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Splanchnic blood flow and vasoactive mediators in acute pancreatitis
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Electronic Poster Abstracts
EP02A-045 NEW SURGICAL TECHNIQUE IN THE MANAGEMENT OF CHRONIC CALCULOUS PANCREATITIS. SHAHID PROCEDURE P. D. M. S. Rahman Hepatobiliary and Pancreatic Surgery, Bangobandhu Sk.Mujib Medical University, Bangladesh Introduction: Chronic pancreatitis characterized by progressive fibrosis and loss of exocrine and en docrine function. Pain is prime symptoms that due to dilatation of main pancreatic duct & perineural inflammation. Pain is intractable. Treatment are non operative, surgery and endotherapy. New technique convenient, operative time, bleeding, morbidity less. No mortality. Included 59 cases from January 2008 to December 2012. Male more than female. Age from 17 yrs to 57 yrs. Materials and method: Pancreas prism shaped. New technique one anastomosis lateral pancreaticojejunostomy at anteroinferior surface. Single layer anastomosis between main pancreatic duct and proximal jejunal loop. Used 3e 0 silk, continuous suture from near tail to head. Pancreas identified after transverse colon, mesocolon is pulled upwards. Pancreas covered by peritoneum incised along the whole length from its head to tail without injuring blood vessel. The main pancreatic duct palpated, opened at anteroinferior surface.In dilated MPD with multiple stones it is easier to identified the duct. After removal of all stones the anastomosis is made between jejunum and opened MPD. The jejunal loop is selected about 5-6 cm away from the DJ flexure. This loop opened at its antimesenteric border. This opening is equal to the opening of MPD. Anastomosis at antero-inferior surface the dependent part. All secreations, liquid food easily gravitate down to jejunum avoiding second anastomosis. Results: Malignant lesion, pancreatic calcification not included. 5 yrs study 1e2% cases experience pain recurrence. Conclusion: Small number cases, single centre study. Multicentre study for establishment of the procedure.
EP02A-046 PREVALENCE RATE OF AUTOIMMUNE PANCREATITIS IN CHILDREN WITH CHRONIC PANCREATITIS J. Kierkus, J. Ryzko and G. Oracz Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, Poland The etiology of chronic pancreatitis in children is varied. The reported paediatric experience with chronic pancreatitis (CP) is small and little is known about the role of autoimmune pancreatitis (AIP). The aim of the study was to assess the frequency of autoimmune markers in children with CP. Patients and methods: 156 children with CP hospitalized between 2005 and 2015 were examined for the presence of AIP; the level of IgG4 was determined, and the tests for anti-tissue antibodies were conducted. AIP was diagnosed
according to the IAP guidelines, i.e. on the basis of immunological criteria, radiological criteria and response to corticosteroid therapy. Clinical data were recorded and analyzed. Results: Anti-tissue antibodies were detected in 95/156 children (60.1%), and 34/92 patients (36.9%) showed an increased IgG4 level. Based on the IAP criteria, a suspicion of AIP was raised in 10 patients. This diagnosis was definitely confirmed in 6 cases, based on clinical improvement observed after corticosteroid therapy. Due to the inactive phase of the disease, the immunosuppressive therapy was not implemented in the remaining suspected patients. In 47/ 95 (49.5%) patients with autoimmune markers we found gene mutations predisposing to CP. In 18/95 children (18.9%) anatomic anomalies were fund. There was no difference in the severity of the disease and clinical course between children with autoimmune stigmata and patients without autoimmune markers. Conclusions: In children with CP, similarly to adults, there is a high frequency of biochemical markers of autoimmunity. AIP can be the cause of CP in children.
EP02A-047 SPLANCHNIC BLOOD FLOW AND VASOACTIVE MEDIATORS IN ACUTE PANCREATITIS S. Chooklin, O. Usach and I. Osmilovsla Regional Clinical Hospital, Ukraine Introduction: Changes of microcirculation and endothelial dysfunction are an important step from mild to severe disease. Changes in splanchnic arteries in acute necrotizing pancreatitis are the consequence of the release of vasoactive mediators. Materials and methods: The study involved 53 acute pancreatitis patients (28 e severe, 25 e mild). We measured interleukin-6, C3a and endothelin-1 in the blood plasma. Flow in the visceral arteries was assessed with the help of the Doppler sonography. Results: Mild acute pancreatitis often not accompanied by hemodynamic disorders according to Doppler ultrasound during the first week of illness. Pancreatic necrosis is noted a steady increase in peak systolic blood flow velocity and resistance index in the common hepatic, splenic and superior mesenteric arteries during the first week. In patients with acute pancreatitis on admission identified increase the levels endothelin-1 and C3a. A significant increase of both substances determined only in severe acute pancreatitis. The IL-6 levels were increased in all patients. There was a significant direct correlation concentration of IL-6 with peak systolic velocity in the superior mesenteric artery, with an index of resistance in common hepatic and superior mesenteric arteries. There was a significant direct correlation concentrations of C3a with peak systolic in the common hepatic and splenic arteries, with an index of resistance in superior mesenteric artery. Conclusion: Changes in the quantitative and qualitative detection of Doppler spectrum are ahead echographic signs of necrotizing forms of pancreatitis in B-mode ultrasound. IL-6, endothelin-1, and C3a levels of correlates with disturbances in splanchnic blood flow.
