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Plasmocitary autoimmune cronic pancreatitis
e16
Abstracts / Pancreatology 13 (2013) e1–e19
determination of IgG. Only in selected cases, biopsy was performed to exclude cancer (ADK). Results: Median age was 67. Mean follow-up was 29.6 months. Most common initial symptom was jaundice (20p); 6p presented high levels of IgG4; 2p had rheumatoid arthritis associated; biopsy was need in 4p. In 12p surgery was performed, including 4 patients with pathological review of pancreaticoduodenectomy without ADK operated before 2003. The rest of patients (11) were treated with steroids. Two patients had recurrence of AIP; 2p presented autoimmune cholangitis and one of them was successfully treated with steroids. Conclusions: AIP should be suspected in patients with jaundice and typical images in CT/MR, in addition with high levels of IgG4. If only 1 criterion can be found, biopsies are mandatory to rule out ADK. In case of suspicion, a trial of steroids response can be considered as a diagnostic test. Surgery should be indicated only in cases of doubt of ADK.
Introduction: Exocrine Pancreatic Insufficiency is an underdiagnosed disease which may be the cause of maldigestion and malabsortion syndromes, one of which aetiologies is Chronic Pancreatitis. Objective: Evaluate the association between Exocrine Pancreatic Insufficiency and severity of endoscopic ultrasound findings. Design: Descriptive, retrospective, transversal study including all patients with Rosemont endoscopic ultrasound criteria for Chronic Pancreatitis between 2001 and 2011. Additional data was recorded from computerized clinical reports, such as Exocrine Pancreatic Insufficiency through mixed triglycerides breath test. Results: 73 Chronic Pancreatitis were found. Mean age: 54,99 years (80.8% men). 75.3% had pancreatic function tests. 29% of them had mild findings in endoscopic ultrasound and 71% had severe findings. 50% of those with mild findings had exocrine pancreatic insufficiency. 41% of those with severe findings had exocrine pancreatic insufficience. Conclusions: Endoscopic Ultrasound findings (Rosemont criteria) is not related with the presence or absence of Exocrine Pancreatic Insufficiency (measured through mixed triglyceride breath test).
P39. Association between pancreatic dysfunction and aetiology of chronic pancreatitis ndez Cano, M.A. Romero Ordo lez Ba rcenas, M.C. n ~ ez, M. Gonza F.M. Ferna pez Vega, J.M. Navarro Jarabo, A. P Lo erez Aisa. Agencia Sanitaria Costa del Sol, Spain Introduction: Chronic Pancreatitis (CP) is a difficult to diagnose clinical-pathological syndrome, with multiple aetiologies in which the endocrine and exocrine pancreatic gland tissue is replaced by proliferative fibrosis and may condition endocrine and exocrine pancreas dysfunction, declared as Exocrine or Endocrine Pancreatic insufficiency. Objective: Descriptive study with patients wit CP in our area. Evaluation weather it exists or not association between pancreatic dysfunction and the aetiology of the Chronic Pancreatitis. Design: Transversal, retrospective study. Reviewing all patients with CP diagnosed between 2001 and 2011, collecting demographic, clinical and analytic variables from computerized clinical reports. Exocrine pancreatic dysfunction defined through marked triglycerides breath test and Endocrine pancreatic dysfunction through the presence or absence of type 2 Diabetes Mellitus. Results: 73 patients were diagnosed with CP. Mean age: 54,99 years old, 80.8% men. Evolution of CP: mean 5,44 years. With a population in our area of 379.334 people, the prevalence is 19,24/100.000 inhabitants. Aetiology was 39,7% mixed toxic CP, 35,6% alcoholic, 12,3% idiopathic, 6,8% recidivant acute pancreatitis and 5,2% other. A 52,1% of Exocrine Pancreatic Insufficiency prevalence was found and 21,9% of Endocrine Pancreatic Insufficiency. Overall Pancreatic Insufficiency: 61,6%. Statistical significance was not reached when the association between Pancreatic Dysfunction and aetiology was investigated. Conclusions: With a lower prevalence than described in our neighbour countries, we suspect that CP is underdiagnosed in our hospital. Due to high prevalence of pancreatic dysfunction among these patients, all of them should be derived to an specific Unit for diagnose and treatment. With the actual data, we do not find association between CP aetiology and Pancreatic Dysfunction.
