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Mo1158 The Epidemiology and Clinical Outcome of Pancreatic Solid Pseudopapillary Neoplasms: A Systematic Review
AGA Abstracts
that younger age, Hispanic race and female gender were independent predictors of microcolitis (see TABLE). Furthermore, among cancer cases, microcolitis was not associated with higher stage cancers (OR 0.943, 95% CI 0.819-1.087). CONCLUSION: Microcolitis is not associated with colorectal cancer. Therefore, despite the chronic inflammation seen on biopsy, these patients likely do not require any additional cancer screening compared to their nonaffected peers. Microcolitis risk factors in the Medicare population include younger age, Hispanic ethnicity and female gender.
was higher in the male diabetic patients. The users of sulfonylurea showed a tendency to have a large colorectal adenoma. Further evaluation with more patients will be needed. Key Words: Colorectal adenoma, Diabetes mellitus Mo1158 The Epidemiology and Clinical Outcome of Pancreatic Solid Pseudopapillary Neoplasms: A Systematic Review Aadil Ahmed, Joanna K. Law, Ralph H. Hruban, Matthew Olson, Elliot K. Fishman, Siva P. Raman, Susan Hutfless, Vikesh K. Singh, Mouen Khashab, Christopher L. Wolfgang, Anne Marie Lennon Background: Solid pseudopapillary neoplasms (SPN) are rare pancreatic tumors, accounting for 1-2% of resected pancreatic neoplasms. They present most frequently in young women. The majority of studies describing SPN are case reports or small case series, with the largest review of the literature published on 718 cases. Aims: To perform a systematic review of published literature on SPN and specifically analyse epidiomology and clinical outcomes. Methods: We searched MEDLINE, SCOPUS, and EMBASE for relevant studies published in full text and in English. Reference lists were also reviewed and any additional studies reviewed. Two authors independently collected and analyzed data using a data extraction form with differences adjucated through consensus panel. Results: A total of 514 studies from 54 countries were identified with 3,468 cases of SPN between 1952 and 2012. 2,970 (85.7%) of cases were reported within the past 10 years. The majority of patients (91.4%) were female. The mean age at diagnosis was 28.9 (range 4 to 85) years. The mean tumor size was 8.5 cm (range 0.3-26 cm). SPNs were slightly more common in the pancreatic head (36.3%), compared with the body (32.6%) or tail (28.9%). The presence or absence of symptoms was reported in 2,783 patients. The most common presentation was abdominal pain (61.4%) followed by an abdominal fullness/mass (25%) and 24.6% of patients were asymptomatic. The results of abdominal imaging studies were reported in 82.3% papers. CT was performed in 60.0% of patients, transabdominal ultrasound in 40.5%, with MRI (16.5%) and EUS (2.9%) used less frequently. 3,052 patients (88.1%) had reported surgical resection of which pancreaticoduodenectomy (24%) and distal pancreatectomy (37.4%) were the most commonly described procedures. 30 (0.87%) patients who underwent surgery had local lymph node metastases, and 127 (3.7%) distant metastases. 2,512 patients had follow up reported, with a median of 38.3 months (range 1-329 months). 4.1% of patients presented with recurrent disease with a mean time to recurrence of 50.6 (range 3 to 190) months. Overall 2.5% of patients died due to their disease. Conclusion: This is the largest systematic review of SPN, with the number of SPN reported in the literature increasing dramatically over the previous 10 years. SPNs occur predominantly in young women and usually present with non-specific symptoms. Surgery continues to be the mainstay of treatment and while rare, recurrence tends to occur more than 4 years from time of diagnosis. The overall prognosis is excellent with only 2.5% of patients succumbing to their disease.
