Sa1305 Visceral Obesity As a Risk Factor for Gallbladder Polyp: A Cross-Sectional, Case - Control Study

cholangiography (MRCP) for suspicion of pCBDS without pancreatitis in our institution between January 2008 and June 2011. Persistent CBDS was diagnosed if confirmed at ERCP, EUS or MRCP. Bilirubin, AST, ALT, alkaline phosphatase (ALP) and GGT done during the 48h preceding the test were collected. Blood samples done at 6:00 am (±6h) 2 days before, 1 day before and the day of ERCP/EUS/MRCP were identified respectively as D-2, D-1 and D0. The area under the ROC curves (AUC) was used to compare diagnostic accuracy in pCBDS and to determine best cut-off values. Sensitivities (Ss) and specificities (Sp) were calculated at cut-off points. Results: Three hundred patients were included, among which 159 had pCBDS and 81 had cholangitis (59 with pCBDS). Median bilirubin was significantly higher in patients with than without pCBDS at D-2 (32 vs 17mmol/L; p ,0.01), D-1 (33 vs 16mmol/L; p,0.01) and D0 (41 vs 16mmol/L; p ,0.01). Median ALP was significantly higher in patients with pCBDS at D0 (215 vs 169UI/L; p ,0.01). Median ALP at another time and median of other LFTs at any time were not significantly different. Best cut-off values to predict pCBDS for bilirubin at D-2, D-1 and D0 were 33mmol/L (Ss 50%; Sp 80%; AUC 0.69), 36mmol/L (Ss 48%; Sp 81%; AUC 0.69) and 27mmol/L (Ss 63%; Sp 74%; AUC 0.73). Best cut-off value for ALP at D0 was 159UI/L (Ss 74%; Sp 47%; AUC 0.62). Regarding variation of LFTs, only evolution of bilirubin over 48h was significantly different between patients with and without pCBDS (p=0.01). An increase of 25% over 48h was the best cut-off value to predict pCBDS (Ss 32%; Sp 81%; AUC 0.56). When combining bilirubin level at D0 (.27mmol/L) and increase of bilirubin over 48h ( .25%), Ss and Sp were 30% and 89% if both criterions were present, and 68% and 65% if only one criterion was present. Conclusion: This is the first study that compares LFTs as predictors of pCBDS according to time. Over 48h, only bilirubin at D-2, D-1, D0 and AP at D0 can predict pCBDS. Regarding variation of LFTs, only evolution of bilirubin over 48h has a predictive value. Combining variation of bilirubin with statics levels may improve prediction. These observations should be considered in the interpretation of LFTs for suspected pCBDS.

Sa1306

Introduction: Pregnancy and the postpartum period are risk factors for gallstone disease. Due to a desire to avoid potential fetal harm, management of gallstone disease and its complications varies during pregnancy. We sought to examine the antepartum interventions and postpartum outcomes in women with complicated gallstone disease (CGD) Methods: We retrospectively analyzed all patients who sought medical care for suspected CGD during pregnancy at a large academic tertiary care institution over a 10-year period (2002-12). Patients were identified by querying an electronic data repository for relevant clinical diagnoses, imaging, and procedure codes. Patients with prior cholecystectomy were excluded. CGD was defined as cholecystitis, choledocholithiasis, or gallstone pancreatitis and a diagnosis was made by a composite of laboratory testing and manual chart review. An attempt was made to contact all patients via a standardized telephone survey to supplement chart review and account for outside institution hospitalizations. Results: A total of 56 patients with CGD comprised the study population. Choledocholithiasis was the most common diagnosis (n=30) followed by gallstone pancreatitis (n=19) and cholecystitis (n=7). Mean patient age was 27.2y; the majority of patients presented in the second (42.9%) or third (37.5%) trimester (Table 1). Mean total hospitalization days during pregnancy was 3.4d (Range 117d) and 17 patients (30.3%) had multiple antepartum hospitalizations for gallstone disease. ERCP was performed in 30 patients (53.6%). Ten patients (17.9%) underwent antepartum cholecystectomy, all in the first or second trimester. Postpartum cholecystectomy was recommended in 46 patients, 17 of whom (37%) did not follow up (non-adherence to recommended follow-up) and could not be contacted by telephone. Of the remaining 29 patients, 17 (58.6%) had recurrent symptoms or were hospitalized with gallstone disease postpartum, the majority (88.2%) within 3 months of delivery (Table 2). Fourteen patients underwent cholecystectomy after symptom recurrence postpartum; 9 patients (31%) underwent cholecystectomy prior to symptoms. Six patients did not undergo cholecystectomy (3 with symptom recurrence and 3 without). Antepartum ERCP with biliary sphincterotomy appeared to be protective with a trend towards decreased occurrence of postpartum symptoms (29.4% vs. 58.3%, P=0.2). Conclusions: Patients with CGD who do not undergo antepartum cholecystectomy are at significant risk for recurrent symptoms and hospital admission within 3 months of delivery. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations in the postpartum period. Table 1. Patients with antepartum cholecystectomy vs. recommended postpartum cholecystectomy for complicated gallstone disease

