Su1144 Conventional Y Stent Versus Niti-S Large Cell D-Type (LCD) Stent in Bilateral Stent Placement for Advanced Hilar Malignancy

AGA Abstracts

evidence-based consensus statements for the diagnosis of biliary strictures. Methods: Initial statements on the use of CLE for the characterization of indeterminate biliary strictures were developed by a single CLE expert based on the available clinical evidence. Those preliminary statements were edited and submitted by an external group of 16 GI physicians using a modified Delphi approach. After two rounds of votes based on relevant data, quality of the evidence and strength of recommendation, statements were validated if the threshold of agreement was higher than 75%. Results: Out of 9 proposed statements, 7 were validated and 3 rejected.CLE can be used to evaluate biliary strictures, and the probe can be delivered via a catheter or a cholangioscope. CLE is more accurate than ERCP with brush cytology and/or forceps biopsy in determining malignant or benign strictures, using established criteria. The accuracy of CLE in indeterminate biliary strictures may be decreased by prior presence of plastic stent. The Negative Predictive Value (NPV) of CLE is very high. The use of CLE can assist clinical decision-making such as excluding malignancy. CLE should be cited as a valuable tool for an increased diagnostic yield in official guidelines. The «black bands» that can be seen in pCLE images have been shown to be collagen fibrils that predictably increase in pathologic tissue. Conclusion: According to the panel of 16 physicians, given its very high accuracy, Confocal Laser Endomicroscopy has the potential to improve the current diagnostic algorithm of biliary strictures. At centers where expertise is available, Confocal Laser Endomicroscopy used during ERCP in the evaluation of biliary strictures should be considered as a standard practice complementary to conventional tissue sampling.

only represents one year of ERCP volume at our centre, expanding the study to previous years may provide further insight towards the impact of ERCP volume on patient outcomes. Su1146 Comparative Analysis Between Early and Delayed Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage Jong-Yul Lee, In Seok Lee, Chul-Hyun Lim, Jin Su Kim, Jae Myung Park, Sang Woo Kim, Myung-Gyu Choi Background/Aims: Percutaneous transhepatic gallbladder drainage (PTGBD) is an effective procedure to resolve acute cholecystitis (AC) before laparoscopic cholecystectomy (LC). Although clinical manifestations related to AC were resolved in a few days after PTGBD, early LC after PTGBD was considered not applicable for patients with critical illness. The aim of this study is to elucidate whether early LC after PTGBD could be comparable to delayed LC after PTGBD in patients with acute cholecystitis. Methods: A retrospective analysis was carried out of patients who underwent LC after PTGBD for acute cholecystitis between January 2009 to June 2013. Patients were divided into two groups on the basis of a cutoff of 1 week (early vs. delayed LC group). And these patients were compared with 50 ageand sex-matched control subjects who underwent LC without PTGBD. Results: LC was performed after PTGBD in 134 patients during the study period. Based on the 1 week cutoff, there were 48 patients in the early LC group and 86 in the delayed LC group. Compared to control subjects, patients underwent LC after PTGBD had more complicated cholecystits and comorbid disease. But there was no difference between early and delayed LC group in terms of severity, ASA class, or combined morbidities. There were no significant differences between early and delayed LC group with respect to operation time (70.9 vs. 63.8 min, p= 0.226), postoperative hospital stay (3.6 vs. 5.3 days, p=0.265), open conversion rate (4.2 vs. 4.7 %, p=1.000), and complication rate (6.3 vs. 10.5 %, p=0.537). Conclusion Early surgery after PTGBD does not influence surgery time, postoperative hospital stay, rate of conversion to an open laparotomy, and complication. Early laparoscopic cholecystectomy after PTGBD is also feasible and safe.

Su1144 Conventional Y Stent Versus Niti-S Large Cell D-Type (LCD) Stent in Bilateral Stent Placement for Advanced Hilar Malignancy Sung Ill Jang, Hong Kyu Choi, Hae Won Kim, Yong Hoon Kim, Jeong-Sik Yu, Jin-hyeok Hwang, DongKi Lee Introduction: Endoscopic bilateral drainage for advanced hilar malignancy using metal stents is considered difficult. Various types of self-expandable metallic stents (SEMSs) are available. Niti-S large cell D-type(LCD) biliary stent is uniform, large cell(7mm) stent with thick nitinol wire(0.178mm). The purpose of this study is to compare conventional Y with Niti-S large cell D-type(LCD) stent in bilateral stent placement for malignant hilar biliary obstruction. Methods: This is a prospective study of 69 patients with inoperable advanced hilar tumor. We categorized our patients into 2 groups as follows: Group I = patients with conventional bilateral Y-stenting (n=55), Group II = patients with bilateral newly designed Niti-S large cell D-type(LCD) stenting(n=14). The main outcome measurements were technical and functional success, complications, stent patency, revision efficacy, procedure time. Results: The technical success rates of two groups were 65.5%(36/55) for conventional Y and 78.6%(11/14) for LCD. The functional success rates were 86.1%(31/36) for conventional Y and 90.9%(10/11) for LCD. Complications were observed in six of the 36(19.4%) for conventional Y and zero of 11(0%) for LCD. Stent occlusion occurred in 14 of the 36(38.9%) for conventional Y and in 4 of the 11(36.4%) for LCD. Stent patency time was 203 days for conventional Y and 168 days for LCD. Reintervention was performed: plastic stent(3/ 14), percutaneous transhepatic biliary drainage(7/14), metal stent(4/14) in conventional Y and metal stent(4/4) in LCD. Procedure time was 42.68 minutes for conventional Y and 27.82 minutes for LCD.(p<0.05) Conclusions: LCD stent is equally effective as conventional Y stent in terms of technical and functional success rates, complications, and stent patency, revision efficacy, moreover it has no procedure related complication and decreases procedure time significantly compared to conventional Y stent.