Mo1155 The Polymorphisms of Embryonic Ectoderm Development Gene in Colorectal Cancer Sung Hee Lee, Geom Seog Seo The risk of developing colorectal cancer (CRC) increases in patients with inflammatory bowel diseases (IBD). Crohn's disease (CD) and ulcerative colitis (UC) are the two main clinical forms of IBD in humans. Our previous work indicated that the embryonic ectoderm development (EED) gene is a candidate gene associated with the pathogenesis of UC and the halotypes of the EED polymorphism is one of the markers for UC susceptibility. The aim of the present study was to determine whether the polymorphisms in the EED gene are associated with CRC. Genotype analysis in the EED single nucleotide polymorphisms (SNPs) were performed by high resolution melting analysis, and the genotype and allele frequencies of EED SNPs were compared between the CRC patients (n=292) and the healthy controls (n=535). The haplotype frequencies of EED for multiple loci were estimated using the expectation maximization (EM) algorithm. The genotype and allele frequencies of the SNPs or halotype frequencies of EED gene in the CRC patients were not significantly different from those of the healthy controls. These results suggest that the SNPs of EED gene might be not associated with susceptibility to CRC. Mo1156 Malignant Gastrointestinal Tumors After Orthotopic Liver TransplantationSingle Center Experience Pavel Wohl, Marek Benes, Monika Drastichova, Petr Wohl, Pavel Drastich, Julius Spicak
Mo1159 Chemoprevention of Oesophageal Carcinomas by NSAIDs. How Much Does It Count? Eugen F. Georgescu, Deliu Cristina, Ramona Teodorescu, Lucretiu Radu, Mihaela Tataru
Introduction: "De novo" gastrointestinal tumors " are a serious problem after orthotopic liver transplantation (OLTx). The aim of this retrospective study was to evaluate the incidence of gastrointestinal malignancies after OLTx. Methods: A total of 938 patients underwent OLTx in IKEM ( Czech Republic) between 1995 - 2012, among them 106 (11,6 %) were suffering from primary sclerosing cholangitis and ulcerative colitis. In all patients, annual cancer screening was performed based on a chest X-ray, abdominal ultrasound and tumor markers. Colonoscopy was performed before OLTx and post-transplant in UC patiens annualy, in other patients every 5 years. Results: Overall 68 "de novo" malignant tumors were found after OLTx. Gastrointestinal malignant tumors were diagnosed in six of them (8.82%). Colorectal carcinoma was found in 4 patients (4/938, 0,42%). Four patients with ulcerative colitis (4/106, 3.77%) had premalignant and malignant lesions (2 patients with HGD and two patients had colorectal carcinoma). Two patients from the group without ulcerative colitis had colorectal carcinoma (2/938, 0,21%). Statistically higher incidence of colorectal carcinoma was found in patients with ulcerative colitis as compared to patients without ulcerative colitis (2 of 106; 1.88% vs. 2 of 834, 0.23%, p .0.05). No patient died due to CRC. Among other malignancies, two pancreatic cancer patients were observed and both patients died (2/938, 0.21%). Other malignancies were not detected. Conclusion: The incidence of gastrointestinal tumors after OLTx is relativelly small. A higher incidence of colorectal cancer was found in the group of patients with ulcerative colitis, but without any influence on mortality.
INTRODUCTION: Oesophageal carcinomas (OECA) are of two major types: squamous cell carcinomas (SCC), and adenocarcinomas (ADK). Prevention of OECA may include prophylactic administration of NSAIDs. Our aim was to evaluate whether long-term use of aspirin at cardioprotective doses can prevent occurrence of OECA in male heavy smokers who do not quit tobacco use. PATIENTS AND METHODS. We conducted a 10-year (20012011) survey over chemoprotective effects of low doses of aspirin taken on regularly base in order to prevent OECA in 1565 caucasian male heavy smoker patients aged 54,8±0,2 (mean±SEM). Patients had to be long-life smokers (at least 20 cigarettes/day for at least 10 years). Subjects with high-grade dysplasia Barrett's oesophagus, oesophageal polyps, and regular use of PPIs at any dose were excluded, as well as non-compliant patients, so at the end of the study our database included 1174 (75.01%) patients who completed the survey. The group was divided in two subgroups: A (intervention group) consisting in 564 patients (48%) who regularly took daily doses of aspirin (150±50 mg) mainly for cardioprotective reasons and C (control group) with 610 (52%) subjects who did not receive aspirin. Upper digestive endoscopy with biopsy was performed every year in each patient and patients who missed any of the nine annual evaluations were excluded from the study, as well as those who abandoned the survey, discontinued aspirin use, or took PPIs for more than three months/year. Significant events were considered only occurrence of biopsy-proven OECA (either SCC or ADK). RESULTS. There was no significant difference between groups A and C concerning number of subjects ( 564 vs. 610, p = 0.18, Chi2 = 1.725), age (55.13 vs. 54.47, p = 0.10), years of tobacco use (31.98 vs. 32, p = 0.9) and daily number of cigarette smoked. Global incidence of OECA was 56 cases /1174 patients, i.e. 4.8% (95% CI = 3.60 to 6.19). Overall, OECA occurred after 40,30±1,38 years of smoking, while histological type was 25/56 cases SCC, i.e. 44.6% (95% CI = 28.89 to 65.9) and 31/56 cases ADK (55.4% with 95%CI = 37.61 to 78.58). In group C, we noticed a significantly two fold higher incidence of OECA than in group A (39/610 pts. i.e. 6.39% with 95% CI = 4.54 to 8.74 vs. 17/564 pts, i.e. 3.01% with 95% CI 1.75 to 4.82; p =0.01, Chi2 = 6.642), suggesting that indeed, aspirin has a chemprotective effect against OECA in heavy smokers. Consensually, relative risk for OECA in in group C was significantly higher (0,96 with 95% CI 0,94 to 0,98, p = 0.006) than in group A. CONCLUSION. Low dose aspirin can prevent OECA in heavy smoker male patients when taken on a regularly base. However, this protective effect seems to appear only after more than 10 years of use and further study are needed to confirm these data.
