Immature granulocytes (IGS) at admission independently predict severe acute pancreatitis (AP)

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Abstracts / Pancreatology 17 (2017) S1eS68

0046. Follow-up prognosis of endoscopic papillectomy for early ampullary cancers Jose Henrique Silvah 1, Rafae Pasqualini Carvalho 1, Rafael Kemp 1, Jose Sebastiao Dos Santos 1, Joao Guilherme Guerra 2, Carolin Nava 2, Jose Celso Ardengh 1 1 2

Ribeirao Preto Medical School, University of Sao Paulo, Brazil Hospital 9 de Julho, Brazil

Introduction: The evidence suggests that endoscopic papillectomy (EP) may be curative for the treatment of ampullary tumors. However, due to few cases in the literature, radical surgery is still the only accepted treatment modality. Aim: To assess whether EP could be an alternative to radical surgery for the treatment of ampullary adenoma with HGIN/Tis or focal pT1 or pT2 cancer. Method: Prospective case series from a tertiary-care university teaching hospital during April 2009 to December 2015. Loco regional extension and medium-term follow-up were evaluated in 25 subjects submitted to EP due to ampullary cancer. Based on histopathology results, these patients were submitted to surgery after EP (EP-S) or followed-up (EP). The both groups were compared. Results: Comparing EP-S (n¼9) and EP (n¼16) groups, age, lesion size, time of follow-up, main pancreatic duct size, number of stents used, EUS staging (p¼1), and adverse events were not different. The common bile duct size was larger (p¼0.03) in the EP-S group. Compared to EP (4±1 days), the length of hospital stay was higher after PD (13±2 days) (p<0.001). The EP-S group presented more adenocarcinoma than the EP group (p¼0.009). Using Kaplan-Meier curves, the global survival (deaths) and the survival free of relapse were not different between the EP-S and EP groups, according to a log-rank test (p¼0.23 and p¼0.08, respectively). Resection in “en bloc” was associated with higher survival free of relapse (en bloc versus piecemeal, in mean [95% CI] ¼ 55 months [44-67] versus 31 months [11-51], p ¼ 0.02). Conclusion: EP may be a curative treatment for papillary adenoma with HGIN/Tis and should also be considered as an alternative to surgery in focal T1 and selected cases of T2 cancer in papillary adenoma.

Conclusion: Consequently, the level of intratumoral immunohistochemical expression of hENT1 may predict the response to GemTeg adjuvant chemotherapy regime in patients with PC.

0048. Non-surgical therapy for pain of chronic pancreatitis improves exocrine function and body mass index. C Ganesh Pai 1, M Ganesh Kamath 2, Mamatha V. Shetty 3, Annamma Kurien 2 1

Department of Gastroenterology & Hepatology, Kasturba Medical College, Manipal, 576104, India 2 Melaka Manipal Medical College, Manipal University, Manipal, 576014, India 3 Kasturba Medical College, Manipal University, Manipal, 576104, India Introduction: Surgery is considered the best option to decrease the pain of chronic pancreatitis (CP). Aim: To prospectively evaluate the outcomes of a standardized protocol of non-surgical therapy in patients with pain of CP. Method: Consecutive patients with painful CP were prospectively followed up for 1 year on oral pancreatic enzyme supplementation and anti-oxidants (drug therapy; DT) or pancreatic papillotomy and stent placement (endotherapy; ET) if DT failed. The severity and frequency of pain, Quality of life (QoL), body mass index (BMI), fecal elastase (FE) and serum C-peptide were determined at baseline and end of follow up. Results: Fifty-two patients, 12 (22.6%) of these younger than 18 years of age, completed the follow up. 22 (42.3%) responded to DT and 30 (57.7%) underwent ET. VAS (6.3 (5.0, 8.0) vs 0 (0, 2.4); P < 0.001) and QoL scores (60.8 ±13.4 vs 47.4 ±15.8; P < 0.001) decreased significantly during follow up. While FE levels improved significantly in (177.39 (99.88, 420.50) vs 530.50 (134.40, 598.40) mg/g; P < 0.001), serum C-peptide levels did not change. The BMI, improved in all patients above the age of 18 years (19.4 ± 3.2 vs 20.3 ± 3.4 kg/m2; P < 0.01); this was significant only in the subgroup on ET (19.5 ± 3.2 vs 20.6 ± 3.7 kg/m2; P < 0.01) but not in those on DT. Conclusion: Non-surgical therapy significantly improved pain, QoL, BMI and exocrine function in patients with painful CP.

