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Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis
S150
Abstracts / Pancreatology 16 (2016) S1eS192
P-222. Significance of normal appearance on endoscopic ultrasound in the diagnosis of early chronic pancreatitis Ai Sato 1, Atsushi Irisawa 1, Manoop S. Bhutani 2, Goro Shibukawa 1, Koki Hoshi 1, Akane Yamabe 1, Ryo Igarashi 1, Takumi Maki 1, Hiromasa Ohira 3 1 Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Japan 2 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, USA 3 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
Background and aim: Although Rosemont Classification was developed as a consensus-based standard for the EUS diagnosis of chronic pancreatitis (CP), it is more complicated than the traditional scoring system. We have noticed that not infrequently abnormal appearing pancreas coexists with areas of normal parenchyma in early changes of CP. The aim of this study was to investigate the validity of the“normal”appearance of the pancreas and to evaluate the usefulness of a modified diagnostic criteria in comparison to the traditional EUS criteria and the Rosemont Classification. Patients and methods: One hundred seventy-seven patients who were undergone both EUS and ERP within 2 months were enrolled, excluding in patients with pancreatic cancer. For evaluating the EUS findings, ERP findings was set as the gold standard for diagnosis of CP. The obtained EUS images were classified according to the Rosemont criteria and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) as a normal pancreatic parenchyma. we made a comparison of the accuracy between the new EUS criteria and Rosemont classification. Results: 1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 cases of 45 CP cases on ERP (p＜0.0001). 2) We investigated whether our new criteria have a high diagnostic capability of ERCP normal/equivocal pancreas in comparison with traditional criteria. In this case where fewer than two points were defined as normal, the rate of normal pancreas was significantly higher in new criteria than in traditional ones (112/132 vs. 87/ 132, p¼0.002). 3) In no ERP grade was a significant difference found between the new criteria and Rosemont classification. Conclusion: New proposed“convenient”EUS criteria for diagnosing CP presented the equivalent ability to Rosemont classification.
P-223. Reoperation for relapsing symptoms after surgery for chronic pancreatitis Keiko Kamei, Ippei Matsumoto, Masataka Matsumoto, Takaaki Murase, Shumpei Satoi, Takuya Nakai, Yoshifumi Takeyama
(n¼4) and anomalous arrangement of pancreaticobiliary maljunction (n¼1) who underwent Frey operation (n¼2), distal pancreatectomy (n¼1), partington procedure (n¼1) and cystoileostomy (n¼1) for first operation, 3 patients required Frey procesure (n¼2) or pancreaticoduodenectomy (n¼1) for reoperation. Median operation time was 265 minutes (range, 120-501 minutes), amount of bleeding was 828ml (range, 107-2,810 ml). Postoperative complication occurred in 4 (30.7%) patients. The rate of complete pain relief and increased body weight were 61.5% each after reoperation. All of them abstained from alcohol. Conclusion: Reoperation for CP could be perfomed safely and effective in patients with recurrent pancreatitis and/or intractable pain. Abstinence from drinking may be very important. In patinets with CP of which causes are in the pancreas head, careful follow up will be need after distal pancreatectomy or lateral pancreaticojejunostomy.
P-224. Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis Toshiki Matsui, Akihiro Tanemura, Yusuke Iizawa, Hiroyuki Kato, Yasuhiro Murata, Yoshinori Azumi, Naohisa Kuriyama, Masashi Kishiwada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Japan Background: According to Japanese guideline for chronic pancreatitis, surgical treatment should be considered when endoscopic treatment is difficult to perform or unsuccessful. The hybrid surgery, which includes decompression of the pancreatic duct and local resection of the inflammatory lesion in pancreatic head is becoming mainstream. We evaluated postoperative outcomes of the Frey procedure. Patients and methods: The subjects were 20 patients who underwent Frey procedire for chronic pancreatitis between Jan 2002 to August 2015. We evaluated surgical outcomes and long-term pain relief. Results: The mean age was 53.2 years old, and the male/female ratio was 19: 1. Thirteen patients (65%) underwent preoperative treatment (endoscopic treatment/ESWL). Nine patients (45%) had bile duct stenosis due to the inflammation of pancreatic head, receiving choledocoduodenostomy during Frey procedure. Five patients (25%) experienced postoperative complications (Clavian-Dindo classification Grade III or more). Among them, abdominal abscess and postoperative haemorrhage occurred in 2 and in 3 patients, respectively. As for long-term pain relief after operation which could be assessed in 14 patients, partial pain relief was found in 12 (85.7%) and complete pain relief was found in 9 (64.3%). Conclusions: For intractable chronic pancreatitis, surgical treatment should be considered earlier, because that can provide the reliable and long-term pain relief. In surgical procedure, Frey procedure with or without choledochoduodenostomy should be the first choice from the viewpoint of safety and efficacy.