Mo1157 Factors Affecting the Incidence of Colorectal Adenoma in Diabetic Patients Sung Chul Park, Jaihwan Kim, DaeHee Choi, Chang Don Kang, Sung Joon Lee Background: It has been reported that type 2 diabetes mellitus (DM) is associated with higher relative risk for colorectal cancers. Hyperinsulinemia associated with DM may lead to carcinogenesis through increased level of insulin-like growth factor-1. The aim of this study is to evaluate the factors affecting on the incidence of colorectal adenoma known as precancerous lesions in diabetic patients. Methods: We retrospectively analyzed the data of patients who have type 2 DM and had a colonoscopy from august 2008 to august 2012. After having a colonoscopy, patients were divided into 2 groups with or without colorectal adenoma by pathologic findings and then the data from the both groups were analyzed by multivariate logistic regression analysis. The cases of incomplete study, familial polyposis, inflammatory bowel disease, prior colon cancer and other malignancy were excluded. Results: 72 patients were excluded in 383 enrolled patents from the study by exclusion criteria and the adenomas were found in 134 patents (43%). Higher incidence of adenoma was shown in the males (odds ratio=1.950, 95% CI 1.021-3.724, p=0.043) in multivariate analysis. Sulfonylurea was significantly related to the more than 10 mm sized adenoma (odds ratio= 2.363, 95% CI 1.042-5.357, p=0.037). There was no relationship between the level of HbA1c and colorectal adenoma incidence. Conclusions: The incidence of colorectal adenoma
AGA Abstracts
S-594
that younger age, Hispanic race and female gender were independent predictors of microcolitis (see TABLE). Furthermore, among cancer cases, microcolitis was not associated with higher stage cancers (OR 0.943, 95% CI 0.819-1.087). CONCLUSION: Microcolitis is not associated with colorectal cancer. Therefore, despite the chronic inflammation seen on biopsy, these patients likely do not require any additional cancer screening compared to their nonaffected peers. Microcolitis risk factors in the Medicare population include younger age, Hispanic ethnicity and female gender.
was higher in the male diabetic patients. The users of sulfonylurea showed a tendency to have a large colorectal adenoma. Further evaluation with more patients will be needed. Key Words: Colorectal adenoma, Diabetes mellitus Mo1158 The Epidemiology and Clinical Outcome of Pancreatic Solid Pseudopapillary Neoplasms: A Systematic Review Aadil Ahmed, Joanna K. Law, Ralph H. Hruban, Matthew Olson, Elliot K. Fishman, Siva P. Raman, Susan Hutfless, Vikesh K. Singh, Mouen Khashab, Christopher L. Wolfgang, Anne Marie Lennon Background: Solid pseudopapillary neoplasms (SPN) are rare pancreatic tumors, accounting for 1-2% of resected pancreatic neoplasms. They present most frequently in young women. The majority of studies describing SPN are case reports or small case series, with the largest review of the literature published on 718 cases. Aims: To perform a systematic review of published literature on SPN and specifically analyse epidiomology and clinical outcomes. Methods: We searched MEDLINE, SCOPUS, and EMBASE for relevant studies published in full text and in English. Reference lists were also reviewed and any additional studies reviewed. Two authors independently collected and analyzed data using a data extraction form with differences adjucated through consensus panel. Results: A total of 514 studies from 54 countries were identified with 3,468 cases of SPN between 1952 and 2012. 2,970 (85.7%) of cases were reported within the past 10 years. The majority of patients (91.4%) were female. The mean age at diagnosis was 28.9 (range 4 to 85) years. The mean tumor size was 8.5 cm (range 0.3-26 cm). SPNs were slightly more common in the pancreatic head (36.3%), compared with the body (32.6%) or tail (28.9%). The presence or absence of symptoms was reported in 2,783 patients. The most common presentation was abdominal pain (61.4%) followed by an abdominal fullness/mass (25%) and 24.6% of patients were asymptomatic. The results of abdominal imaging studies were reported in 82.3% papers. CT was performed in 60.0% of patients, transabdominal ultrasound in 40.5%, with MRI (16.5%) and EUS (2.9%) used less frequently. 3,052 patients (88.1%) had reported surgical resection of which pancreaticoduodenectomy (24%) and distal pancreatectomy (37.4%) were the most commonly described procedures. 30 (0.87%) patients who underwent surgery had local lymph node metastases, and 127 (3.7%) distant metastases. 2,512 patients had follow up reported, with a median of 38.3 months (range 1-329 months). 4.1% of patients presented with recurrent disease with a mean time to recurrence of 50.6 (range 3 to 190) months. Overall 2.5% of patients died due to their disease. Conclusion: This is the largest systematic review of SPN, with the number of SPN reported in the literature increasing dramatically over the previous 10 years. SPNs occur predominantly in young women and usually present with non-specific symptoms. Surgery continues to be the mainstay of treatment and while rare, recurrence tends to occur more than 4 years from time of diagnosis. The overall prognosis is excellent with only 2.5% of patients succumbing to their disease.