P40. Do endoscopic ultrasound provides information in evaluating exocrine pancreatic insufficiency in chronic pancreatitis? ndez Cano 1, M.A. Romero Ordo lez Ba rcenas 1, R. n ~ ez 1, M. Gonza F.M. Ferna 1 1 1 Rivera Irigoin , M.C. Lopez Vega , J.M. Rosales Zabal , J.M. Navarro erez Aisa 1. Jarabo 1, F. Rivas Ruiz 2, A. P 1 Agencia Sanitaria Costa del Sol, Unidad de Aparato Digestivo, Marbella, Spain 2 n, Spain Agencia Sanitaria Costa del Sol, Unidad de Investigacio
P41. Idiopathic fibrosing pancreatitis S. Niky Mocanu, M. Rodriguez Blanco, J.A. Gonzalez Lopez, V. Artigas s, A. Farre Viladrich, F.J. Sancho Poch, M. Trias. Ravento Hepatobiliopancreatic and Oncological Unit, General and Digestive Surgery Department, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Spain Introduction: Idiopathic fibrosing pancreatitis (IFP), described by Comfort in 1946, is a rare entity, predominant in children and adolescents. It consists in a extensive fibrosis of the exocrine pancreas with relative sparing of Langerhans cells. The clinical picture is usually that of an obstructive jaundice. Its treatment is mainly conservative – based on corticosteroid therapy and biliary stens – but, in refractory cases, the surgery offers an adequate palliation by means of a bilioenteric anastomosis or, in few cases, a duodenopancreatic resection. Material and methods: 20-year old male patient admitted for obstructive jaundice. The ultrasonography showed a dilated extrahepatic biliary duct without evidence of cholelithiasis. Colecystectomy with intraoperative cholangiography was performed showing a irregular stenosis of the terminal choledocus. Results: Radiological, biochemical and immunological studies could not identify the cause of the process. Eventually, the patient underwent open surgical exploration with pancreatic biopsy and hepaticojejunostomy. The pathology report described a chronic inflammatory infiltrate with fibrosis and sparing of Langerhans islets. The clinical context and the pathologic findings led to the definitive diagnosis of IPF. Discussion: Although rare, IFP must be considered in the differential diagnosis of obstructive jaundice in young patients.
P42. Plasmocitary autoimmune cronic pancreatitis s, M. Rodriguez Blanco, A. Farr S. Mocanu, V. Artigas Ravento e Viladrich, F.J. Sancho Poch, J.A. Gonzalez, M. Trias. Surgical HBP-Oncologic Surgical General and Digestive, Digestive Patrhology and Patologic Departments, Hospital de la Santa Creu i Sant noma de Barcelona, Spain Pau, Universitat Auto Objects: The Autoimmune Pancreatitis (PAI) is a infrequent disease.The focal pancreatic presentation induced dificulty for diferencial diagnosis with pancreatic neoplasms. Material and methods: Three patients with a indolor obtructive icterice. The analitics and serologics controls, as well as radiologics (ECO/ TC/ColangioRMN) explorations was done. We considered the utility of surgical resection for definitive diagnosis.
Abstracts / Pancreatology 13 (2013) e1–e19
Results: Too patients was a cefalic pseudotumoral mass indistingible for pancreatic cancer. Definitive diagnosis after surgical resection was compatible with PAI. In the third case, the preoperatory explorations indicated a cronic pancreatitis, stenosis of terminal coledoc and retroperitoneal fibrosis. The study of citologic sample confirmed a mix-inflamatory infiltration. The obstructive icteric sindrom remised temporaly with corticoitherapy, The DPC was indicated for persisitent cefalic mass with suspitous pancreatic cancer. The definitive diagnosis was a PAI. Conclusions: The autoimmune pancreatitis (PAI) is manifested with obstructive icteric sindrom in 70% of cases. Diagnosis is based in clinical and serologic (Ig4)signs, radiologic imagins, and patologic results.The corticoitherapy response is another important clinical sign for PAI diagnosis. In the psedotumorals forms, surgical resection is a corrected actitude from diferential diagnosis with pancreatic cancer.
