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Long term cancer surveillance of patients with hereditary pancreatitis and ERCP-proven pancreatic duct strictures
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Abstracts / Pancreatology 15 (2015) S1eS141
factor that significantly correlated with health related quality of life in all reviewed studies. Several studies suggested alcohol consumption was important factor as well. However, comorbidities were not shown to have a significant impact on quality of life. Conclusion: As a long-term disease, chronic pancreatitis definitely decreases quality of life. Questionnaires assessing quality of life should be included in chronic pancreatitis patients follow up routine to evaluate the effect of treatment.
Conclusion: in clinical practice should take into account not so rare anomaly of duodenum, which has the peculiarities of diagnosis and treatment.
835. Application of intelligent systems of the type DSM for the analysis of clinical data patients with chronic pancreatitis
824.
Ludmila Vinokourova 1, Maxim Agafonov 1, Galina Varvanina 1, Viktor Finn 2, Elena Pankratova 2, D. Dobrynin 2, Ilya Shulyatyev 1
Opportunities of non-invasive diagnostics of pancreatic fibrosis in chronic pancreatitis (CP)
2
Natalya Gubergrits, Oksana Golubova, Pavel Fomenko, Viktoriya Kolkina Donetsk National Medical University, Ukraine Introduction: Identification of structural changes of the pancreas, including its fibrosis, by the results of sonography as the most affordable practical method, is subjective and depends on the experience and qualification of the doctor of ultrasonic diagnostics. Ultrasonic histography allows to quantify the density of the pancreatic tissue. Aims: To study the possibility of using ultrasonic histography to assess the severity of pancreatic fibrosis in CP. Patients & methods: The study included 182 patients with CP. Ultrasonic histography of the pancreas was performed during sonographic examination. The main indicator was index L in the area of the pancreatic head, which was determined automatically. The results were compared with indices of fecal elastase test to detect the correlation with the state of exocrine pancreatic function. Index of the pancreatic tissue homogeneity N and histographic coefficient were also calculated. Thirty healthy persons were examined. Results: Doctors of ultrasound diagnostics revealed inhomogeneous induration of the pancreatic tissue in 156 (85.7%) patients. Index L in patients with CP was 32.3±4.1, in healthy d 18.1±2.3 (p<0.01). There was a substantial negative correlation between index L and results of fecal elastase test in CP (r¼e0.52). Healthy persons didn’t have such a correlation. Index of the pancreatic tissue homogeneity N and histographic coefficient were significantly reduced in patients with CP, indicating the heterogeneity of fibrotic changes in the organ. Conclusion: The use of ultrasonic histography of the pancreas is quite possible in clinical practice to assess the severity of pancreatic fibrosis in CP.
1
Moscow clinical scientific center, gastroenterology, Russia Russian Institute for Scientific and Technical Information Sciences, Russia
Introduction: Intelligent systems (IS) be used in clinical medicine. Aims: Apply the method of IS like JSM (named in honor of John Stuart Mill) to predict the development of diabetes pancreatogenic genesis (DM) in patients with chronic pancreatitis. Materials & methods: In the sector of IS VINITI created an intelligent system such as JSM, based on JSM-automatic method for generating hypotheses. Existing IntJSM includes: IntJSM¼solversþInformation Environment (base facts (BF) and Knowledge Base (KB)þintelligent interface (dialogþþlearning presentation of the results with the system). Results: In the first stage by means of JSM-system rules plausible conclusion of the first kind (induction) on the training sample of 81 patients were generated hypotheses of the 1st kind: the presence of a specific set of symptoms the patient is the cause of the presence or absence of the diagnosis of diabetes. in the second stage of hypotheses using a first-order rules of the 2nd kind is extended presence or the absence of diabetes in 42 patients submitted to the forecast. As a result, computer studies, 10 patients were positive to extend the definition, ie they have been diagnosed with diabetes, 28 patients were to extend the definition in the negative. The results extend the definition coincided with real medical data (accuracy completions-100% and completeness-90%). Conclusion: The proposed IS is a tool to support medical research with complex structured data and the set of facts, boundless without the use of computer technology, results of applying JSM-method as a means of analyzing medical data, pointed to a new tool of evidence medicine.