Mo1155 The Polymorphisms of Embryonic Ectoderm Development Gene in Colorectal Cancer Sung Hee Lee, Geom Seog Seo The risk of developing colorectal cancer (CRC) increases in patients with inflammatory bowel diseases (IBD). Crohn's disease (CD) and ulcerative colitis (UC) are the two main clinical forms of IBD in humans. Our previous work indicated that the embryonic ectoderm development (EED) gene is a candidate gene associated with the pathogenesis of UC and the halotypes of the EED polymorphism is one of the markers for UC susceptibility. The aim of the present study was to determine whether the polymorphisms in the EED gene are associated with CRC. Genotype analysis in the EED single nucleotide polymorphisms (SNPs) were performed by high resolution melting analysis, and the genotype and allele frequencies of EED SNPs were compared between the CRC patients (n=292) and the healthy controls (n=535). The haplotype frequencies of EED for multiple loci were estimated using the expectation maximization (EM) algorithm. The genotype and allele frequencies of the SNPs or halotype frequencies of EED gene in the CRC patients were not significantly different from those of the healthy controls. These results suggest that the SNPs of EED gene might be not associated with susceptibility to CRC. Mo1156 Malignant Gastrointestinal Tumors After Orthotopic Liver TransplantationSingle Center Experience Pavel Wohl, Marek Benes, Monika Drastichova, Petr Wohl, Pavel Drastich, Julius Spicak
Mo1159 Chemoprevention of Oesophageal Carcinomas by NSAIDs. How Much Does It Count? Eugen F. Georgescu, Deliu Cristina, Ramona Teodorescu, Lucretiu Radu, Mihaela Tataru
Introduction: "De novo" gastrointestinal tumors " are a serious problem after orthotopic liver transplantation (OLTx). The aim of this retrospective study was to evaluate the incidence of gastrointestinal malignancies after OLTx. Methods: A total of 938 patients underwent OLTx in IKEM ( Czech Republic) between 1995 - 2012, among them 106 (11,6 %) were suffering from primary sclerosing cholangitis and ulcerative colitis. In all patients, annual cancer screening was performed based on a chest X-ray, abdominal ultrasound and tumor markers. Colonoscopy was performed before OLTx and post-transplant in UC patiens annualy, in other patients every 5 years. Results: Overall 68 "de novo" malignant tumors were found after OLTx. Gastrointestinal malignant tumors were diagnosed in six of them (8.82%). Colorectal carcinoma was found in 4 patients (4/938, 0,42%). Four patients with ulcerative colitis (4/106, 3.77%) had premalignant and malignant lesions (2 patients with HGD and two patients had colorectal carcinoma). Two patients from the group without ulcerative colitis had colorectal carcinoma (2/938, 0,21%). Statistically higher incidence of colorectal carcinoma was found in patients with ulcerative colitis as compared to patients without ulcerative colitis (2 of 106; 1.88% vs. 2 of 834, 0.23%, p .0.05). No patient died due to CRC. Among other malignancies, two pancreatic cancer patients were observed and both patients died (2/938, 0.21%). Other malignancies were not detected. Conclusion: The incidence of gastrointestinal tumors after OLTx is relativelly small. A higher incidence of colorectal cancer was found in the group of patients with ulcerative colitis, but without any influence on mortality.