0051. 0047. Intratumoral expression of hENT1 in patients with pancreatic cancer on adjuvant gemcitabine and tegafur regimen Olexiy Dronov, Victoria Dronova, Sergiy Zemskov, Inna Kovalska Bogomolets National Medical University, Ukraine Introduction: Pancreatic cancer (PC) is one of the most frequent causes of death in cancer mortality. Fluorpyrim?dine and gemcitabine is a popular combination in palliative treatment of PC. For the first time this combination was used in adjuvant setting in Japan in 2002. The combination can influence long term survival but its effect is different depending on tumor cell phenotype. Aim: The aim of this study is to investigate the relevance between intratumoral hENT1 expression and response to gemcitabine þ tegafur (GemTeg) scheme in PC patients in adjuvant setting. Method: Patients and methods: 62 PC patients after curative resection from 2012 until 2016 were involved in the study. Adjuvant chemotherapy started at least after 2 weeks postoperatively using new regime GemTeg. Ductal adenocarcinoma of the pancreas was diagnosed at routine histological examination prior to immunohistochemical investigation. Overall survival was evaluated by Kaplan d Meyer and compared by log-rank test. Results: The overall survival in among patients treated with GemTeg regime was statistically higher in those with high hENT1 expression then in those with low hENT1 expression (p¼0,005). Median overall survival was 36 and 20 months for patients with high and low hENT1 expression, correspondingly.

Immature granulocytes (IGS) at admission independently predict severe acute pancreatitis (AP) Michal Lipinski, Grazyna Rydzewska Central Clinical Hospital of The Ministry of Interior and Administration, Poland Introduction: Early prediction of severity of AP by a simple parameter which positively correlates with the activation stage of the immune system would be very helpful as it may influence management and improve outcome. Aim: The aim of the study was to assess whether the IGS% in plasma could represent an independent (regarding SIRS and white blood cell count (WBC)) marker of AP severity. Background: Early prediction of severity of AP by a simple parameter which positively correlates with the activation stage of the immune system would be very helpful as it may influence management and improve outcome. TNF-? and interleukin-1 play a critical role in the pathogenesis SIRS and severity of AP. One of the effects of interleukin-1 and TNF-? is an increase in the number of IGs in the peripheral blood. In our preliminary data we found significant relationship between the IGs% and AP severity. Method: Cohort of 77 patients with AP were prospectively enrolled in the study. IGS were measured from whole blood samples obtained from the first day of hospitalization using an automated analyzer. Severe AP (SAP) was defined as the persistence of organ failure exceeding 48 hours. SIRS was identified during the first 24 hours of hospitalization when patient fulfilled at least two classic diagnostic criteria.

Abstracts / Pancreatology 17 (2017) S1eS68

Results: We observed 44 (57%) patients with mild AP, 21 (27%) patients with moderate SAP and 12 (16%) patients with SAP. The cutoff value of IGS was 0.6%. IGS>0.6% had a sensitivity, specificity, positive and negative predictive value of 100%, 96%, 85.7% and 100% respectively; AUC¼0.98. On admission SIRS was present in 25 (32%) patients. We found that in patients who fulfilled at least two criteria for SIRS, SAP could be predicted with 75% sensitivity and 75.4% specificity, PPV 36%, NPV 94.2%. ROC analyses showed that the IGS% was superior to the SIRS and the WBC in prediction of AP severity. Conclusion: IGS% as obtained routinely marker appears to be a promising, independent biomarker and a better predictor of early prognosis in SAP than SIRS and WBC. Further studies are required to validate the IGS% in predicting severity and mortality in AP.

0052. Integrated DIGE and SILAC quantitative proteomic analysis to identify metastasis-related proteins in pancreatic cancer Xinlu Liu, Peng Liu, Xiaodong Tan China Medical University Affiliated Shengjing Hospital, China Introduction: Pancreatic cancer is an aggressive cancer characterized by extremely low survival rate due to early invasion and metastasis. In the past decades, many efforts have been made to uncover the key proteins in its malignant behaviors for more effective treatments. However, there is still no remarkable progress in pancreatic cancer therapy. Aim: To identify new metastasis-related proteins in pancreatic cancer for improving therapy. Background: Two homologous hamster cell line PC-1.0 (highly aggressive) and PC-1 (lowly aggressive). Differences between this pair of cell lines are mainly associated with invasion and metastasis. Method: By using high-throughput screening analysis DIGE and SILAC respectively, we performed comparative proteomics of this pair of homologous hamster cell linee. Verification of identified proteins were performed by western-blot, immunohistochemistry and Transwell analysis. Results: Total 42 proteins in DIGE and 155 proteins in SILAC showed a differential expression(>¼1.5-fold). 26 proteins in DIGE and 89 proteins in SILAC were up-regulated in PC-1.0. 16 proteins in DIGE and 66 proteins in SILAC were down-regulated in PC-1.0 cell line. ALDOA, PGAM1 and Cpn10 were three overlapping up-regulated proteins in PC-1.0. PDIA3, Calreticulin, Calumenin and HIP1R were four overlapping down-regulated proteins in PC-1.0. Further transwell analysis indicated that inhibition of PGAM1 decreased migration and invasion of pancreatic cancer cell line. Discussion: Glycolysis process is more active in highly invasive and metastatic pancreatic cancer cells. However, the multifunction of upregulated glycolytic proteins should get our more attention. Target therapies on glycolytic proteins may be more effective than inhibition of glycolytic pathway on pancreatic cancer therapy. Conclusion: Metabolic change play important role in invasion and metastasis of pancreatic cancer. PGAM1 was found play essential role in malignant behavior of pancreatic cancer and suggest as a potential therapeutic target.

