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Management of chronic calcific pancreatitis with sinistrial portal hypertension – A retrospective study
Electronic Poster Abstracts Introduction: Cholecystectomy is mandatory to prevent further biliary events in patients with biliary acute pancreatitis, but timing of cholecystectomy remains controversial. Aims: To compare the outcomes of early versus delayed cholecystectomy in acute mild biliary pancreatitis. Material and methods: The prospective study included 100 patients of acute mild biliary pancreatitis Group A comprised of 50 patients underwent laparoscopic cholecystectomy in the same admission (within 10 days ) and Group B comprised 50 patients operated after 6 weeks. Operative time, blood loss, unclear Calots antomy, conversion to open cholecystectomy, need for drains, intraoperative/postoperative complications, hospital stay after surgery were compared. Results: The mean operative time was 28.2 5.3 minutes in Group A and 26.8 4.8 minutes in Group B, the mean blood loss was 22.6 7.6 ml in Group A and 18 6.7 ml in Group B, Calot’s triangle anatomy was unclear in 10 (20%) cases in Group A and 8(16%) cases in Group B, conversion to open cholecystectomy was done in 6 (12%) cases in Group A and 4 (8%) cases in Group B.12 (24%) cases in Group A and 6 (12%) in Group B had a need for drain. Mean hospital stay was 3.04 days in Group A and 3.02 days in Group B. 24 (48%) of cases in Group B had recurrent attacks ranging from 1 to 5, during the waiting period for surgery. Conclusion: From the study it is clear that early laparoscopic cholecystectomy is safe, effective feasible in patients of acute mild biliary pancreatitis, preventing recurrent attacks which otherwise cause significant morbidity in those undergoing delayed cholecystectomy.
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them 105 patients received PCD and conservative management were performed in remained 57 patients. Outcome measures were operation rate (OR), pancreatic infection rate (IR) and mortality. Result: The rate of large amount sterile APFC were higher in SAP(a) and SAP(b) + MOF ( > 80%) than in SAP(b) + MOF and MSAP( < 60%). In severer groups PCD reduced the OR (SAP(a)), IR(SAP(a) + SOF and SAP(b)) and mortality(SAP(a) and SAP(b) + MOF). In contrast, PCD raised the OR and IR in MSAP. Conclusion: The amount of APFC is positively related to the severity of pancreatitis, also the intensity of the development of organ failure. Sterile PCD in early stage may ameliorate the prognosis in severer AP but not in MSAP.
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EP02A-013 DOES THE EFFICIENCY OF PERCUTANEOUS CATHETER DRAINAGE EQUAL IN TREATING WITH ACUTE PERIPANCREATIC FLUID COLLECTION INDUCED BY ACUTE PANCREATITIS WITH VARIOUS DEGREE OF SEVERITY Y. Zhang, S. Zhang, W. Yu and T. Liang Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, China Introduction: Acute peripancreatic fluid collection (APFC) always exits in severe or moderately severe acute pancreatitis (SAP&MSAP). A widespread consensus of not draining the sterile APFC virtually neglected the various degree of severity in pancreatitis all along. The aim of this study was to evaluate the efficacy of percutaneous catheter drainage (PCD) of sterile APFC in AP with different severity. Methods: 229 patients classified as SAP or MSAP according to the revised Atlanta classification were further divided into 6 subgroups according to the speed of organ failure (OF) developing and the number of organs involved. SAP(a) + MOF: multiple OF occurred within 3 days; SAP(a) + SOF: single OF within 3 days; SAP(b) + MOF: MOF within 7 days; SAP(b) + SOF: SOF within 7 days; MSAP with OF and MSAP without OF. 162 patients were found enough sterile APFC to drain within 1 week, among
HPB 2016, 18 (S1), e1ee384
EP02A-014 MANAGEMENT OF CHRONIC CALCIFIC PANCREATITIS WITH SINISTRIAL PORTAL HYPERTENSION e A RETROSPECTIVE STUDY S. Muthukrishnan, R. Vellaisamy, A. Anbalagan, B. Duraisamy, P. Raju, C. Servarayan Murugesan and K. DevyGounder Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Govt General Hospital, India Objectives: Left sided or sinistrial portal hypertension is one of the vascular complications in Chronic calcific pancreatitis patients. The aim of this study was to analyse the clinical presentation, management and outcomes of this complication in a tertiary care centre. Methods: This is a retrospective study of 154 patients with Chronic calcific pancreatitis between Aug 2010 to May 2015. Out of 154 cases 16 (10%) had sinistrial portal hypertension. The male:female ratio was 3:1. The factors analysed were Demographic profile, clinical presentation, investigation, management modalities, perioperative morbidity and mortality. Results: The average age was 34.5 years. 12 patients were alcoholics. One patient had Jaundice, Three had Upper GI bleeding and five had steatorrhoea. All had abdominal pain radiating to back with pain score between 8 and 9. Two patients had small duct disease. Four of them had fundal varices on OGD.
