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The roles of intraductal US in acute biliary pancreatitis patients without choledocholithiasis on ERCP
Abstracts / Pancreatology 13 (2013) e1–e94
for hemostasis. We were reviewed and compared staging of disease, regarding age, sex, histopathological diagnosis, operating time, postoperative complications, hospital stay and morbidity. Results: The two groups had similar demographics and staging of the process. The second group had lower operating times, less postoperative pain and early pain-free return to normal activity and less time of hospitality, postoperative mortality was identical. Conclusion: Regular use of LVSS and Ultrasonic harmonic scalpel: reduces the PDE operation time on about 1 hour; decreases the risk of postoperative complications; decreases the length of hospital stay; enables to obtain more careful and extended lymph node dissection.
P113. Mucin MUC4 resists gemcitabine-induced pancreatic cancer cell death by promoting autophagy S. Kaur, S. Bafna, S. Rachagani, A.K. Ganti, S.K. Batra. Department of Biochemistry and Molecular Biology, UNMC, Omaha, NE, USA Background and hypothesis: Pancreatic cancer (PC) has mortality almost equivalent to its incidence and is the 4th leading cause of cancer related deaths in the US. Resistance to radiation and chemotherapy caused by altered apoptotic threshold of PC cell are major attributes for its lethality. While absent from the normal pancreas, an aberrant expression of mucin MUC4 has been associated with increased tumorigenicity, enhanced metastasis and resistance of PC cells from gemcitabine-induced apoptosis. We report here an elevated autophagy in PC cell expressing MUC4 in comparison to control cells in response to chemotherapeutic stress induced by gemcitabine. Based on these studies, we hypothesized that mucin MUC4 alters apoptotic threshold of PC cells by inducing autophagy. Methods: The role of MUC4 in tumor cell survival under chemotherapeutic stress (Gemcitabine) was assessed by knockdown. Association between autophagy and apoptosis was studied by immunoblotting, electron microscopy and flow cytometry. The impact of autophagy inhibition on apoptosis was determined by treating the cells with autophagy inhibitor and knocking key autophagy genes. Further, downstream signaling pathway was analyzed by immunoblotting to determine the molecular pathway of mucin mediated autophagy induction. Results: Significant induction of apoptosis was observed in PC cells upon knockdown of MUC4 that matched with simultaneous increase in autophagic response in these cells. Inhibition of autophagy via specific autophagy inhibitors as well as knockdown of key players of autophagic pathways (ATG7) sensitized cells the pancreatic cancer cells to apoptosis. Analysis of downstream signaling revealed that HER2/RAS/RAF/ERK pathway independent of mTOR is involved in mucin-mediated activation of autophagy under chemotherapeutic stress. Conclusion: Pancreatic cancer cells by aberrantly expressing mucin MUC4 induces cellular survival machinery and resist apoptosis. Chemotherapies targeting alternative survival machineries should be designed for better treatment of pancreatic cancer.
e43
was to prospectively evaluate the ability of IDUS for detecting small stones in patients with biliary pancreatitis having no choledocholithiasis by ERCP. Methods: Sixty-seven patients with suspicious acute biliary pancreatitis were studied. All patients had no evidence of bile duct stones on ERCP. ERCP was performed within 24 hours of admission for 31 patients having severe pancreatitis and within 72 hours in patients with mild attacks. Wire-guided IDUS was performed during ERCP in all patients. The outcomes of IDUS were compared with the results of endoscopic extraction as the reference standard for choledocholithiasis and sludge. Results: 1) Sixteen (23.9%) patients had small bile duct stones (<3 mm) on IDUS. Stones were confirmed after sphincterotomy and extraction in fifteen (22.4%) patients. IDUS revealed sludge in twenty-four (35.8%) patients. 2) Choledocholithiasis was more frequent in patients with bile duct dilatation (>10 mm) and cholelithiasis (p<0.05). 3) Cholelithiasis was combined in fiftythree (79.1%) patients. Among them, thirty-four patients performed laparoscopic cholecystectomy and two patients performed cholangioscopic stone removal. 4) With a median follow-up of ? months, three patients having cholelithiasis without treatment developed recurrent pancreatitis. Conclusion: Intraductal US can be considered reliable for the detection of small choledocholithiasis in patients with biliary pancreatitis. IDUS may be useful to reduce the risk of recurrent pancreatitis after treatment.