1102. 834. Duodenal dystrophy and chronic pancreatitis Ludmila Vinokourova, Dubcova Elena, Nikolskaya Karina, Bordin Dmitriy, Agafonov Maxim, Shulyatyev Ilya Moscow clinical scientific center, gastroenterology, Russia Introduction: Duodenal dystrophy leads to frequent exacerbation of chronic pancreatitis. Aims: To determine the characteristics of the course and management of patients with duodenal dystrophy (DD). Materials & methods: The age of patients ranged from 37 to 67 years (average age 49.7 ± 8.8 years). All patients were examineted bu ultrasonography, endoscopic ultrasonography, endoscopy, with computed tomography with contrast bolus, a study on fecal elastase. Results: It was revealed that, according to verbal descriptive scale of pain (10 point scale) pain varied in the range of 4-6 points. Pancreatic hypertension was demonstrated in 12 (66.7%) patients, biliary hypertension in 4 (22.2%) ; DD combined with calcific pancreatitis was revealed in 9 (50%) patients, diabetes mellitus (DM) was observed in 8 patients (44.4%). 10 patients underwent surgical treatment. Pancreatoduodenal resection was performed. Exocrine insufficiency detected before surgery in 2 (11.1%) patients and after surgery it was revealed in 8 (44.4%). Fecal elastase varies from 15 to 54 mcg / g, the number of patients with diabetes for six months has not increased.
Long term cancer surveillance of patients with hereditary pancreatitis and ERCP-proven pancreatic duct strictures Peter Simon, Frank Ulrich Weiß, Aline Brockmann, Julia Mayerle, Markus Lerch Department of Internal Medicine A, Ernst-Moritz-Arndt University Greifswald, Germany Introduction: Patients with hereditary pancreatitis (HP, PRSS1-mutations) have a cumulative lifetime pancreatic cancer risk of 40-70% and are urgently in need of a surveillance strategy. Pancreatic duct stenosis has been reported to be an early sign of pancreatic cancer development and duct assessment by ERCP a sensitive tool to detect it. Aims: We have prospectively investigated HP-patients with pancreatic duct changes on ERCP. Patients & methods: 99 patients were diagnosed with HP (PRSS1: pR122H, pR122C and pN29I). 30 of these had undergone therapeutic ERCP with available films on at least one occasion after disease onset and, after informed consent, were recruited to a follow-up surveillance study. The endpoint was resective pancreatic surgery, death or confirmed pancreatic cancer. Results: One patient died from pancreatic cancer (aged 83) never having undergone ERCP. Of 30 recruited patients (19 male, 11 female, age 33±6 years, SEM) two were lost to follow-up and 28 were followed for a median of 20±1,8years. 5 patients had pancreatic duct stenosis at initial ERCP without mass lesions on imaging, of which none developed cancer. 5
Abstracts / Pancreatology 15 (2015) S1eS141
patients underwent resective surgery for complications of pancreatitis; none had developed pancreatic cancer. 3 patients died, one from metastatic oral cavity cancer, one from metastatic malignant melanoma and one from oesophagus cancer. Conclusion: In clinical follow up of patients with hereditary pancreatitis pancreatic cancer development is rare. Neither is the presence of pancreatic duct stenosis on ERCP a reliable positive predictor for pancreatic cancer development, nor its absence a negative predictor (Choudari et al. Gastrointest Endosc.2002;561:66-71).