Department of Surgery, Kindai University, Faculty of Medicine, Japan Background and aim: Many studies showed that surgry is one of the most effective treatments for chronic pancreatic (CP). However, some patients require reoperation for recurrent pancreatitis and/or pain relapse after surgery for CP. The indication and timing of the operation, and surgical outcome have not been studied well. In this study, we report 13 patients who underwent reoperation after surgery for CP. Patients and Methods: We retrospectively analyzed the data of 13 patients who underwent reoperation for CP between 2005 to 2015 in our hospital. Result: The patients consisted of 11 men and 2 women with a mean age of 49 years. The etiology of CP were alcoholic in 11 patients and idiopathic in 2 patients. Indication for reoperation were recurrent pancreatitis in 7 (53.8%) patinets, intractable pain in 3 (23%), stricture of bile duct in 2 (15%), and 1 pseudo cyst in 1 (7%). We performed 6 Frey procedures, 3 distal pancreatectomies, 2 pancreaticoduodenectomies, 1 partington procedure, and 1 cholangioduodenostomy. In 5 patients with pancreatic divisum
P-225. The experience of 133 pancreatoduodenectomy with pancreaticogastric anastomosis Hisashi Ikon, Ryou Morimura, Tomohiro Arita, Toshiyuki Kosuga, Takahiro Konishi, Yasutoshi Murayama, Syuhei Komatsu, Astushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ishikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Eigo Otsuji Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Japan Introduction: To present the procedure and experience of pancreatoduodenectomy with pancreaticogastric anastomosis in our institute.
Abstracts / Pancreatology 16 (2016) S1eS192
P-222. Significance of normal appearance on endoscopic ultrasound in the diagnosis of early chronic pancreatitis Ai Sato 1, Atsushi Irisawa 1, Manoop S. Bhutani 2, Goro Shibukawa 1, Koki Hoshi 1, Akane Yamabe 1, Ryo Igarashi 1, Takumi Maki 1, Hiromasa Ohira 3 1 Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Japan 2 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, USA 3 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
Background and aim: Although Rosemont Classification was developed as a consensus-based standard for the EUS diagnosis of chronic pancreatitis (CP), it is more complicated than the traditional scoring system. We have noticed that not infrequently abnormal appearing pancreas coexists with areas of normal parenchyma in early changes of CP. The aim of this study was to investigate the validity of the“normal”appearance of the pancreas and to evaluate the usefulness of a modified diagnostic criteria in comparison to the traditional EUS criteria and the Rosemont Classification. Patients and methods: One hundred seventy-seven patients who were undergone both EUS and ERP within 2 months were enrolled, excluding in patients with pancreatic cancer. For evaluating the EUS findings, ERP findings was set as the gold standard for diagnosis of CP. The obtained EUS images were classified according to the Rosemont criteria and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) as a normal pancreatic parenchyma. we made a comparison of the accuracy between the new EUS criteria and Rosemont classification. Results: 1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 cases of 45 CP cases on ERP (p＜0.0001). 2) We investigated whether our new criteria have a high diagnostic capability of ERCP normal/equivocal pancreas in comparison with traditional criteria. In this case where fewer than two points were defined as normal, the rate of normal pancreas was significantly higher in new criteria than in traditional ones (112/132 vs. 87/ 132, p¼0.002). 3) In no ERP grade was a significant difference found between the new criteria and Rosemont classification. Conclusion: New proposed“convenient”EUS criteria for diagnosing CP presented the equivalent ability to Rosemont classification.