0053. Pancreaticobiliary ductal anatomy in the normal population Chumpon Wilasrusmee 1, Jakrapan Jirasiritham 1, Napaphat Poprom 1, Noppadol Larbcharoensub 2 1

Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand 2 Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand Introduction: The complex anatomy of the pancreaticobiliary duct was crucial in management of pancreatic and biliary tract disease.

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Aim: To demonstrate complex anatomy of the pancreaticobiliary duct anatomy. Background: It is useful not only for pancreaticoduodenectomy or distal pancreatectomy, but also for limited resection of the pancreas for low-grade malignancy such as mucin-producing tumors or cystic lesions of the pancreas. Method: Fresh specimens of pancreas, common bile duct (CBD), and duodenum were obtained en bloc from autopsies of 160 patients. Results: Ninety-three male and 67 female patients were included. The length of the pancreas ranged from 9.8-20 cm (mean, 16.20 þ/- 1.70 cm). The intrapancreatic portion of the CBD showed patterns of three types: most common (85.30%) was type A, in which the anterior surface of the common bile duct was totally covered, while its posterior surface was partially covered, by the pancreatic parenchyma. On dissection of the accessory duct of Santorini, the accessory duct was traceable to the duodenal wall in 67.6%. The anatomy of the Wirsung-choledochus confluence was grouped into five different types. The common channel was found in 75.60% and its length varied from just a common junction (so-called “V-type” anatomy) to 15 mm (Y-type-b). Separate papillae (socalled “II-type”) were found in 15.3% of specimens. Discussion: Several important points regarding the anatomy of the pancreaticobiliary junction and pancreatic ductal system were illustrated in this study. Some of these data were different from those reported in the literature for other population groups. Conclusion: These results can be used in pancreatic cancer surgery.

0054. Hepatic artery anatomical variants in laparoscopic pancreaticoduodenectomy. Surgical and oncological comparation with normal anatomy patients Lucio Uranga, Analía In es Potolicchio, Diego Haberman, Mirta Kujaruk, Marcela Carballido, Sandra Basso, Luciano Bisio, Jorge Omar Monest es Hospital Bonorino Udaondo, Argentina Introduction: Variation in Hepatic Artery (HA) occurs in 55 to 79 % of the people, being the aberrant right hepatic artery (RHA) the most frequent. During a Whipple procedure, it is important to consider this situation because it could modify the postoperative course, causing biliary leaks, hepatic abscess, or acute hepatic failure. Aim: To analyze the short-term surgical and oncological outcomes after laparoscopic pancreatoduodenectomy (LPD) in patients with anatomical HA variants. Background: The appropriate approach, in the case of an aberrant RHA during open pancreaticoduodenectomy (PD), has already been established. In LPD, on the contrary, there are not enough publications to demonstrate its efficacy. Method: This study is a retrospective review of a prospectively maintained database collected from consecutive patients who underwent LPD at Bonorino Udaondo Gastroenterology Hospital, between February 2013 and March 2017. Results: Sixteen patients (43.2%) presented a relevant anatomical variation of the HA when performing LPD. Five patients had an accessory RHA, nine had a totally replaced RHA and two had a totally replaced common hepatic artery (CHA) from the superior mesenteric artery (SMA). 50% of these cases were recognized by the radiologist preoperatively. There were no significant differences during the surgery and in the postoperative outcomes of the aberrant and normal HA group. The mean number of harvested lymph nodes in the anatomical variation group was 21.5 (range 15-31) and in the normal group 14 (range 7-31) (P¼0.04). The rate of positive resection margins was 30% in the aberrant HA group and 31.5% in the normal HA group (P¼NS). Discussion: Aberrant hepatic arteries are a common finding that HPB surgeons must recognize and know how to solve during a Pancreaticoduodenectomy. The handling of this situation has already been well established in open surgery. Otherwise, in the robotic Whipple procedure, there is a publication from the University of Illinois where authors