P43. Pancreatic exocrine insufficiency (PEI) and need for pancreatic enzyme replacement therapy (PERT) in patients with chronic pancreatitis (CP) is predicted by the degree of pancreatic fibrosis as measured by endoscopic ultrasound (EUS)-guided elastography
e17
Paraduodenal pancreatitis (PDP) comprises cystic dystrophy in heterotopic pancreas of duodenal wall (CDHP) and groove pancreatitis (GP), specific histopathological forms of chronic pancreatitis (CP). Objectives: To describe the prevalence of PPD and assess its clinical complications and therapeutic management. Material and methods: Retrospective study of 99 patients with CP followed in our center. Quantitative data are expressed as median (p25p75). Results: We diagnosed 17 PDP (9 CDHP and 10 GP, 2 with both). Median age at diagnosis of 46 years, 16 were male. The PC was calcifying in 14, eight had ductal alterations. All 17 had a history of alcohol consumption, 13 of them in etiological range. The 100% smoked or had smoked. 100% had pain at some time, with a median number of hospital admissions of 4 (3-5). Three patients had symptomatic duodenal stenosis and 4 biliary stricture. The treatment was surgical in 6 patients 1 for pain, 4 for pain associated with duodenal and/or biliary, stenosis 1 duodenal and biliary strictures. One Puestow operation was performed, 2 Whipple operations and 3 biliary bypass operations. Conclusions: The PDP appears in men with CP by alcohol and / or tobacco. The main symptom is pain. CDHP and GP have a similar prevalence. Surgical treatment it’s indicated in 30% of patients, when exists duodenal and/or biliary stenosis.
~ oz, M. Castin ~ eiras, M. Luaces, J. Larin ~ o-Noia, L. J.E. Domínguez-Mun Nieto, J. Iglesias-García. Department of Gastroenterology, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain Background: We hypothesized that the degree of fibrosis can predict the probability of PEI and the need for PERT in patients with CP. Fibrosis may be accurately quantified by EUS-guided elastography. Aim: To evaluate whether pancreatic elastography can be used to diagnose PEI in patients with CP. Methods: CP patients were included in this prospective study. Diagnosis of CP was based on EUS and/or MRCP findings. A 13C-MTG breath test was performed in all patients after the diagnosis of CP to detect PEI. EUSguided elastography was performed by the lineal Pentax EUS and HITACHIPREIRUS processor. Two different areas (A and B) were selected for elastographic evaluation: Area A is a representative area of the pancreatic parenchyma and B refers to a soft peripancreatic reference area. The quotient B/A (strain ratio –SR-) was considered as the elastographic result. Data are shown as mean and 95% CI and compared by Student-t test. The probability of PEI according to the SR was calculated. Results: 115 consecutive patients with CP (mean age 50.2 years, range 21-81 years, 92 male) were included. 35 patients (30.4%) suffered from PEI. Patients with PEI had a higher SR (4.89, 95%CI 4.36-5.41) than those with a normal breath test result (2.99, 95%CI 2.82-3.16) (p<0.001). A close relationship was found between the SR and the probability of PEI. Conclusion: The degree of pancreatic fibrosis as measured by EUSguided elastography allows quantifying the probability of PEI and the need for PERT in patients with CP.