847. Evaluation of A Checklist for Rapid Evaluation of Exocrine Pancreatic Insufficiency Raffaele Pezzilli, Gabriele Capurso, Giuseppe Del Favero, Santino Marchi, Luca Frulloni Exocrine Pancreatic Insufficiency collaborative (EPIc)-2 Project of the Italian Association for the Study of the Pancreas (AISP), Italy Introduction: There a high demand for rapid diagnosis of severe exocrine pancreatic insufficiency (EPI). Aims: To produce a rapid checklist able to identify EPI in outpatients. Materials & methods: Seven pancreatologists and two gastroenterologists produced a checklist for rapid clinical diagnosis of EPI. The checklist is divided in three parts: 1. Patient complaints (increase in daily bowel movements, with fatty, bulky stools which are difficult to flush away, bulky stools are sometimes not a daily symptom, and steatorrhea occurs after meals 2 to 3 times a day in individuals with a normal lipidcontent diet, weight loss), 2. Physical examination (weight loss of 10%, temporal scalloping, interosseous wasting, lack of subcutaneous fat, nail leukonychia, clinical signs of liposoluble vitamin deficiency); 3. Tubeless tests (fecal elastase-1 determination and/or serum parameters reflecting nutritional status). The checklist underwent to an objective evaluation by 49 gastroenterologists according to the AGREE II 23 items instrument that generate 6 domains and two supplementary evaluation items. Results: 81.6% of gastroenterologists completed the AGREE II questionnaire. All the domains resulted to be high; the score was 74 for Scope and purpose, 72 for Stakeholder involvement, 77 for Rigor of development, 73 for Clarity and presentation, 71 for Applicability, and 76 for Editorial independence. The score of overall quality was 5 (scale 0-7). Finally, 61.8% of the gastroenterologist suggested the use of the checklist in clinical practice, 32.8% suggested changes, 5.9% no recommended its utilization. Conclusion: The checklist developed may be utilized in clinical practice and the next step is to test it in real world.
1112. Who needs to be operated? Prognostic evaluation of the necessity of surgery in chronic pancreatitis according to the M-ANNHEIM classification Michael Hirth 1, Sarah Kolb 1, Christel Weiß 2, Felix Rückert 3, Torsten Wilhelm 3, Philip Hardt 4, Monika Hantelmann 4, Natalia Gubergrits 5, Matthias Ebert 1, Alexander Schneider 1 1
II. Medical Department, University Medical Centre Mannheim, Germany 2 Medical Statistics, University Medical Centre Mannheim, Germany 3 Surgical Department, University Medical Centre Mannheim, Germany 4 Department of Gastroenterology, University Hospital Giessen, Germany 5 Department of Gastroenterology, University Hospital Donetsk, Ukraine
Introduction: The M-ANNHEIM classification (MC) represents a clinical classification system of chronic pancreatitis (cP). It stratifies all
S71
etiological risk factors and defines different degrees of disease severity according to clinical parameters. Aims: To analyze whether the MC can be used as a prognostic tool according to the necessity of a surgical intervention. Patients & methods: Retrospective classification of 740 patients with cP according to the MC from three medical departments (Mannheim/ Germany, n¼536; Giessen/Germany, n¼100; Donetsk/Ukraine). Results: In 12% (n¼89) of patients, the classification was applied immediately before a pancreatic surgical intervention. Preoperatively classified patients presented a significantly higher MC-Severity-Index (mean 13,3 ± 4,4 vs. 6,9 ± 4,5; p<0,001; U-Test Mann/Withney). A ROCanalysis revealed a cut-off value of 11 to distinguish patients with the indication for surgery versus conservative treatment (sensitivity and specify 81%, each). We found a positive correlation of increasing MCSeverity-Levels with the incidence of surgery (p<0,0001; Cochran-Armitage Trend Test; incidence of surgery in MC-Severity-Levels A: 0,7%; B: 6%; C: 33%; D: 53%, E: 31%). Several factors were associated with increasing necessity of surgery: duration of cP (p¼0,027; Kruskal-Wallis), presence of multiple risk factors (p¼0,0077; Chi-c-Test), alcoholic etiology (p¼0,0011; Chi-c-Test), nicotine dependence (p¼0,0049; Chi-c-Test), increasing painscore, complication-score, exocrine insufficiency, imaging-score and modified Zürich Classification (each p<0,0001; Cochrane-Armitage-TrendTest). Significant differences between the three centers were not observed (p¼0,47; Chi-c-Test). Conclusion: The MC provides a useful tool to monitor the clinical course of cP and allows a prognostic assessment with regard to the necessity of surgical interventions.