P115. Usefulness of 18-flurodeoxyglucose positron emmission tomography in predicting survival and gemcitabine based chemoresponse of patients with locally advanced pancreatic cancer D.U. Kim 1, 3, S. Kim 2, Y.J. Choi 1, G.H. Kim 1, D.H. Kang 1, G.A. Song 1. 1 Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea 2 Department of Nuclear Medicine, Pusan National University Hospital, Busan, South Korea 3 Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea Aim & background: Gemcitabine is approved for treatment of pancreatic cancer. However, only minority of patients display a response with drug. So it is important to select the optimal candidates for treatment. In this study, we investigated the usefulness of 18-Fluorodeoxyglucose positron emission tomography in predicting survival and gemcitabine based chemoresponse of patients with locally advanced pancreatic cancer. Methods: A total 33 pancreatic cancer patients who were treated by gemcitabine based chemotherapy were included. Baseline 18-FDG PET scnas were performed before chemotherapy. The standardized uptake value (SUV) was calculated in the mass lesion. Patients were divided into two groups : High SUV (SUV 6) and Low SUV (SUV < 6). Results: The median over survival (OS) time of high andlow SUV groups were 10.4 months (95% CI, 4.1 and 16.6 months) and 16.4 months (95% CI, 13.3 and 16.7 months), respectively. The high SUV group showed significantly shorter OS (P ¼ 0.012). However, there is no correlation between degree of 18-FDG SUV and chemoresponse Conclusion: We conclude the 18-FDG PET is a useful tool for predicting the prognosis of patients receiving gemcitabine based chemotherapy. However, the SUV of 18-FDG were not associated with the chemoresponse for gemcitabine.
P114. The roles of intraductal US in acute biliary pancreatitis patients without choledocholithiasis on ERCP D.C. Kim, H.J. Choi, J.H. Moon, T.H. Lee, S.-W. Cha, Y. Deok Cho, S.-H. Park, S.-J. Kim. Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, South Korea Backgrounds: ERCP is considered the standard for the detection of bile duct stones, but small stones may not be detected in patients with biliary pancreatitis. Failure to image stones may lead to recurrent attacks of pancreatitis. Intraductal US (IDUS) is easily performed during the same endoscopic session as ERCP without sphincterotomy. The aim of this study
P116. Usefulness of the BISAP in the early prediction of severity and mortality in acute pancreatitis H.K. Kim, Y.S. Cho, E.C. Jang, J.O. Yeom, S.Y. Kim, J.Y. Yu, Y.J. Kim, K.R. Do, S.S. Kim, H.S. Chae. Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine and Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea
for hemostasis. We were reviewed and compared staging of disease, regarding age, sex, histopathological diagnosis, operating time, postoperative complications, hospital stay and morbidity. Results: The two groups had similar demographics and staging of the process. The second group had lower operating times, less postoperative pain and early pain-free return to normal activity and less time of hospitality, postoperative mortality was identical. Conclusion: Regular use of LVSS and Ultrasonic harmonic scalpel: reduces the PDE operation time on about 1 hour; decreases the risk of postoperative complications; decreases the length of hospital stay; enables to obtain more careful and extended lymph node dissection.
P113. Mucin MUC4 resists gemcitabine-induced pancreatic cancer cell death by promoting autophagy S. Kaur, S. Bafna, S. Rachagani, A.K. Ganti, S.K. Batra. Department of Biochemistry and Molecular Biology, UNMC, Omaha, NE, USA Background and hypothesis: Pancreatic cancer (PC) has mortality almost equivalent to its incidence and is the 4th leading cause of cancer related deaths in the US. Resistance to radiation and chemotherapy caused by altered apoptotic threshold of PC cell are major attributes for its lethality. While absent from the normal pancreas, an aberrant expression of mucin MUC4 has been associated with increased tumorigenicity, enhanced metastasis and resistance of PC cells from gemcitabine-induced apoptosis. We report here an elevated autophagy in PC cell expressing MUC4 in comparison to control cells in response to chemotherapeutic stress induced by gemcitabine. Based on these studies, we hypothesized that mucin MUC4 alters apoptotic threshold of PC cells by inducing autophagy. Methods: The role of MUC4 in tumor cell survival under chemotherapeutic stress (Gemcitabine) was assessed by knockdown. Association between autophagy and apoptosis was studied by immunoblotting, electron microscopy and flow cytometry. The impact of autophagy inhibition on apoptosis was determined by treating the cells with autophagy inhibitor and knocking key autophagy genes. Further, downstream signaling pathway was analyzed by immunoblotting to determine the molecular pathway of mucin mediated autophagy induction. Results: Significant induction of apoptosis was observed in PC cells upon knockdown of MUC4 that matched with simultaneous increase in autophagic response in these cells. Inhibition of autophagy via specific autophagy inhibitors as well as knockdown of key players of autophagic pathways (ATG7) sensitized cells the pancreatic cancer cells to apoptosis. Analysis of downstream signaling revealed that HER2/RAS/RAF/ERK pathway independent of mTOR is involved in mucin-mediated activation of autophagy under chemotherapeutic stress. Conclusion: Pancreatic cancer cells by aberrantly expressing mucin MUC4 induces cellular survival machinery and resist apoptosis. Chemotherapies targeting alternative survival machineries should be designed for better treatment of pancreatic cancer.