P44. Paraduodenal pancreatitis E. Domenech Pina, E. De Madaria Pascual, M. Rey Riveiro, I. Lopez Font, P. Melgar Requena, L. Sempere Robles, Felix Lluis Casajuana. Hospital General Universitario Alicante, Spain
P45. Autoimmune pancreatitis in Barcelona as assessed by the international consensus diagnostic criteria (ICDC). Review of a series of 25 patients from two centers n Suero, E.C. Vaquero Raya, M.T. Salcedo Allende, M. Cuatrecasas H. De Leo s, A. Gin Freixas, X. Merino Casabiel, J.R. Ayuso Colella, S. Navarro Cola es ndez-Cruz P Gilbert, M. Abu-Suboh Abadia, J. Balsells Valls, L. Ferna erez, X. Molero Richard. gica, Cirurgia, Serveis de Gastroenterologia, Anatomia Patolo pia i Radiologia, Hospital Clínic i Hospital Universitari Vall Endosco d’Hebron, Barcelona, Spain Diagnosis of autoimmune pancreatitis (AIP) remains challenging. 2 AIP subtypes with clinical implications have been defined. Aim: To describe a series of 25 Spanish AIP patients. Methods: Imaging, histopathology and clinical features were reviewed according to the ICDC. Results: 23 males and 2 female (17-79 years) were studied (14 smokers, 5 alcohol abusers). 16 patients underwent pancreatectomy for suspected malignancy. 12 patients had type 1 and 10 type 2 AIP (3 undetermined). Type 1 patients were older (594 vs 354 years). Presentation was (%) epigastric pain(80), acute pancreatitis(52), weight loss(36), jaundice(36), GI bleeding(24), altered liver tests(68), leukocytosis(40), antinuclear antibodies >1/160(36), IgG4> 280 mg/dl(24). Other organs involved were gallbladder (44), bile duct (40), duodenum (24), colon(24), stomach(24), liver (20), and kidney(20). Common imaging findings were focal(62) and/or diffuse(25) pancreatic enlargement, multiple pancreatic duct stenosis, and bile duct stenosis. Six patients had splenic/portal vein thrombosis. Steroid therapy improved symptoms, IgG4 levels (523143 to 18116 mg/dl), extrapancreatic involvement and, occasionally, pancreatic function. Six type 1 AIP patients had (pre)malignant lesions. Conclusions: In this series, 70% AIPs have low IgG4 and 48% type 1 features. Diagnosis is often made after pancreatic resection.
Abstracts / Pancreatology 13 (2013) e1–e19
determination of IgG. Only in selected cases, biopsy was performed to exclude cancer (ADK). Results: Median age was 67. Mean follow-up was 29.6 months. Most common initial symptom was jaundice (20p); 6p presented high levels of IgG4; 2p had rheumatoid arthritis associated; biopsy was need in 4p. In 12p surgery was performed, including 4 patients with pathological review of pancreaticoduodenectomy without ADK operated before 2003. The rest of patients (11) were treated with steroids. Two patients had recurrence of AIP; 2p presented autoimmune cholangitis and one of them was successfully treated with steroids. Conclusions: AIP should be suspected in patients with jaundice and typical images in CT/MR, in addition with high levels of IgG4. If only 1 criterion can be found, biopsies are mandatory to rule out ADK. In case of suspicion, a trial of steroids response can be considered as a diagnostic test. Surgery should be indicated only in cases of doubt of ADK.
Introduction: Exocrine Pancreatic Insufficiency is an underdiagnosed disease which may be the cause of maldigestion and malabsortion syndromes, one of which aetiologies is Chronic Pancreatitis. Objective: Evaluate the association between Exocrine Pancreatic Insufficiency and severity of endoscopic ultrasound findings. Design: Descriptive, retrospective, transversal study including all patients with Rosemont endoscopic ultrasound criteria for Chronic Pancreatitis between 2001 and 2011. Additional data was recorded from computerized clinical reports, such as Exocrine Pancreatic Insufficiency through mixed triglycerides breath test. Results: 73 Chronic Pancreatitis were found. Mean age: 54,99 years (80.8% men). 75.3% had pancreatic function tests. 29% of them had mild findings in endoscopic ultrasound and 71% had severe findings. 50% of those with mild findings had exocrine pancreatic insufficiency. 41% of those with severe findings had exocrine pancreatic insufficience. Conclusions: Endoscopic Ultrasound findings (Rosemont criteria) is not related with the presence or absence of Exocrine Pancreatic Insufficiency (measured through mixed triglyceride breath test).
