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Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients
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Electronic Poster Abstracts
performed after several months. In 4, drainage of peripancreatic collections was alone performed and surgery deferred. In 41 cases Frey procedure was performed. There was no mortality. Complications occurred in 19 patients. Univariate analysis showed that peripancreatic necrotic material, raised C Reactive Protein over 40 and systemic sepsis predisposed to postoperative complications. In multivariate analysis, CRP over 40 correlated with complications. Hospital stay and ICU stay were prolonged in Group 1. Conclusion: Definitive surgery can be performed safely in patients with chronic pancreatitis during the acute episode. Patients with sepsis, pancreatic necrosis and high CRP over 40 may benefit from conservative approach.
EP02A-004 PREGABALIN AND PLACEBO RESPONDERS SHOW DIFFERENT EFFECTS ON CENTRAL PAIN PROCESSING IN CHRONIC PANCREATITIS PATIENTS S. Bouwense1, S. Olesen2, A. Drewes2, H. van Goor1 and O. Wilder-Smith1 1 Radboudumc, Netherlands, and 2Aalborg University Hospital, Denmark Background: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. The study aims to investigate differences in pain sensitivity and modulation in chronic pancreatitis among responders and non-responders to placebo or pregabalin treatment. Methods: This study was part of a randomized, doubleblind, placebo-controlled trial evaluating analgesic effects of pregabalin and placebo in chronic pancreatitis. Post hoc, patients were assigned to one of four groups, ie responders and non-responders to pregabalin (n = 16; n = 15) or placebo (n = 12; n = 17) treatment. Responders were defined as >30% pain reduction after three weeks’ treatment. We measured change in pain sensitivity before and after treatment, using electric pain detection thresholds (ePDT) in dermatomes C5 (generalised effects) and ventral T10 (segmental effects). Descending endogenous pain modulation was quantified via conditioned pain modulation (CPM) paradigm. Results: Sixty patients were analysed in a per protocol analysis. ePDT change in C5 was significant vs baseline and greater in pregabalin (1.3 mA) vs placebo responders ( 0.1 mA; p = 0.015). This was not so for ePDT in ventral T10. CPM increased more in pregabalin (3%) vs placebo responders ( 17%; p < 0.001). CPM changed significantly vs baseline only for pregabalin responders. Conclusions: This hypothesis generating study provides first evidence that pain relief with pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation. No such effects were observed in patients experiencing pain relief with placebo treatment. The mechanisms underlying analgesic response to placebo vs drug treatments are different and, together with their interactions, deserve further study.
EP02A-005 THE VALUE OF CT-BASED BODY COMPOSITION ANALYSES IN PATIENTS WITH NECROTIZING PANCREATITIS J. van Grinsven1,2, J. L. A. van Vugt2,3, A. Gharbaharan3, T. L. Bollen4, M. G. H. Besselink1, H. C. van Santvoort2, C. H. J. van Eijck3, D. Boerma2 and Dutch Pancreatitis Study Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, St. Antonius Hospital, 3Surgery, Erasmus University Medical Center, and 4Radiology, St. Antonius Hospital, Netherlands Introduction: Necrotizing pancreatitis (NP) is associated with high mortality and morbidity rates. Identification of patients at risk for a complicated course could improve outcome. Low muscle mass and -density and visceral obesity are predictors for impaired outcome in various other diseases. We aimed to investigate the association between body composition and outcome in patients with NP. Methods: A post-hoc analysis was performed in a prospective cohort of 639 patients with NP. Skeletal muscle mass (cross-sectional muscle area [CSA] corrected for patients’ height [L3-index]), skeletal muscle density (SMD), and visceral fat (VF) were measured at the L3 vertebra level on baseline CT-scans and one month (15 days) hereafter. Multivariable analyses were performed to identify predictors for mortality and severe complications. Results: Baseline CT-scans were available in 574 patients (62.5% males, median age 58), follow-up CT-scans in 232 patients. Overall mortality rate was 14.3%. (Low) L3index, (low) SMD, and (high) VF did not predict mortality. Low baseline SMD was independently associated with severe complications (OR 2.37 [95%-CI 1.53e3.69], p < 0.001). CSA and L3-index significantly decreased between baseline and one month (p < 0.001). Mortality rate was significantly higher in patients with 25% compared with <25% CSA decrease (30.8% (8/26 patients) versus 11.2% (23/206 patients), p = 0.011). CSA decrease 25% was independently associated with mortality (OR 3.54, 95%-CI [1.38e9.04], p = 0.008). Conclusions: Early CT-based body composition analysis in patients with NP has little prognostic value, although low SMD is associated with severe complications. CSA decrease 25% within one month identifies patients with higher mortality.