Sa1304 The Risk Factors of Steatocholecystitis Compared With Acute Calculous Cholecystitis Jin Ok Kim, Ho Soon Choi, Hye Jin Tae, Kang Nyeong Lee, Dae Won Jun, Hang Lak Lee, Oh Young Lee, Byung Chul Yoon, Joon Soo Hahm, Kyo-Sang Yoo Background/Aims: Cholescystectomy rate is increasing in patients with steatocholecystitis, which is characterized by fatty infiltration of the gallbladder wall. The purpose of the study was to investigate risk factors of steatocholecystitis compared to acute acalculous cholecystitis. Methods: Total of 84 patients was shown to have subserosal fat accumulation of gallbladder wall by endoscopic ultrasonography (EUS) from December 2005 to June 2012. Forty four of them were diagnosed as steatocholecystitis and underwent cholecystectomy. Age and sexmatched 44 patients with acute calculous cholecystitis were selected as control. Clinical variables associated with obesity were reviewed by medical records. The thickness of total gallbladder wall and subserosal fat accumulation was measured by EUS. For understanding the relationship between steatocholecystitis and adipokines, we also examined the expression and location of the gallbladder wall tissues of steatocholecystitis patients using immunohistochemical stains for adiponectin receptor 1 and leptin. Results: Univariate analysis showed significant differences between the steatocholecystitis group and acute calculous cholecystitis group in body mass index (25.50±3.20 vs 23.48±2.51 kg/m2, p=0.02), low-density lipoprotein (LDL) (103.54±39.05 vs 79.80±36.70, p=0.027), hypertension (19 vs 7, p = 0.005) , and the thickness of gallbladder wall (6.26 ± 1.73 vs 5.00 ± 1.43 mm, p ,0.001). Only BMI were positively correlated with steatocholecystitis by multivariate logistic regression analysis (OR (95% CI) =1.535 (1.106 - 2.131), p=0.01). In the steatocholecystitis group, adiponectin receptor 1 and leptin expressions in epithelial cells of the gallbladder were observed in 53.6% (22/41) and 56% (23/41), respectively. Patients with both increased strength of leptin and decreased strength of adiponectin receptor 1 were 9 (9/41, 21.9%). Conclusions: BMI was a potent risk factor for steatocholecystitis compared with acute calculous cholecystitis. Our study indicates that obesity is closely related to steatocholecystitis. Sa1305

Table 2. Comparison of patients with and without postpartum symptoms (n=29)

Visceral Obesity As a Risk Factor for Gallbladder Polyp: A Cross-Sectional, Case - Control Study Hyoun Woo Kang, Jae Hak Kim, Jun Kyu Lee, Yun Jeong Lim, Moon-Soo Koh, Jin Ho Lee Background/Aims: Gallbladder polyp (GBP) is known to be associated with obesity, but the association between GBP and adipose tissue (AT) area measured by abdominal computed tomography (CT) has not been studied extensively yet. The aim of this study was to evaluate the relevance between AT area and GBP occurence. Methods: From Jan 2006 to Dec 2011, a total of 1,621 patients, who underwent abdominal ultrasonography and abdominal CT at the same time for the health screening checkups, were included in this study. Six patients were excluded due to previous cholecystectomy. Ninety-three patients with GBP incidentally found on the USG and 186 age- and sex-matched subjects were enrolled. And we analyzed the medical chart, laboratory test, abdominal CT, and abdominal ultrasonography. Total adipose tissue (TAT), and visceral adipose tissue (VAT) were evaluated by univariate and multivariate logistic regression analyses to determine adipose tissue as a potential risk factor for GBP. Results: According to univariate analysis, the prevalences of hypertension and hepatitis B carrier, body mass index, total cholesterol, TAT and VAT areas were significantly were higher in the GBP group than in the normal control group. According to the multivariate analysis adjusted for multiple confounders, TAT, and VAT were independently associated with the risk of GBP (TAT; odds ratio (OR) = 3.701, 95 % confidence interval (CI): 1.6878.118 highest quartile vs. lowest quartile, VAT; OR=3.701, 95 % CI: 1.687-8.118 highest quartile vs. lowest quartile). Conclusions: VAT was significantly higher in GBP patients and may be an important risk factor for GBP.

Sa1307 New Technique of Endoscopic Sphincterotomy With Iso-Tome® to Incise Completely Distal Papillary Roof in Patients With Choledocholithiasis and With Spontaneous or Artificial(Fistulotomy) Choledochoduodenal Fistula on the Ampulla of Vater Young Sin Cho, Sang-Heum Park, Tae Hoon Lee, Hyun Jong Choi, Sang-Woo Cha, Jong Ho Moon, Young Deok Cho, Sun-Joo Kim ABSTRACT Background/Aims: It is sometimes problematic to incise completely distal papillary roof(PR) in patients with choledocholithiasis and with spontaneous or artificial(fistulotomy) choledochoduodenal fistula(CDF) on the ampulla of Vater(AV). An isolated-tip needleknife papillotome(Iso-Tome®) which is helpful in preventing electric leakage from the tip

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AGA Abstracts

AGA Abstracts

Postpartum Cholecystectomy Recommendation for Complicated Gallstone Disease Is Associated With Early Postpartum Symptom Recurrence Annapoorani Veerappan, Andrew J. Gawron, Rajesh N. Keswani