P39. Association between pancreatic dysfunction and aetiology of chronic pancreatitis ndez Cano, M.A. Romero Ordo lez Ba rcenas, M.C. n ~ ez, M. Gonza F.M. Ferna pez Vega, J.M. Navarro Jarabo, A. P Lo erez Aisa. Agencia Sanitaria Costa del Sol, Spain Introduction: Chronic Pancreatitis (CP) is a difficult to diagnose clinical-pathological syndrome, with multiple aetiologies in which the endocrine and exocrine pancreatic gland tissue is replaced by proliferative fibrosis and may condition endocrine and exocrine pancreas dysfunction, declared as Exocrine or Endocrine Pancreatic insufficiency. Objective: Descriptive study with patients wit CP in our area. Evaluation weather it exists or not association between pancreatic dysfunction and the aetiology of the Chronic Pancreatitis. Design: Transversal, retrospective study. Reviewing all patients with CP diagnosed between 2001 and 2011, collecting demographic, clinical and analytic variables from computerized clinical reports. Exocrine pancreatic dysfunction defined through marked triglycerides breath test and Endocrine pancreatic dysfunction through the presence or absence of type 2 Diabetes Mellitus. Results: 73 patients were diagnosed with CP. Mean age: 54,99 years old, 80.8% men. Evolution of CP: mean 5,44 years. With a population in our area of 379.334 people, the prevalence is 19,24/100.000 inhabitants. Aetiology was 39,7% mixed toxic CP, 35,6% alcoholic, 12,3% idiopathic, 6,8% recidivant acute pancreatitis and 5,2% other. A 52,1% of Exocrine Pancreatic Insufficiency prevalence was found and 21,9% of Endocrine Pancreatic Insufficiency. Overall Pancreatic Insufficiency: 61,6%. Statistical significance was not reached when the association between Pancreatic Dysfunction and aetiology was investigated. Conclusions: With a lower prevalence than described in our neighbour countries, we suspect that CP is underdiagnosed in our hospital. Due to high prevalence of pancreatic dysfunction among these patients, all of them should be derived to an specific Unit for diagnose and treatment. With the actual data, we do not find association between CP aetiology and Pancreatic Dysfunction.
P40. Do endoscopic ultrasound provides information in evaluating exocrine pancreatic insufficiency in chronic pancreatitis? ndez Cano 1, M.A. Romero Ordo lez Ba rcenas 1, R. n ~ ez 1, M. Gonza F.M. Ferna 1 1 1 Rivera Irigoin , M.C. Lopez Vega , J.M. Rosales Zabal , J.M. Navarro erez Aisa 1. Jarabo 1, F. Rivas Ruiz 2, A. P 1 Agencia Sanitaria Costa del Sol, Unidad de Aparato Digestivo, Marbella, Spain 2 n, Spain Agencia Sanitaria Costa del Sol, Unidad de Investigacio
P41. Idiopathic fibrosing pancreatitis S. Niky Mocanu, M. Rodriguez Blanco, J.A. Gonzalez Lopez, V. Artigas s, A. Farre Viladrich, F.J. Sancho Poch, M. Trias. Ravento Hepatobiliopancreatic and Oncological Unit, General and Digestive Surgery Department, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Spain Introduction: Idiopathic fibrosing pancreatitis (IFP), described by Comfort in 1946, is a rare entity, predominant in children and adolescents. It consists in a extensive fibrosis of the exocrine pancreas with relative sparing of Langerhans cells. The clinical picture is usually that of an obstructive jaundice. Its treatment is mainly conservative – based on corticosteroid therapy and biliary stens – but, in refractory cases, the surgery offers an adequate palliation by means of a bilioenteric anastomosis or, in few cases, a duodenopancreatic resection. Material and methods: 20-year old male patient admitted for obstructive jaundice. The ultrasonography showed a dilated extrahepatic biliary duct without evidence of cholelithiasis. Colecystectomy with intraoperative cholangiography was performed showing a irregular stenosis of the terminal choledocus. Results: Radiological, biochemical and immunological studies could not identify the cause of the process. Eventually, the patient underwent open surgical exploration with pancreatic biopsy and hepaticojejunostomy. The pathology report described a chronic inflammatory infiltrate with fibrosis and sparing of Langerhans islets. The clinical context and the pathologic findings led to the definitive diagnosis of IPF. Discussion: Although rare, IFP must be considered in the differential diagnosis of obstructive jaundice in young patients.