e43
was to prospectively evaluate the ability of IDUS for detecting small stones in patients with biliary pancreatitis having no choledocholithiasis by ERCP. Methods: Sixty-seven patients with suspicious acute biliary pancreatitis were studied. All patients had no evidence of bile duct stones on ERCP. ERCP was performed within 24 hours of admission for 31 patients having severe pancreatitis and within 72 hours in patients with mild attacks. Wire-guided IDUS was performed during ERCP in all patients. The outcomes of IDUS were compared with the results of endoscopic extraction as the reference standard for choledocholithiasis and sludge. Results: 1) Sixteen (23.9%) patients had small bile duct stones (<3 mm) on IDUS. Stones were confirmed after sphincterotomy and extraction in fifteen (22.4%) patients. IDUS revealed sludge in twenty-four (35.8%) patients. 2) Choledocholithiasis was more frequent in patients with bile duct dilatation (>10 mm) and cholelithiasis (p<0.05). 3) Cholelithiasis was combined in fiftythree (79.1%) patients. Among them, thirty-four patients performed laparoscopic cholecystectomy and two patients performed cholangioscopic stone removal. 4) With a median follow-up of ? months, three patients having cholelithiasis without treatment developed recurrent pancreatitis. Conclusion: Intraductal US can be considered reliable for the detection of small choledocholithiasis in patients with biliary pancreatitis. IDUS may be useful to reduce the risk of recurrent pancreatitis after treatment.
P115. Usefulness of 18-flurodeoxyglucose positron emmission tomography in predicting survival and gemcitabine based chemoresponse of patients with locally advanced pancreatic cancer D.U. Kim 1, 3, S. Kim 2, Y.J. Choi 1, G.H. Kim 1, D.H. Kang 1, G.A. Song 1. 1 Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea 2 Department of Nuclear Medicine, Pusan National University Hospital, Busan, South Korea 3 Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea Aim & background: Gemcitabine is approved for treatment of pancreatic cancer. However, only minority of patients display a response with drug. So it is important to select the optimal candidates for treatment. In this study, we investigated the usefulness of 18-Fluorodeoxyglucose positron emission tomography in predicting survival and gemcitabine based chemoresponse of patients with locally advanced pancreatic cancer. Methods: A total 33 pancreatic cancer patients who were treated by gemcitabine based chemotherapy were included. Baseline 18-FDG PET scnas were performed before chemotherapy. The standardized uptake value (SUV) was calculated in the mass lesion. Patients were divided into two groups : High SUV (SUV 6) and Low SUV (SUV < 6). Results: The median over survival (OS) time of high andlow SUV groups were 10.4 months (95% CI, 4.1 and 16.6 months) and 16.4 months (95% CI, 13.3 and 16.7 months), respectively. The high SUV group showed significantly shorter OS (P ¼ 0.012). However, there is no correlation between degree of 18-FDG SUV and chemoresponse Conclusion: We conclude the 18-FDG PET is a useful tool for predicting the prognosis of patients receiving gemcitabine based chemotherapy. However, the SUV of 18-FDG were not associated with the chemoresponse for gemcitabine.
P114. The roles of intraductal US in acute biliary pancreatitis patients without choledocholithiasis on ERCP D.C. Kim, H.J. Choi, J.H. Moon, T.H. Lee, S.-W. Cha, Y. Deok Cho, S.-H. Park, S.-J. Kim. Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, South Korea Backgrounds: ERCP is considered the standard for the detection of bile duct stones, but small stones may not be detected in patients with biliary pancreatitis. Failure to image stones may lead to recurrent attacks of pancreatitis. Intraductal US (IDUS) is easily performed during the same endoscopic session as ERCP without sphincterotomy. The aim of this study
P116. Usefulness of the BISAP in the early prediction of severity and mortality in acute pancreatitis H.K. Kim, Y.S. Cho, E.C. Jang, J.O. Yeom, S.Y. Kim, J.Y. Yu, Y.J. Kim, K.R. Do, S.S. Kim, H.S. Chae. Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine and Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea