding , and 1 patient (0.2%) suffered from acute pancreatitis. Only three (0.4%) patients required hospitalization after the procedure for 2-3 day.
e12
Abstracts / Pancreatology 15 (2015) e1ee17
There were no complications related to sedation, no cases requiring surgical intervention, and there was no mortality associated to the procedure. Conclusion: EUS-guided FNA/FNB of solid pancreatic lesions is a very safe technique. Severe complications requiring hospitalization develop in only 0.4% of the patients with no need for surgery and no mortality.
32. Pancreatic collection including an arterial bypass: Contraindication for EUS- guided drainage? lez de la Higuera, F. Bolado, J.J. Vila M.A. Casi, D. Ruiz-Clavijo, B. Gonza Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: The endoscopic approach of symptomatic pancreatic collections are considered first-line treatment. The development of endoscopic ultrasound (EUS) has resulted in greater applicability and effectiveness of transluminal drainage.Within the current indications for endoscopic treatment of pancreatic collections highlights the compression of vascular structures. We present a case of endoscopic drainage of peripancreatic collection with an arterial bypass inside the collection. Case report: A male, 63 years old with aortic dissection and thrombosis of the superior mesenteric artery (SMA) in May / 2013. Iliac Bypass urgent AMS. After that, he had a postoperative mesenteric ischemia, an acute pancreatitis and an important bleeding that required two reoperations. Furthermore he suffered a pancreaticutaneous fistula and abdominal sepsis. Good outcome, he was discharged in September / 2013. He was to reentering because of fever the day after, observing a nine centimeters collection surrounding the bypass. Antibiotic treatment was started, and percutaneous drainage of the collection that shows infection by Pseudomonas and Serratia bypass was performed. Repeated bacteremia requiring performs four sets of three weeks of home intravenous treatment with different antibiotics between October and April / 2014. A four centimeters, peripancreatic collection surrounding the infected bypass returned again.Because an unaffordable risk of replacement bypass, endoscopic drainage of the collection was decided. Technique: In ERCP residual ductal disruption was discarded. By ultrasound endoscopy, a 2,5x2,5x7 cm collection was identified with a vascular bypass floating. A fistula between the collection and the stomach, introducing a 19 G needle was created, avoiding the bypass. The fistula was dilated. A double pigtail (10F and 5 cm) stent is placed and then a nasocystic catheter was inserted. Daily collection aspiration and washings was performed through the nasocystic drainage for a week and the patient was discharged. After confirming resolution of the collection, the pigtail was removed after four weeks. Subsequently the patient continued asymptomatic except febrile episode that subsided with conservative management without recurrence of the collection. Conclusions: Endoscopic drainage may be feasible and effective in selected patients with vascular structures inside the collection.
33. Pancreatic stent related complications: Endoscopic management and outcomes lez de la M.A. Casi, C. Prieto, F. Bolado, J. Urman, D. Ruiz-Clavijo, B. Gonza Higuera, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: Expansion of indications has increased pancreatic stent placement during an ERCP. Therefore, complications related with pancreatic stents have also increased. Aim: To analyze the incidence and management of pancreatic stent related complications.
Materials and methods: Retrospective analysis of a prospectively filled database including patients who underwent ERCP (endoscopic retrograde cholangiopancreatography) with pancreatic stent placement between january/2009 and september/2014. Variables included: sex, indication for stent placement (therapeutic or prophylactic), pancreatic stent related complications and treatment (endoscopy or surgery). Post-ERCP pancreatitis was not considered a pancreatic stent related complication. Results: During the study period 205 therapeutic pancreatic stents and 121 prophylactic stents were placed. Pancreatic stent related complications occurred in 16 patients (2 women): external migration (1 patient), internal migration (8 patients although 2 of them were referred from other hospitals to retrieve the migrated stent), pancreatic-type pain for excessive duct distention (4 patients), pancreatic stent rupture (2 patients) and pancreatic perforation related to stent intraductal rectification (1 patient). Two internal migrations occurred after prophylactic stent placement; the rest of complications were related to therapeutic stents. All complications were managed endoscopically: new stent placement after external migration, stent retrieval after internal migration (Lasso technique in 4 patients, Dormia basket in 2 patients and Fogarty balloon in 2 patients), stent retrieval after rupture since it resembles internal migration (Lasso technique), pancreatic type pain was resolved by extraction of one of the previously placed stents. Stent related pancreatic perforation caused complete duct dysruption and was resolved by bridging with a softer stent. Conclusions: Pancreatic stent related complications ocurred in 4.3% of patients. All complications were resolved endoscopically.
34. Analysis of the relationship between pancreatic duct fusion anomalies and risk for development of post-ERCP pancreatitis lez de la Higuera, J.M. Urman, F. Bolado, C. Prieto, M. Casi, B. Gonza D. Ruiz-Clavijo, J.J. Vila Complejo Hospitalario de Navarra, Pamplona, Spain Introduction: Pancreatic ductal fusion anomalies have been possibly linked with pancreatic ductal morphology and the occurrence of postERCP pancreatitis. Objective: Our aim was to evaluate the possible association between abnormal fusion of the pancreatic duct and the development of post- ERCP pancreatitis. Material and methods: We reviewed the pancreatic ERCPs (PERCP) performed in our center from June 2009 to June 2013. The wirsungrafies were blindly reviewed by one ERCPist who classified the pancreatic ductal fusion unaware of the identity and evolution of patients after PERCP. The ductal fusion was classified into four groups: Normal (Group I); “Ansa Pancreatica” (Group II); Pancreatic Loop (Group III) and Pancreas Divisum (Group IV). Incomplete wirsungrafies were considered indeterminate and not analyzed. Groups II, III and IV were considered together as Fusion Anomalies (FA) Group. We compared the incidence of post-ERCP pancreatitis in each of the groups with respect to the rest and the AF group with Group I. Results: We performed 134 PERCPs in 68 patients during the inclusion period. We were able to determine with certainty the type of ductal fusion in 56 patients (40 men). Twenty-seven patients suffered a previous acute pancreatitis and 28 had chronic pancreatitis. Women had significantly more FA (69% vs 37%, p ¼ 0.04). Thirty patients were included in Group I; 10 in Group II; 3 in Group III and 13 in Group IV. Complications occurred in 8 patients (14%), pancreatitis in 5 of them (8,9%). Only Group III was significantly associated with a higher rate of post-ERCP pancreatitis (67% vs 11.3%, p¼0.019). The incidence of post-ERCP pancreatitis in Group II and IV was 10% and 15,4% respectively. FA Group showed a significantly higher incidence of post-ERCP pancreatitis compared with Group I (19,2% vs 0%, p¼0.017) and this comparison remained significant after adjusting for sex (p¼0.017). Conclusion: Pancreatic ductal fusion anomalies are a risk factor for development of post-ERCP pancreatitis. This association should be confirmed by means of prospective comparative studies.