P42. Plasmocitary autoimmune cronic pancreatitis s, M. Rodriguez Blanco, A. Farr S. Mocanu, V. Artigas Ravento e Viladrich, F.J. Sancho Poch, J.A. Gonzalez, M. Trias. Surgical HBP-Oncologic Surgical General and Digestive, Digestive Patrhology and Patologic Departments, Hospital de la Santa Creu i Sant noma de Barcelona, Spain Pau, Universitat Auto Objects: The Autoimmune Pancreatitis (PAI) is a infrequent disease.The focal pancreatic presentation induced dificulty for diferencial diagnosis with pancreatic neoplasms. Material and methods: Three patients with a indolor obtructive icterice. The analitics and serologics controls, as well as radiologics (ECO/ TC/ColangioRMN) explorations was done. We considered the utility of surgical resection for definitive diagnosis.
Abstracts / Pancreatology 13 (2013) e1–e19
Results: Too patients was a cefalic pseudotumoral mass indistingible for pancreatic cancer. Definitive diagnosis after surgical resection was compatible with PAI. In the third case, the preoperatory explorations indicated a cronic pancreatitis, stenosis of terminal coledoc and retroperitoneal fibrosis. The study of citologic sample confirmed a mix-inflamatory infiltration. The obstructive icteric sindrom remised temporaly with corticoitherapy, The DPC was indicated for persisitent cefalic mass with suspitous pancreatic cancer. The definitive diagnosis was a PAI. Conclusions: The autoimmune pancreatitis (PAI) is manifested with obstructive icteric sindrom in 70% of cases. Diagnosis is based in clinical and serologic (Ig4)signs, radiologic imagins, and patologic results.The corticoitherapy response is another important clinical sign for PAI diagnosis. In the psedotumorals forms, surgical resection is a corrected actitude from diferential diagnosis with pancreatic cancer.
P43. Pancreatic exocrine insufficiency (PEI) and need for pancreatic enzyme replacement therapy (PERT) in patients with chronic pancreatitis (CP) is predicted by the degree of pancreatic fibrosis as measured by endoscopic ultrasound (EUS)-guided elastography
e17
Paraduodenal pancreatitis (PDP) comprises cystic dystrophy in heterotopic pancreas of duodenal wall (CDHP) and groove pancreatitis (GP), specific histopathological forms of chronic pancreatitis (CP). Objectives: To describe the prevalence of PPD and assess its clinical complications and therapeutic management. Material and methods: Retrospective study of 99 patients with CP followed in our center. Quantitative data are expressed as median (p25p75). Results: We diagnosed 17 PDP (9 CDHP and 10 GP, 2 with both). Median age at diagnosis of 46 years, 16 were male. The PC was calcifying in 14, eight had ductal alterations. All 17 had a history of alcohol consumption, 13 of them in etiological range. The 100% smoked or had smoked. 100% had pain at some time, with a median number of hospital admissions of 4 (3-5). Three patients had symptomatic duodenal stenosis and 4 biliary stricture. The treatment was surgical in 6 patients 1 for pain, 4 for pain associated with duodenal and/or biliary, stenosis 1 duodenal and biliary strictures. One Puestow operation was performed, 2 Whipple operations and 3 biliary bypass operations. Conclusions: The PDP appears in men with CP by alcohol and / or tobacco. The main symptom is pain. CDHP and GP have a similar prevalence. Surgical treatment it’s indicated in 30% of patients, when exists duodenal and/or biliary stenosis.