858. Chronic pancreatitis in children- over 25 years of single-centre experience Grzegorz Oracz 1, Elwira Kolodziejczyk 1, Agnieszka Rygiel 2, Karolina Wejnarska 1, Jaroslaw Kierkus 1, Jerzy Bal 2, Jozef Ryzko 1 1 Dep. of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, Warsaw, Poland 2 Department of Medical Genetics, National Research Institute of Mother and Child, Warsaw, Poland
Introduction: Chronic pancreatitis (CP) is of a rare occurrence in childhood. The etiology of CP in children is varied and includes anatomic anomalies, gene mutations, metabolic disorders and others. Aims: The aim of this study was to investigate the etiological aspects of CP in children from well-defined homogenous single-centre cohort. Patients & methods: 271 children with CP (aged: 0.6-18 years; mean 8.8; F-144, M-127) hospitalized between 1988 and 2014 were enrolled into the study. Clinical and epidemiological data were recorded and analyzed. All patients were screened for gene mutations predisposing to CP. All children had preceding imaging studies, including US, CT, MRCP and/or ERCP. Results: Gene mutations were found in 127 children (46.9%) (PRSS1 mutation in 34 children, CFTR in 42 patients, SPINK1 in 65 children). In 22 cases were found two gene mutations. Anatomic anomalies of pancreatic duct were diagnosed in 46 patients (17%) (29-pancreas divisum, 8-ansa pancreatica, 4-ABPU, 2-two main pancreatic ducts, 3-other). CP was associated with biliary tract diseases in 26 patients (9.6%). Lipid disturbances were found in 21 patients (7.7%). Autoimmune pancreatitis was diagnosed in 6 children (2.2%). History of trauma was present in 15 cases (5.5%). In 7 cases (2.6%) CP was probably associated with drugs, in 3 patients (1.1%) with alcohol and cigarettes smoking. Idiopathic CP was diagnosed in 74 children (27.3%). Conclusion: 1. Gene mutations and anatomic anomalies of pancreatic duct are the most common etiologic factors of CP in children. 2. Our data demonstrate the need for genetic testing in children with CP.
Abstracts / Pancreatology 15 (2015) S1eS141
factor that significantly correlated with health related quality of life in all reviewed studies. Several studies suggested alcohol consumption was important factor as well. However, comorbidities were not shown to have a significant impact on quality of life. Conclusion: As a long-term disease, chronic pancreatitis definitely decreases quality of life. Questionnaires assessing quality of life should be included in chronic pancreatitis patients follow up routine to evaluate the effect of treatment.
Conclusion: in clinical practice should take into account not so rare anomaly of duodenum, which has the peculiarities of diagnosis and treatment.
835. Application of intelligent systems of the type DSM for the analysis of clinical data patients with chronic pancreatitis
824.
Ludmila Vinokourova 1, Maxim Agafonov 1, Galina Varvanina 1, Viktor Finn 2, Elena Pankratova 2, D. Dobrynin 2, Ilya Shulyatyev 1
Opportunities of non-invasive diagnostics of pancreatic fibrosis in chronic pancreatitis (CP)
2
Natalya Gubergrits, Oksana Golubova, Pavel Fomenko, Viktoriya Kolkina Donetsk National Medical University, Ukraine Introduction: Identification of structural changes of the pancreas, including its fibrosis, by the results of sonography as the most affordable practical method, is subjective and depends on the experience and qualification of the doctor of ultrasonic diagnostics. Ultrasonic histography allows to quantify the density of the pancreatic tissue. Aims: To study the possibility of using ultrasonic histography to assess the severity of pancreatic fibrosis in CP. Patients & methods: The study included 182 patients with CP. Ultrasonic histography of the pancreas was performed during sonographic examination. The main indicator was index L in the area of the pancreatic head, which was determined automatically. The results were compared with indices of fecal elastase test to detect the correlation with the state of exocrine pancreatic function. Index of the pancreatic tissue homogeneity N and histographic coefficient were also calculated. Thirty healthy persons were examined. Results: Doctors of ultrasound diagnostics revealed inhomogeneous induration of the pancreatic tissue in 156 (85.7%) patients. Index L in patients with CP was 32.3±4.1, in healthy d 18.1±2.3 (p<0.01). There was a substantial negative correlation between index L and results of fecal elastase test in CP (r¼e0.52). Healthy persons didn’t have such a correlation. Index of the pancreatic tissue homogeneity N and histographic coefficient were significantly reduced in patients with CP, indicating the heterogeneity of fibrotic changes in the organ. Conclusion: The use of ultrasonic histography of the pancreas is quite possible in clinical practice to assess the severity of pancreatic fibrosis in CP.
1
Moscow clinical scientific center, gastroenterology, Russia Russian Institute for Scientific and Technical Information Sciences, Russia
Introduction: Intelligent systems (IS) be used in clinical medicine. Aims: Apply the method of IS like JSM (named in honor of John Stuart Mill) to predict the development of diabetes pancreatogenic genesis (DM) in patients with chronic pancreatitis. Materials & methods: In the sector of IS VINITI created an intelligent system such as JSM, based on JSM-automatic method for generating hypotheses. Existing IntJSM includes: IntJSM¼solversþInformation Environment (base facts (BF) and Knowledge Base (KB)þintelligent interface (dialogþþlearning presentation of the results with the system). Results: In the first stage by means of JSM-system rules plausible conclusion of the first kind (induction) on the training sample of 81 patients were generated hypotheses of the 1st kind: the presence of a specific set of symptoms the patient is the cause of the presence or absence of the diagnosis of diabetes. in the second stage of hypotheses using a first-order rules of the 2nd kind is extended presence or the absence of diabetes in 42 patients submitted to the forecast. As a result, computer studies, 10 patients were positive to extend the definition, ie they have been diagnosed with diabetes, 28 patients were to extend the definition in the negative. The results extend the definition coincided with real medical data (accuracy completions-100% and completeness-90%). Conclusion: The proposed IS is a tool to support medical research with complex structured data and the set of facts, boundless without the use of computer technology, results of applying JSM-method as a means of analyzing medical data, pointed to a new tool of evidence medicine.
1102. 834. Duodenal dystrophy and chronic pancreatitis Ludmila Vinokourova, Dubcova Elena, Nikolskaya Karina, Bordin Dmitriy, Agafonov Maxim, Shulyatyev Ilya Moscow clinical scientific center, gastroenterology, Russia Introduction: Duodenal dystrophy leads to frequent exacerbation of chronic pancreatitis. Aims: To determine the characteristics of the course and management of patients with duodenal dystrophy (DD). Materials & methods: The age of patients ranged from 37 to 67 years (average age 49.7 ± 8.8 years). All patients were examineted bu ultrasonography, endoscopic ultrasonography, endoscopy, with computed tomography with contrast bolus, a study on fecal elastase. Results: It was revealed that, according to verbal descriptive scale of pain (10 point scale) pain varied in the range of 4-6 points. Pancreatic hypertension was demonstrated in 12 (66.7%) patients, biliary hypertension in 4 (22.2%) ; DD combined with calcific pancreatitis was revealed in 9 (50%) patients, diabetes mellitus (DM) was observed in 8 patients (44.4%). 10 patients underwent surgical treatment. Pancreatoduodenal resection was performed. Exocrine insufficiency detected before surgery in 2 (11.1%) patients and after surgery it was revealed in 8 (44.4%). Fecal elastase varies from 15 to 54 mcg / g, the number of patients with diabetes for six months has not increased.
Long term cancer surveillance of patients with hereditary pancreatitis and ERCP-proven pancreatic duct strictures Peter Simon, Frank Ulrich Weiß, Aline Brockmann, Julia Mayerle, Markus Lerch Department of Internal Medicine A, Ernst-Moritz-Arndt University Greifswald, Germany Introduction: Patients with hereditary pancreatitis (HP, PRSS1-mutations) have a cumulative lifetime pancreatic cancer risk of 40-70% and are urgently in need of a surveillance strategy. Pancreatic duct stenosis has been reported to be an early sign of pancreatic cancer development and duct assessment by ERCP a sensitive tool to detect it. Aims: We have prospectively investigated HP-patients with pancreatic duct changes on ERCP. Patients & methods: 99 patients were diagnosed with HP (PRSS1: pR122H, pR122C and pN29I). 30 of these had undergone therapeutic ERCP with available films on at least one occasion after disease onset and, after informed consent, were recruited to a follow-up surveillance study. The endpoint was resective pancreatic surgery, death or confirmed pancreatic cancer. Results: One patient died from pancreatic cancer (aged 83) never having undergone ERCP. Of 30 recruited patients (19 male, 11 female, age 33±6 years, SEM) two were lost to follow-up and 28 were followed for a median of 20±1,8years. 5 patients had pancreatic duct stenosis at initial ERCP without mass lesions on imaging, of which none developed cancer. 5
Abstracts / Pancreatology 15 (2015) S1eS141
patients underwent resective surgery for complications of pancreatitis; none had developed pancreatic cancer. 3 patients died, one from metastatic oral cavity cancer, one from metastatic malignant melanoma and one from oesophagus cancer. Conclusion: In clinical follow up of patients with hereditary pancreatitis pancreatic cancer development is rare. Neither is the presence of pancreatic duct stenosis on ERCP a reliable positive predictor for pancreatic cancer development, nor its absence a negative predictor (Choudari et al. Gastrointest Endosc.2002;561:66-71).
847. Evaluation of A Checklist for Rapid Evaluation of Exocrine Pancreatic Insufficiency Raffaele Pezzilli, Gabriele Capurso, Giuseppe Del Favero, Santino Marchi, Luca Frulloni Exocrine Pancreatic Insufficiency collaborative (EPIc)-2 Project of the Italian Association for the Study of the Pancreas (AISP), Italy Introduction: There a high demand for rapid diagnosis of severe exocrine pancreatic insufficiency (EPI). Aims: To produce a rapid checklist able to identify EPI in outpatients. Materials & methods: Seven pancreatologists and two gastroenterologists produced a checklist for rapid clinical diagnosis of EPI. The checklist is divided in three parts: 1. Patient complaints (increase in daily bowel movements, with fatty, bulky stools which are difficult to flush away, bulky stools are sometimes not a daily symptom, and steatorrhea occurs after meals 2 to 3 times a day in individuals with a normal lipidcontent diet, weight loss), 2. Physical examination (weight loss of 10%, temporal scalloping, interosseous wasting, lack of subcutaneous fat, nail leukonychia, clinical signs of liposoluble vitamin deficiency); 3. Tubeless tests (fecal elastase-1 determination and/or serum parameters reflecting nutritional status). The checklist underwent to an objective evaluation by 49 gastroenterologists according to the AGREE II 23 items instrument that generate 6 domains and two supplementary evaluation items. Results: 81.6% of gastroenterologists completed the AGREE II questionnaire. All the domains resulted to be high; the score was 74 for Scope and purpose, 72 for Stakeholder involvement, 77 for Rigor of development, 73 for Clarity and presentation, 71 for Applicability, and 76 for Editorial independence. The score of overall quality was 5 (scale 0-7). Finally, 61.8% of the gastroenterologist suggested the use of the checklist in clinical practice, 32.8% suggested changes, 5.9% no recommended its utilization. Conclusion: The checklist developed may be utilized in clinical practice and the next step is to test it in real world.