EP02A-006 TRANSGASTRIC NECROSECTOMY: LONG-TERM FOLLOW UP IS IMPERATIVE A. Jester, M. House, A. Nakeeb, C. M. Schmidt, E. Ceppa and N. Zyromski Surgery, Indiana University School of Medicine, United States Introduction: Surgical transgastric necrosectomy with cyst-gastrostomy (TGN) has emerged as an attractive treatment for select patients with walled-off pancreatic necrosis (WON). However, few data documenting long-
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
performed after several months. In 4, drainage of peripancreatic collections was alone performed and surgery deferred. In 41 cases Frey procedure was performed. There was no mortality. Complications occurred in 19 patients. Univariate analysis showed that peripancreatic necrotic material, raised C Reactive Protein over 40 and systemic sepsis predisposed to postoperative complications. In multivariate analysis, CRP over 40 correlated with complications. Hospital stay and ICU stay were prolonged in Group 1. Conclusion: Definitive surgery can be performed safely in patients with chronic pancreatitis during the acute episode. Patients with sepsis, pancreatic necrosis and high CRP over 40 may benefit from conservative approach.
EP02A-004 PREGABALIN AND PLACEBO RESPONDERS SHOW DIFFERENT EFFECTS ON CENTRAL PAIN PROCESSING IN CHRONIC PANCREATITIS PATIENTS S. Bouwense1, S. Olesen2, A. Drewes2, H. van Goor1 and O. Wilder-Smith1 1 Radboudumc, Netherlands, and 2Aalborg University Hospital, Denmark Background: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. The study aims to investigate differences in pain sensitivity and modulation in chronic pancreatitis among responders and non-responders to placebo or pregabalin treatment. Methods: This study was part of a randomized, doubleblind, placebo-controlled trial evaluating analgesic effects of pregabalin and placebo in chronic pancreatitis. Post hoc, patients were assigned to one of four groups, ie responders and non-responders to pregabalin (n = 16; n = 15) or placebo (n = 12; n = 17) treatment. Responders were defined as >30% pain reduction after three weeks’ treatment. We measured change in pain sensitivity before and after treatment, using electric pain detection thresholds (ePDT) in dermatomes C5 (generalised effects) and ventral T10 (segmental effects). Descending endogenous pain modulation was quantified via conditioned pain modulation (CPM) paradigm. Results: Sixty patients were analysed in a per protocol analysis. ePDT change in C5 was significant vs baseline and greater in pregabalin (1.3 mA) vs placebo responders ( 0.1 mA; p = 0.015). This was not so for ePDT in ventral T10. CPM increased more in pregabalin (3%) vs placebo responders ( 17%; p < 0.001). CPM changed significantly vs baseline only for pregabalin responders. Conclusions: This hypothesis generating study provides first evidence that pain relief with pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation. No such effects were observed in patients experiencing pain relief with placebo treatment. The mechanisms underlying analgesic response to placebo vs drug treatments are different and, together with their interactions, deserve further study.
EP02A-005 THE VALUE OF CT-BASED BODY COMPOSITION ANALYSES IN PATIENTS WITH NECROTIZING PANCREATITIS J. van Grinsven1,2, J. L. A. van Vugt2,3, A. Gharbaharan3, T. L. Bollen4, M. G. H. Besselink1, H. C. van Santvoort2, C. H. J. van Eijck3, D. Boerma2 and Dutch Pancreatitis Study Group 1 Surgery, Academic Medical Center Amsterdam, 2Surgery, St. Antonius Hospital, 3Surgery, Erasmus University Medical Center, and 4Radiology, St. Antonius Hospital, Netherlands Introduction: Necrotizing pancreatitis (NP) is associated with high mortality and morbidity rates. Identification of patients at risk for a complicated course could improve outcome. Low muscle mass and -density and visceral obesity are predictors for impaired outcome in various other diseases. We aimed to investigate the association between body composition and outcome in patients with NP. Methods: A post-hoc analysis was performed in a prospective cohort of 639 patients with NP. Skeletal muscle mass (cross-sectional muscle area [CSA] corrected for patients’ height [L3-index]), skeletal muscle density (SMD), and visceral fat (VF) were measured at the L3 vertebra level on baseline CT-scans and one month (15 days) hereafter. Multivariable analyses were performed to identify predictors for mortality and severe complications. Results: Baseline CT-scans were available in 574 patients (62.5% males, median age 58), follow-up CT-scans in 232 patients. Overall mortality rate was 14.3%. (Low) L3index, (low) SMD, and (high) VF did not predict mortality. Low baseline SMD was independently associated with severe complications (OR 2.37 [95%-CI 1.53e3.69], p < 0.001). CSA and L3-index significantly decreased between baseline and one month (p < 0.001). Mortality rate was significantly higher in patients with 25% compared with <25% CSA decrease (30.8% (8/26 patients) versus 11.2% (23/206 patients), p = 0.011). CSA decrease 25% was independently associated with mortality (OR 3.54, 95%-CI [1.38e9.04], p = 0.008). Conclusions: Early CT-based body composition analysis in patients with NP has little prognostic value, although low SMD is associated with severe complications. CSA decrease 25% within one month identifies patients with higher mortality.
EP02A-006 TRANSGASTRIC NECROSECTOMY: LONG-TERM FOLLOW UP IS IMPERATIVE A. Jester, M. House, A. Nakeeb, C. M. Schmidt, E. Ceppa and N. Zyromski Surgery, Indiana University School of Medicine, United States Introduction: Surgical transgastric necrosectomy with cyst-gastrostomy (TGN) has emerged as an attractive treatment for select patients with walled-off pancreatic necrosis (WON). However, few data documenting long-
HPB 2016, 18 (S1), e1ee384