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Electronic Poster Abstracts
Out of 16 patients, 12 were treated with Frey s procedure and splenectomy, 2 were treated with Lateral pancreaticojejunostomy with splenectomy and 2 were treated with Izbiki procedure with splenectomy. One patient required Choledochodudenostomy for jaundice along with Frey’s. Average duration of surgery was 200 minutes with mean blood loss 240 ml. Eleven patients required blood transfusion. The followup period was 3e57 months. None of them had UGI bleed in the followup period. Conclusion: Concomitant splenectomy should be strongly considered in patients undergoing operative treatment of symptomatic chronic pancreatitis with sinistral portal hypertension. Adding splenectomy to the pancreatic procedure did not increase morbidity or mortality.
EP02A-015 PATIENTS’ PERSPECTIVES ON FUTURE CLINICAL AND RESEARCH TOPICS IN PANCREATIC DISEASES J. van Grinsven1,2, Y. Issa1, M. J. Bruno3, O. R. C. Busch1, A. Gerritsen1, H. van Goor4, B. van Oostveen5, J. A. Vogel1, H. D. G. van Willigen1, M. A. Boermeester1, M. G. H. Besselink1 and Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, St. Antonius Hospital, 3Gastroenterology and Hepatology, Erasmus University Medical Center, 4Surgery, Radboud University Medical Center, and 5St. Antonius Hospital, Netherlands Introduction: Topics and outcomes for clinical research are usually determined by clinicians which may differ from patients’ preferences. We aimed to assess the most relevant clinical and research topics according to patients with pancreatic disease. Methods: A combined questionnaire was developed for patients with acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer (PC). In June 2014 this questionnaire was distributed to 925 members of the Dutch national pancreatic patient association. Results: The response rate was 32.6% (N = 302/925); AP 28.5%, CP 31.1%, AP/CP 23.8%, PC 14.2%, and other 2.3%. The most relevant problems reported were pain by 69.2% of patients and fatigue by 52.0%. Of all patients 52.7% felt they had suboptimal pain management. More patients with AP and CP considered pain and diet major problems as compared to PC patients; 76.0% vs. 52.5%, p = 0.002, and 36.4% vs. 17.5%, p = 0.02. Fewer AP and CP patients felt they received sufficient information about their disease compared to PC patients; 61.8% vs. 81.0%, p = 0.04. Previous participation in medical research was a positive experience to 65.1% (54/83 patients) of patients. In total, 65.9% of all patients would be willing to participated in future medical research. Nutrition was most often suggested (54.0%) as important topic for future research projects. Conclusion: Patients with pancreatic disease, particularly with AP and CP reported pain, fatigue, and nutrition as most relevant problems. Two-third of patients with pancreatic disease are willing to participate in medical research. Most suggest nutrition as most relevant topic for future research.
EP02A-016 THE VALUE OF A 24/7 ONLINE NATIONWIDE MULTIDISCIPLINARY EXPERT PANEL FOR NECROTIZING PANCREATITIS: A 5-YEARS’ EXPERIENCE J. van Grinsven1, S. van Brunschot2, M. G. H. Besselink1, H. C. van Santvoort3 and for the Dutch Pancreatitis Study Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, Unversity Medical Center Utrecht, and 3Surgery, St. Antonius Hospital, Netherlands Introduction: Clinical decision-making regarding invasive interventions in patients with necrotizing pancreatitis can be extremely difficult. This is mainly due to the complexity of this disease and its relatively low incidence. To improve clinical outcome of these patients and to ensure high quality of nationwide randomized trials, we launched a 24/7 online nationwide pancreatitis expert panel, including surgeons, gastroenterologists, and radiologists. The current study aimed to evaluate the experience with this panel, with the emphasis on feasibility and accessibility. Methods: From 2009 to 2014 we prospectively registered all cases evaluated by the expert panel, and requested all physicians who consulted the expert panel to fill out an evaluation. Results: In total 397 cases were assessed by the expert panel, in 122 cases (31%) treatment advice was requested outside office hours. Time between onset of disease and the request for expert advice was median 26 days (IQR 16e 46). In 133 cases (34%), patients were admitted on the ICU, and in 285 cases (72%) antibiotic treatment was already started prior to consultation. In 299 cases (75%) expert advices could be pooled and sent back to the physicians within 24 hours. In 157/397 cases (40%), the referring physician completed an evaluation. According to 148 physicians (94%) the expert panel was easily accessible and 138 (88%) considered it a valuable tool. In 132 cases (84%) the expert advice was followed. Conclusion: A 24/7 online nationwide multidisciplinary expert panel for necrotizing pancreatitis is feasible, and considered an accessible and valuable tool for physicians treating these patients.
EP02A-017 THE ROLE OF THE LIVER IN THE DEVELOPMENT OF RESPIRATORY FAILURE IN EXPERIMENTAL ACUTE PANCREATITIS (AP) P. Miguel, J. Camelione, L. Cardozo Bidart, R. Trapani, P. Curvale and A. Ferreres General Surgery, University of Buenos Aires, Argentina Introduction: Multiple organ failure is the systemic most feared complication in AP and is associated with a high mortality. The acute respiratory failure is related to the infiltration of the lung alveolar wall by neutrophils and macrophages, due to the release of systemic mediators (TNF, MIP2). Our aim was to assess the role of the liver in the pathophysiology of the respiratory failure in AP by comparing 2 groups, with and without portocaval shunt.
HPB 2016, 18 (S1), e1ee384
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them 105 patients received PCD and conservative management were performed in remained 57 patients. Outcome measures were operation rate (OR), pancreatic infection rate (IR) and mortality. Result: The rate of large amount sterile APFC were higher in SAP(a) and SAP(b) + MOF ( > 80%) than in SAP(b) + MOF and MSAP( < 60%). In severer groups PCD reduced the OR (SAP(a)), IR(SAP(a) + SOF and SAP(b)) and mortality(SAP(a) and SAP(b) + MOF). In contrast, PCD raised the OR and IR in MSAP. Conclusion: The amount of APFC is positively related to the severity of pancreatitis, also the intensity of the development of organ failure. Sterile PCD in early stage may ameliorate the prognosis in severer AP but not in MSAP.
[Figure]
EP02A-013 DOES THE EFFICIENCY OF PERCUTANEOUS CATHETER DRAINAGE EQUAL IN TREATING WITH ACUTE PERIPANCREATIC FLUID COLLECTION INDUCED BY ACUTE PANCREATITIS WITH VARIOUS DEGREE OF SEVERITY Y. Zhang, S. Zhang, W. Yu and T. Liang Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, China Introduction: Acute peripancreatic fluid collection (APFC) always exits in severe or moderately severe acute pancreatitis (SAP&MSAP). A widespread consensus of not draining the sterile APFC virtually neglected the various degree of severity in pancreatitis all along. The aim of this study was to evaluate the efficacy of percutaneous catheter drainage (PCD) of sterile APFC in AP with different severity. Methods: 229 patients classified as SAP or MSAP according to the revised Atlanta classification were further divided into 6 subgroups according to the speed of organ failure (OF) developing and the number of organs involved. SAP(a) + MOF: multiple OF occurred within 3 days; SAP(a) + SOF: single OF within 3 days; SAP(b) + MOF: MOF within 7 days; SAP(b) + SOF: SOF within 7 days; MSAP with OF and MSAP without OF. 162 patients were found enough sterile APFC to drain within 1 week, among
HPB 2016, 18 (S1), e1ee384
EP02A-014 MANAGEMENT OF CHRONIC CALCIFIC PANCREATITIS WITH SINISTRIAL PORTAL HYPERTENSION e A RETROSPECTIVE STUDY S. Muthukrishnan, R. Vellaisamy, A. Anbalagan, B. Duraisamy, P. Raju, C. Servarayan Murugesan and K. DevyGounder Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Govt General Hospital, India Objectives: Left sided or sinistrial portal hypertension is one of the vascular complications in Chronic calcific pancreatitis patients. The aim of this study was to analyse the clinical presentation, management and outcomes of this complication in a tertiary care centre. Methods: This is a retrospective study of 154 patients with Chronic calcific pancreatitis between Aug 2010 to May 2015. Out of 154 cases 16 (10%) had sinistrial portal hypertension. The male:female ratio was 3:1. The factors analysed were Demographic profile, clinical presentation, investigation, management modalities, perioperative morbidity and mortality. Results: The average age was 34.5 years. 12 patients were alcoholics. One patient had Jaundice, Three had Upper GI bleeding and five had steatorrhoea. All had abdominal pain radiating to back with pain score between 8 and 9. Two patients had small duct disease. Four of them had fundal varices on OGD.
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Electronic Poster Abstracts
Out of 16 patients, 12 were treated with Frey s procedure and splenectomy, 2 were treated with Lateral pancreaticojejunostomy with splenectomy and 2 were treated with Izbiki procedure with splenectomy. One patient required Choledochodudenostomy for jaundice along with Frey’s. Average duration of surgery was 200 minutes with mean blood loss 240 ml. Eleven patients required blood transfusion. The followup period was 3e57 months. None of them had UGI bleed in the followup period. Conclusion: Concomitant splenectomy should be strongly considered in patients undergoing operative treatment of symptomatic chronic pancreatitis with sinistral portal hypertension. Adding splenectomy to the pancreatic procedure did not increase morbidity or mortality.
EP02A-015 PATIENTS’ PERSPECTIVES ON FUTURE CLINICAL AND RESEARCH TOPICS IN PANCREATIC DISEASES J. van Grinsven1,2, Y. Issa1, M. J. Bruno3, O. R. C. Busch1, A. Gerritsen1, H. van Goor4, B. van Oostveen5, J. A. Vogel1, H. D. G. van Willigen1, M. A. Boermeester1, M. G. H. Besselink1 and Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, St. Antonius Hospital, 3Gastroenterology and Hepatology, Erasmus University Medical Center, 4Surgery, Radboud University Medical Center, and 5St. Antonius Hospital, Netherlands Introduction: Topics and outcomes for clinical research are usually determined by clinicians which may differ from patients’ preferences. We aimed to assess the most relevant clinical and research topics according to patients with pancreatic disease. Methods: A combined questionnaire was developed for patients with acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer (PC). In June 2014 this questionnaire was distributed to 925 members of the Dutch national pancreatic patient association. Results: The response rate was 32.6% (N = 302/925); AP 28.5%, CP 31.1%, AP/CP 23.8%, PC 14.2%, and other 2.3%. The most relevant problems reported were pain by 69.2% of patients and fatigue by 52.0%. Of all patients 52.7% felt they had suboptimal pain management. More patients with AP and CP considered pain and diet major problems as compared to PC patients; 76.0% vs. 52.5%, p = 0.002, and 36.4% vs. 17.5%, p = 0.02. Fewer AP and CP patients felt they received sufficient information about their disease compared to PC patients; 61.8% vs. 81.0%, p = 0.04. Previous participation in medical research was a positive experience to 65.1% (54/83 patients) of patients. In total, 65.9% of all patients would be willing to participated in future medical research. Nutrition was most often suggested (54.0%) as important topic for future research projects. Conclusion: Patients with pancreatic disease, particularly with AP and CP reported pain, fatigue, and nutrition as most relevant problems. Two-third of patients with pancreatic disease are willing to participate in medical research. Most suggest nutrition as most relevant topic for future research.
EP02A-016 THE VALUE OF A 24/7 ONLINE NATIONWIDE MULTIDISCIPLINARY EXPERT PANEL FOR NECROTIZING PANCREATITIS: A 5-YEARS’ EXPERIENCE J. van Grinsven1, S. van Brunschot2, M. G. H. Besselink1, H. C. van Santvoort3 and for the Dutch Pancreatitis Study Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, Unversity Medical Center Utrecht, and 3Surgery, St. Antonius Hospital, Netherlands Introduction: Clinical decision-making regarding invasive interventions in patients with necrotizing pancreatitis can be extremely difficult. This is mainly due to the complexity of this disease and its relatively low incidence. To improve clinical outcome of these patients and to ensure high quality of nationwide randomized trials, we launched a 24/7 online nationwide pancreatitis expert panel, including surgeons, gastroenterologists, and radiologists. The current study aimed to evaluate the experience with this panel, with the emphasis on feasibility and accessibility. Methods: From 2009 to 2014 we prospectively registered all cases evaluated by the expert panel, and requested all physicians who consulted the expert panel to fill out an evaluation. Results: In total 397 cases were assessed by the expert panel, in 122 cases (31%) treatment advice was requested outside office hours. Time between onset of disease and the request for expert advice was median 26 days (IQR 16e 46). In 133 cases (34%), patients were admitted on the ICU, and in 285 cases (72%) antibiotic treatment was already started prior to consultation. In 299 cases (75%) expert advices could be pooled and sent back to the physicians within 24 hours. In 157/397 cases (40%), the referring physician completed an evaluation. According to 148 physicians (94%) the expert panel was easily accessible and 138 (88%) considered it a valuable tool. In 132 cases (84%) the expert advice was followed. Conclusion: A 24/7 online nationwide multidisciplinary expert panel for necrotizing pancreatitis is feasible, and considered an accessible and valuable tool for physicians treating these patients.
EP02A-017 THE ROLE OF THE LIVER IN THE DEVELOPMENT OF RESPIRATORY FAILURE IN EXPERIMENTAL ACUTE PANCREATITIS (AP) P. Miguel, J. Camelione, L. Cardozo Bidart, R. Trapani, P. Curvale and A. Ferreres General Surgery, University of Buenos Aires, Argentina Introduction: Multiple organ failure is the systemic most feared complication in AP and is associated with a high mortality. The acute respiratory failure is related to the infiltration of the lung alveolar wall by neutrophils and macrophages, due to the release of systemic mediators (TNF, MIP2). Our aim was to assess the role of the liver in the pathophysiology of the respiratory failure in AP by comparing 2 groups, with and without portocaval shunt.
HPB 2016, 18 (S1), e1ee384