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
EP02A-045 NEW SURGICAL TECHNIQUE IN THE MANAGEMENT OF CHRONIC CALCULOUS PANCREATITIS. SHAHID PROCEDURE P. D. M. S. Rahman Hepatobiliary and Pancreatic Surgery, Bangobandhu Sk.Mujib Medical University, Bangladesh Introduction: Chronic pancreatitis characterized by progressive fibrosis and loss of exocrine and en docrine function. Pain is prime symptoms that due to dilatation of main pancreatic duct & perineural inflammation. Pain is intractable. Treatment are non operative, surgery and endotherapy. New technique convenient, operative time, bleeding, morbidity less. No mortality. Included 59 cases from January 2008 to December 2012. Male more than female. Age from 17 yrs to 57 yrs. Materials and method: Pancreas prism shaped. New technique one anastomosis lateral pancreaticojejunostomy at anteroinferior surface. Single layer anastomosis between main pancreatic duct and proximal jejunal loop. Used 3e 0 silk, continuous suture from near tail to head. Pancreas identified after transverse colon, mesocolon is pulled upwards. Pancreas covered by peritoneum incised along the whole length from its head to tail without injuring blood vessel. The main pancreatic duct palpated, opened at anteroinferior surface.In dilated MPD with multiple stones it is easier to identified the duct. After removal of all stones the anastomosis is made between jejunum and opened MPD. The jejunal loop is selected about 5-6 cm away from the DJ flexure. This loop opened at its antimesenteric border. This opening is equal to the opening of MPD. Anastomosis at antero-inferior surface the dependent part. All secreations, liquid food easily gravitate down to jejunum avoiding second anastomosis. Results: Malignant lesion, pancreatic calcification not included. 5 yrs study 1e2% cases experience pain recurrence. Conclusion: Small number cases, single centre study. Multicentre study for establishment of the procedure.
EP02A-046 PREVALENCE RATE OF AUTOIMMUNE PANCREATITIS IN CHILDREN WITH CHRONIC PANCREATITIS J. Kierkus, J. Ryzko and G. Oracz Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, Poland The etiology of chronic pancreatitis in children is varied. The reported paediatric experience with chronic pancreatitis (CP) is small and little is known about the role of autoimmune pancreatitis (AIP). The aim of the study was to assess the frequency of autoimmune markers in children with CP. Patients and methods: 156 children with CP hospitalized between 2005 and 2015 were examined for the presence of AIP; the level of IgG4 was determined, and the tests for anti-tissue antibodies were conducted. AIP was diagnosed
according to the IAP guidelines, i.e. on the basis of immunological criteria, radiological criteria and response to corticosteroid therapy. Clinical data were recorded and analyzed. Results: Anti-tissue antibodies were detected in 95/156 children (60.1%), and 34/92 patients (36.9%) showed an increased IgG4 level. Based on the IAP criteria, a suspicion of AIP was raised in 10 patients. This diagnosis was definitely confirmed in 6 cases, based on clinical improvement observed after corticosteroid therapy. Due to the inactive phase of the disease, the immunosuppressive therapy was not implemented in the remaining suspected patients. In 47/ 95 (49.5%) patients with autoimmune markers we found gene mutations predisposing to CP. In 18/95 children (18.9%) anatomic anomalies were fund. There was no difference in the severity of the disease and clinical course between children with autoimmune stigmata and patients without autoimmune markers. Conclusions: In children with CP, similarly to adults, there is a high frequency of biochemical markers of autoimmunity. AIP can be the cause of CP in children.
EP02A-047 SPLANCHNIC BLOOD FLOW AND VASOACTIVE MEDIATORS IN ACUTE PANCREATITIS S. Chooklin, O. Usach and I. Osmilovsla Regional Clinical Hospital, Ukraine Introduction: Changes of microcirculation and endothelial dysfunction are an important step from mild to severe disease. Changes in splanchnic arteries in acute necrotizing pancreatitis are the consequence of the release of vasoactive mediators. Materials and methods: The study involved 53 acute pancreatitis patients (28 e severe, 25 e mild). We measured interleukin-6, C3a and endothelin-1 in the blood plasma. Flow in the visceral arteries was assessed with the help of the Doppler sonography. Results: Mild acute pancreatitis often not accompanied by hemodynamic disorders according to Doppler ultrasound during the first week of illness. Pancreatic necrosis is noted a steady increase in peak systolic blood flow velocity and resistance index in the common hepatic, splenic and superior mesenteric arteries during the first week. In patients with acute pancreatitis on admission identified increase the levels endothelin-1 and C3a. A significant increase of both substances determined only in severe acute pancreatitis. The IL-6 levels were increased in all patients. There was a significant direct correlation concentration of IL-6 with peak systolic velocity in the superior mesenteric artery, with an index of resistance in common hepatic and superior mesenteric arteries. There was a significant direct correlation concentrations of C3a with peak systolic in the common hepatic and splenic arteries, with an index of resistance in superior mesenteric artery. Conclusion: Changes in the quantitative and qualitative detection of Doppler spectrum are ahead echographic signs of necrotizing forms of pancreatitis in B-mode ultrasound. IL-6, endothelin-1, and C3a levels of correlates with disturbances in splanchnic blood flow.
HPB 2016, 18 (S1), e1ee384