Su1147 Trends in Chronic Pancreatitis Related Hospitalizations, Cost, and Mortality: Year 2002-2010 Nikhil Shastri, Raxitkumar Jinjuvadia, Suthat Liangpunsakul, Faisal Q. Khan, Vinay K. Katukuri, Robert L. Pompa, Cyrus R. Piraka Background: Patients with chronic pancreatitis (CP) have been shown to have a significant deterioration in their health related quality of life. What is unclear is the mortality and financial burden associated with CP. The aim of this study is to evaluate temporal trend of hospitalizations from chronic pancreatitis and evaluate its financial impact. Methods: The National Inpatient Sample (NIS) databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized for this study. The NIS is the largest all payer inpatient care database containing around 5 to 8 million hospitalizations from around 1000 hospitals in the United States. Individuals with age ≥ 18 years were included in this study. The hospitalizations with a primary or secondary diagnosis of CP were captured by ICD-9 code (577.1). The national estimates of hospitalization were derived using sample weights provided by NIS. The change in total average charges per each hospitalization over the years was calculated after taking inflation into account using the Bureau of Labor Statistics Consumer Price Index (CPI) inflation calculator. SAS 9.3 was utilized for the statistical analysis. Results: Hospitalization with a primary diagnosis of CP has decreased significantly from 24,701 in year 2002 to 19,809 in year 2010, while hospitalization with a secondary diagnosis has increased from 65,987 in 2002 to 143,691 in 2010. A majority of the CP related hospitalizations were in a white male population (male: 54% ± 0.54, white: 60% ± 0.86). Acute pancreatitis was found to be the most common admitting diagnosis for individuals hospitalized with a secondary diagnosis of CP (28.8% in 2002 and 30% in 2010). There was a statistically significant decrease in length of stay for hospitalization (6.26 days in 2002 to 5.96 days in 2010, p<0.001) however; there was not a significant decrease of inpatient mortality in patients with CP 2002 (1.38%) to 2010 (1.53%). There was a significant increase in the additional cost of each hospitalization with CP of 63.6% in 2010 compared to 2002 after adjusting for inflation (additional cost per hospitalization $11,682 in 2010 compared to 2002). Medicare was found to be the most common expected primary payer for these CP hospitalizations (~33%). Conclusion: Hospitalizations for a primary diagnosis of chronic pancreatitis is decreasing; however the overall hospitalization of patients with a diagnosis of chronic pancreatitis, including acute on chronic pancreatitis is on the rise. Despite a statistically significant decrease in length of stay, the increase in financial burden related to chronic pancreatitis is concerning.

Su1145 The Impact of Endoscopist Case Volume on ERCP Outcomes: Experience At a Canadian Tertiary Centre Richa Chibbar, Pernilla D'Souza, Gurpal Sandha, Sergio Zepeda-Gomez, Sander Veldhuyzen van Zanten, Christopher W. Teshima, Richard A. Sultanian Background ERCP is associated with a significant risk of complications. Benchmarking quality assessment in ERCP is an emerging area of clinical outcomes research. Aim The aim of our study was to examine the role of endoscopist case volume on the incidence of ERCP-related complications and other outcome measures, such as successful cannulation of the intended duct and the number of procedures completed. Methods Retrospective review of all ERCPs performed between Jan 1-Dec 31, 2012. Patient demographics, indications and procedural outcomes were stratified based on ERCP case volume. The high volume ERCP (HVE) group performed at least 75 ERCPs/endoscopist/year, while the low volume ERCP (LVE) group performed less than 75 ERCPs each during the year. Results During this period, 6 endoscopists (3 HVE and 3 LVE) performed 465 ERCPs. The HVE performed 367 ERCPs while the LVE performed 98. Patient demographics were similar between groups. Successful cannulation was achieved in 91.0% for HVE group versus 78.6% for the LVE group (p=0.001, OR 2.8), while the overall success rate of the HVE group was 80.7% versus the 66.3% for the LVE group (0.003, OR 2.1). The overall complication rate was 5.2% and 7.1% (p=0.45, 0.71) for the HVE and LVE group, respectively. Once adjusted for ERCP complexity, the OR for successful cannulation was 2.64 (p=0.002), completion of the procedure 2.34 (p=0.001) and complication 0.59 between the HVE and LVE groups. The rate of unintentional PD cannulation in the HVE was 6.8 % (p =0.082) with PD injection in 3.8% of cases (p=0.20). A pancreatic stent was placed in 4 (1.1%) of HVE cases with inadvertent PD manipulation. In contrast, the LVE rate of unintentional cannulation of the PD occurred in 12.2 % cases with PD injection in 1% cases. There was no documentation of PD stent placement. PostERCP pancreatitis was similar in both groups (5.1% for LVE vs. 4.1% for HVE) as was clinically significant bleeding (2.0% for the LVE group vs. 1.0% for the HVE group). The LVE group had a 1.0% perforation rate while no perforations were noted in the HVE group. Conclusion Our study demonstrates a significant difference in successful cannulation and completion of ERCP based on case volume. The considerable difference in inadvertent PD cannulation between the LVE and HVE groups did not reach statistical significance (p = 0.08) perhaps due to low numbers. The overall complication rate and incidence of PEP was not different between the two groups, although we noticed a lack of PD stent placement in the LVE group despite the high frequency of inadvertent PD cannulation. While this data

AGA Abstracts

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