INTRODUCTION: Oesophageal carcinomas (OECA) are of two major types: squamous cell carcinomas (SCC), and adenocarcinomas (ADK). Prevention of OECA may include prophylactic administration of NSAIDs. Our aim was to evaluate whether long-term use of aspirin at cardioprotective doses can prevent occurrence of OECA in male heavy smokers who do not quit tobacco use. PATIENTS AND METHODS. We conducted a 10-year (20012011) survey over chemoprotective effects of low doses of aspirin taken on regularly base in order to prevent OECA in 1565 caucasian male heavy smoker patients aged 54,8±0,2 (mean±SEM). Patients had to be long-life smokers (at least 20 cigarettes/day for at least 10 years). Subjects with high-grade dysplasia Barrett's oesophagus, oesophageal polyps, and regular use of PPIs at any dose were excluded, as well as non-compliant patients, so at the end of the study our database included 1174 (75.01%) patients who completed the survey. The group was divided in two subgroups: A (intervention group) consisting in 564 patients (48%) who regularly took daily doses of aspirin (150±50 mg) mainly for cardioprotective reasons and C (control group) with 610 (52%) subjects who did not receive aspirin. Upper digestive endoscopy with biopsy was performed every year in each patient and patients who missed any of the nine annual evaluations were excluded from the study, as well as those who abandoned the survey, discontinued aspirin use, or took PPIs for more than three months/year. Significant events were considered only occurrence of biopsy-proven OECA (either SCC or ADK). RESULTS. There was no significant difference between groups A and C concerning number of subjects ( 564 vs. 610, p = 0.18, Chi2 = 1.725), age (55.13 vs. 54.47, p = 0.10), years of tobacco use (31.98 vs. 32, p = 0.9) and daily number of cigarette smoked. Global incidence of OECA was 56 cases /1174 patients, i.e. 4.8% (95% CI = 3.60 to 6.19). Overall, OECA occurred after 40,30±1,38 years of smoking, while histological type was 25/56 cases SCC, i.e. 44.6% (95% CI = 28.89 to 65.9) and 31/56 cases ADK (55.4% with 95%CI = 37.61 to 78.58). In group C, we noticed a significantly two fold higher incidence of OECA than in group A (39/610 pts. i.e. 6.39% with 95% CI = 4.54 to 8.74 vs. 17/564 pts, i.e. 3.01% with 95% CI 1.75 to 4.82; p =0.01, Chi2 = 6.642), suggesting that indeed, aspirin has a chemprotective effect against OECA in heavy smokers. Consensually, relative risk for OECA in in group C was significantly higher (0,96 with 95% CI 0,94 to 0,98, p = 0.006) than in group A. CONCLUSION. Low dose aspirin can prevent OECA in heavy smoker male patients when taken on a regularly base. However, this protective effect seems to appear only after more than 10 years of use and further study are needed to confirm these data.
Mo1157 Factors Affecting the Incidence of Colorectal Adenoma in Diabetic Patients Sung Chul Park, Jaihwan Kim, DaeHee Choi, Chang Don Kang, Sung Joon Lee Background: It has been reported that type 2 diabetes mellitus (DM) is associated with higher relative risk for colorectal cancers. Hyperinsulinemia associated with DM may lead to carcinogenesis through increased level of insulin-like growth factor-1. The aim of this study is to evaluate the factors affecting on the incidence of colorectal adenoma known as precancerous lesions in diabetic patients. Methods: We retrospectively analyzed the data of patients who have type 2 DM and had a colonoscopy from august 2008 to august 2012. After having a colonoscopy, patients were divided into 2 groups with or without colorectal adenoma by pathologic findings and then the data from the both groups were analyzed by multivariate logistic regression analysis. The cases of incomplete study, familial polyposis, inflammatory bowel disease, prior colon cancer and other malignancy were excluded. Results: 72 patients were excluded in 383 enrolled patents from the study by exclusion criteria and the adenomas were found in 134 patents (43%). Higher incidence of adenoma was shown in the males (odds ratio=1.950, 95% CI 1.021-3.724, p=0.043) in multivariate analysis. Sulfonylurea was significantly related to the more than 10 mm sized adenoma (odds ratio= 2.363, 95% CI 1.042-5.357, p=0.037). There was no relationship between the level of HbA1c and colorectal adenoma incidence. Conclusions: The incidence of colorectal adenoma
AGA Abstracts
S-594