1112. Who needs to be operated? Prognostic evaluation of the necessity of surgery in chronic pancreatitis according to the M-ANNHEIM classification Michael Hirth 1, Sarah Kolb 1, Christel Weiß 2, Felix Rückert 3, Torsten Wilhelm 3, Philip Hardt 4, Monika Hantelmann 4, Natalia Gubergrits 5, Matthias Ebert 1, Alexander Schneider 1 1
II. Medical Department, University Medical Centre Mannheim, Germany 2 Medical Statistics, University Medical Centre Mannheim, Germany 3 Surgical Department, University Medical Centre Mannheim, Germany 4 Department of Gastroenterology, University Hospital Giessen, Germany 5 Department of Gastroenterology, University Hospital Donetsk, Ukraine
Introduction: The M-ANNHEIM classification (MC) represents a clinical classification system of chronic pancreatitis (cP). It stratifies all
S71
etiological risk factors and defines different degrees of disease severity according to clinical parameters. Aims: To analyze whether the MC can be used as a prognostic tool according to the necessity of a surgical intervention. Patients & methods: Retrospective classification of 740 patients with cP according to the MC from three medical departments (Mannheim/ Germany, n¼536; Giessen/Germany, n¼100; Donetsk/Ukraine). Results: In 12% (n¼89) of patients, the classification was applied immediately before a pancreatic surgical intervention. Preoperatively classified patients presented a significantly higher MC-Severity-Index (mean 13,3 ± 4,4 vs. 6,9 ± 4,5; p<0,001; U-Test Mann/Withney). A ROCanalysis revealed a cut-off value of 11 to distinguish patients with the indication for surgery versus conservative treatment (sensitivity and specify 81%, each). We found a positive correlation of increasing MCSeverity-Levels with the incidence of surgery (p<0,0001; Cochran-Armitage Trend Test; incidence of surgery in MC-Severity-Levels A: 0,7%; B: 6%; C: 33%; D: 53%, E: 31%). Several factors were associated with increasing necessity of surgery: duration of cP (p¼0,027; Kruskal-Wallis), presence of multiple risk factors (p¼0,0077; Chi-c-Test), alcoholic etiology (p¼0,0011; Chi-c-Test), nicotine dependence (p¼0,0049; Chi-c-Test), increasing painscore, complication-score, exocrine insufficiency, imaging-score and modified Zürich Classification (each p<0,0001; Cochrane-Armitage-TrendTest). Significant differences between the three centers were not observed (p¼0,47; Chi-c-Test). Conclusion: The MC provides a useful tool to monitor the clinical course of cP and allows a prognostic assessment with regard to the necessity of surgical interventions.
858. Chronic pancreatitis in children- over 25 years of single-centre experience Grzegorz Oracz 1, Elwira Kolodziejczyk 1, Agnieszka Rygiel 2, Karolina Wejnarska 1, Jaroslaw Kierkus 1, Jerzy Bal 2, Jozef Ryzko 1 1 Dep. of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, Warsaw, Poland 2 Department of Medical Genetics, National Research Institute of Mother and Child, Warsaw, Poland
Introduction: Chronic pancreatitis (CP) is of a rare occurrence in childhood. The etiology of CP in children is varied and includes anatomic anomalies, gene mutations, metabolic disorders and others. Aims: The aim of this study was to investigate the etiological aspects of CP in children from well-defined homogenous single-centre cohort. Patients & methods: 271 children with CP (aged: 0.6-18 years; mean 8.8; F-144, M-127) hospitalized between 1988 and 2014 were enrolled into the study. Clinical and epidemiological data were recorded and analyzed. All patients were screened for gene mutations predisposing to CP. All children had preceding imaging studies, including US, CT, MRCP and/or ERCP. Results: Gene mutations were found in 127 children (46.9%) (PRSS1 mutation in 34 children, CFTR in 42 patients, SPINK1 in 65 children). In 22 cases were found two gene mutations. Anatomic anomalies of pancreatic duct were diagnosed in 46 patients (17%) (29-pancreas divisum, 8-ansa pancreatica, 4-ABPU, 2-two main pancreatic ducts, 3-other). CP was associated with biliary tract diseases in 26 patients (9.6%). Lipid disturbances were found in 21 patients (7.7%). Autoimmune pancreatitis was diagnosed in 6 children (2.2%). History of trauma was present in 15 cases (5.5%). In 7 cases (2.6%) CP was probably associated with drugs, in 3 patients (1.1%) with alcohol and cigarettes smoking. Idiopathic CP was diagnosed in 74 children (27.3%). Conclusion: 1. Gene mutations and anatomic anomalies of pancreatic duct are the most common etiologic factors of CP in children. 2. Our data demonstrate the need for genetic testing in children with CP.