~ oz, M. Castin ~ eiras, M. Luaces, J. Larin ~ o-Noia, L. J.E. Domínguez-Mun Nieto, J. Iglesias-García. Department of Gastroenterology, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain Background: We hypothesized that the degree of fibrosis can predict the probability of PEI and the need for PERT in patients with CP. Fibrosis may be accurately quantified by EUS-guided elastography. Aim: To evaluate whether pancreatic elastography can be used to diagnose PEI in patients with CP. Methods: CP patients were included in this prospective study. Diagnosis of CP was based on EUS and/or MRCP findings. A 13C-MTG breath test was performed in all patients after the diagnosis of CP to detect PEI. EUSguided elastography was performed by the lineal Pentax EUS and HITACHIPREIRUS processor. Two different areas (A and B) were selected for elastographic evaluation: Area A is a representative area of the pancreatic parenchyma and B refers to a soft peripancreatic reference area. The quotient B/A (strain ratio –SR-) was considered as the elastographic result. Data are shown as mean and 95% CI and compared by Student-t test. The probability of PEI according to the SR was calculated. Results: 115 consecutive patients with CP (mean age 50.2 years, range 21-81 years, 92 male) were included. 35 patients (30.4%) suffered from PEI. Patients with PEI had a higher SR (4.89, 95%CI 4.36-5.41) than those with a normal breath test result (2.99, 95%CI 2.82-3.16) (p<0.001). A close relationship was found between the SR and the probability of PEI. Conclusion: The degree of pancreatic fibrosis as measured by EUSguided elastography allows quantifying the probability of PEI and the need for PERT in patients with CP.
P44. Paraduodenal pancreatitis E. Domenech Pina, E. De Madaria Pascual, M. Rey Riveiro, I. Lopez Font, P. Melgar Requena, L. Sempere Robles, Felix Lluis Casajuana. Hospital General Universitario Alicante, Spain
P45. Autoimmune pancreatitis in Barcelona as assessed by the international consensus diagnostic criteria (ICDC). Review of a series of 25 patients from two centers n Suero, E.C. Vaquero Raya, M.T. Salcedo Allende, M. Cuatrecasas H. De Leo s, A. Gin Freixas, X. Merino Casabiel, J.R. Ayuso Colella, S. Navarro Cola es ndez-Cruz P Gilbert, M. Abu-Suboh Abadia, J. Balsells Valls, L. Ferna erez, X. Molero Richard. gica, Cirurgia, Serveis de Gastroenterologia, Anatomia Patolo pia i Radiologia, Hospital Clínic i Hospital Universitari Vall Endosco d’Hebron, Barcelona, Spain Diagnosis of autoimmune pancreatitis (AIP) remains challenging. 2 AIP subtypes with clinical implications have been defined. Aim: To describe a series of 25 Spanish AIP patients. Methods: Imaging, histopathology and clinical features were reviewed according to the ICDC. Results: 23 males and 2 female (17-79 years) were studied (14 smokers, 5 alcohol abusers). 16 patients underwent pancreatectomy for suspected malignancy. 12 patients had type 1 and 10 type 2 AIP (3 undetermined). Type 1 patients were older (594 vs 354 years). Presentation was (%) epigastric pain(80), acute pancreatitis(52), weight loss(36), jaundice(36), GI bleeding(24), altered liver tests(68), leukocytosis(40), antinuclear antibodies >1/160(36), IgG4> 280 mg/dl(24). Other organs involved were gallbladder (44), bile duct (40), duodenum (24), colon(24), stomach(24), liver (20), and kidney(20). Common imaging findings were focal(62) and/or diffuse(25) pancreatic enlargement, multiple pancreatic duct stenosis, and bile duct stenosis. Six patients had splenic/portal vein thrombosis. Steroid therapy improved symptoms, IgG4 levels (523143 to 18116 mg/dl), extrapancreatic involvement and, occasionally, pancreatic function. Six type 1 AIP patients had (pre)malignant lesions. Conclusions: In this series, 70% AIPs have low IgG4 and 48% type 1 features. Diagnosis is often made after pancreatic resection.