P-223. Reoperation for relapsing symptoms after surgery for chronic pancreatitis Keiko Kamei, Ippei Matsumoto, Masataka Matsumoto, Takaaki Murase, Shumpei Satoi, Takuya Nakai, Yoshifumi Takeyama
(n¼4) and anomalous arrangement of pancreaticobiliary maljunction (n¼1) who underwent Frey operation (n¼2), distal pancreatectomy (n¼1), partington procedure (n¼1) and cystoileostomy (n¼1) for first operation, 3 patients required Frey procesure (n¼2) or pancreaticoduodenectomy (n¼1) for reoperation. Median operation time was 265 minutes (range, 120-501 minutes), amount of bleeding was 828ml (range, 107-2,810 ml). Postoperative complication occurred in 4 (30.7%) patients. The rate of complete pain relief and increased body weight were 61.5% each after reoperation. All of them abstained from alcohol. Conclusion: Reoperation for CP could be perfomed safely and effective in patients with recurrent pancreatitis and/or intractable pain. Abstinence from drinking may be very important. In patinets with CP of which causes are in the pancreas head, careful follow up will be need after distal pancreatectomy or lateral pancreaticojejunostomy.
P-224. Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis Toshiki Matsui, Akihiro Tanemura, Yusuke Iizawa, Hiroyuki Kato, Yasuhiro Murata, Yoshinori Azumi, Naohisa Kuriyama, Masashi Kishiwada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Japan Background: According to Japanese guideline for chronic pancreatitis, surgical treatment should be considered when endoscopic treatment is difficult to perform or unsuccessful. The hybrid surgery, which includes decompression of the pancreatic duct and local resection of the inflammatory lesion in pancreatic head is becoming mainstream. We evaluated postoperative outcomes of the Frey procedure. Patients and methods: The subjects were 20 patients who underwent Frey procedire for chronic pancreatitis between Jan 2002 to August 2015. We evaluated surgical outcomes and long-term pain relief. Results: The mean age was 53.2 years old, and the male/female ratio was 19: 1. Thirteen patients (65%) underwent preoperative treatment (endoscopic treatment/ESWL). Nine patients (45%) had bile duct stenosis due to the inflammation of pancreatic head, receiving choledocoduodenostomy during Frey procedure. Five patients (25%) experienced postoperative complications (Clavian-Dindo classification Grade III or more). Among them, abdominal abscess and postoperative haemorrhage occurred in 2 and in 3 patients, respectively. As for long-term pain relief after operation which could be assessed in 14 patients, partial pain relief was found in 12 (85.7%) and complete pain relief was found in 9 (64.3%). Conclusions: For intractable chronic pancreatitis, surgical treatment should be considered earlier, because that can provide the reliable and long-term pain relief. In surgical procedure, Frey procedure with or without choledochoduodenostomy should be the first choice from the viewpoint of safety and efficacy.
Department of Surgery, Kindai University, Faculty of Medicine, Japan Background and aim: Many studies showed that surgry is one of the most effective treatments for chronic pancreatic (CP). However, some patients require reoperation for recurrent pancreatitis and/or pain relapse after surgery for CP. The indication and timing of the operation, and surgical outcome have not been studied well. In this study, we report 13 patients who underwent reoperation after surgery for CP. Patients and Methods: We retrospectively analyzed the data of 13 patients who underwent reoperation for CP between 2005 to 2015 in our hospital. Result: The patients consisted of 11 men and 2 women with a mean age of 49 years. The etiology of CP were alcoholic in 11 patients and idiopathic in 2 patients. Indication for reoperation were recurrent pancreatitis in 7 (53.8%) patinets, intractable pain in 3 (23%), stricture of bile duct in 2 (15%), and 1 pseudo cyst in 1 (7%). We performed 6 Frey procedures, 3 distal pancreatectomies, 2 pancreaticoduodenectomies, 1 partington procedure, and 1 cholangioduodenostomy. In 5 patients with pancreatic divisum
P-225. The experience of 133 pancreatoduodenectomy with pancreaticogastric anastomosis Hisashi Ikon, Ryou Morimura, Tomohiro Arita, Toshiyuki Kosuga, Takahiro Konishi, Yasutoshi Murayama, Syuhei Komatsu, Astushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ishikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Eigo Otsuji Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Japan Introduction: To present the procedure and experience of pancreatoduodenectomy with pancreaticogastric anastomosis in our institute.