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Tu1605 PCR Assay for the Detection of Clonorchis Sinensis DNA in Bile Duct Stones From Patients With CS Positive Serology
AGA Abstracts
moderate, and 23 severe AC cases based on the TG13. The mortality rate was 0.9% (1/113) 2. The incidence of positive rates for fulfilling three SIRS criteria in the mild/moderate/ severe AC cases were 20% (9/45)/33% (15/45)/74% (17/23). The incidence of DIC in the mild/moderate/severe AC cases were 2.2% (1/45)/6.7% (3/45)/74% (17/23). 3. According to the TG13 severity assessment criteria, 3 DIC patients fulfilled both the Plt<100,000/µL and PT-INR>1.5 criteria, which are criteria for severe AC, while 10 DIC patients fulfilled only the Plt<100,000/µL criterion , and 3 patients fulfilled only the PT-INR>1.5 criterion. Seven of the 21 DIC patients fulfilled only the JAAM criteria for DIC.Conclusion:DIC was found to occur as a complication even in AC cases assessed as mild or moderate according to the TG13. It was concluded that using the acute-DIC diagnostic criteria (JAAM criteria) in addition to the severity criteria in the TG13 will make it easier to accurately diagnose coagulation disorders in AC and identify high-risk AC patients, and will improve management according to the TG13.
Tu1605 PCR Assay for the Detection of Clonorchis Sinensis DNA in Bile Duct Stones From Patients With CS Positive Serology Seon Mee Park, Eun Jeoung Lee, Joung-Ho Han Introduction/Aims: High prevalence of bile duct stones in Korea has been postulated to be associated with Clonorchis sinensis (CS) infection. This study describes the development of a PCR assay for the detection of CS DNA in bile duct stones from patients with CS positive serology. Materials and Methods: Twenty-six bile duct stones were obtained during ERCP from five hospitals, which were located at different regions in Korea. Patients revealed all CS (-) in stool exams and CS (+) in eleven patients and CS (-) in fifteen patients with serology. DNA was extracted from gallstones using QIAGEN DNA mini prep kit. We performed PCR with 5 primer sets for adult worm genes and 2 primer sets for egg genes. Results: Positive PCR data were obtained from three samples out of 11 patients with CS (+) serology. Positive data obtained in the assay using 2 primer sets for egg genes among 7 primer sets. All PCR (+) stones were obtained from patients, who were residents of CS endemic area in Korea. Another 8 samples obtained from patients, who lived in non-endemic area, revealed PCR (-) in spite of positive serology. All samples obtained from patients with negative serology were CS DNA (-) in bile duct stones Conclusion: CS eggs may be a nidus during stone formation in endemic areas. Detection of CS DNA from gallstones can be helpful to evaluate the pathogenesis of CS associated biliary diseases and to do diagnosis and treatment.
(1) N(total)=2848, N(incident stones)=250, N(cholecystectomy)=6, N(stone free)=2592. (2) Adjusted for baseline sex, age, body mass index, units of alcohol per week, social group I+II - V, and cohabitant status. Model also includes changes in consumption of alcohol per week and interactions with sex (body mass index, age, and changes in consumption of alcohol units per week).
Tu1606 Abdominal Symptoms and Incident Gallstones in a Population Unaware of Gallstone Status - A Cohort Study Daniel M. Shabanzadeh, Lars T. Sørensen, Torben Jørgensen Background: Gallstone disease is a frequent cause of hospital admissions with high costs as a consequence of treatment and morbidity. Symptoms associated to newly formed gallstones have only been sparsely investigated and never in a population unaware of their gallstones. The objective of this population-based cohort study was to determine which abdominal symptoms were associated to newly formed gallstones. Material and Methods: A cohort study was performed of a general population random sample of Copenhagen. Participants had ultrasound examinations and answered questionnaires about abdominal symptoms at baseline and two re-examinations over 12 years. Inclusion criteria were no gallstones or cholecystectomy at baseline and attending a re-examination. Associations between incident gallstones and abdominal symptoms were investigated with logistic regression. Of 3785 participants, 2845 fulfilled inclusion criteria. Results: Incident gallstones were significantly associated to abdominal pain with projection, pain localized under right rib, epigastrium with projection, whole upper abdomen, longer duration, moderate intensity, dyspepsia of the nausea type, and the irritable bowel syndrome in multiple adjusted analyses. Of debuting symptoms only abdominal pain with projection, localization in the whole upper abdomen, and longer duration was significantly associated to incident gallstones. Sensitivity analyses excluding subgroup with gallstone awareness removed most significant associations but still showed a non-significantly association to the debuting symptoms. Conclusions: A new onset of abdominal pain with projection, localized in the whole upper abdomen, of higher intensity, and of longer duration is associated to newly formed gallstones. Gallstone patients should be selected for surgery based on these symptoms. Dyspepsia with nausea and the irritable bowel syndrome seem to be common in subjects with gallstones but unlikely related to gallstone formation. Logistic regression of changes in symptoms between baseline and follow-up in incident gallstones at ultrasound or incident cholecystectomy
AGA Abstracts
Study design and participant flow
Tu1607 Routine Cholangiography in the Modern Era Ahmed El Hadi, Stephanie Brown, Leyla Swafe, Sarah Ashford-Wilson, Jennifer S. Barwell, Imogen Koopmans, Alexis Sudlow, Michael Lewis Introduction: Performing routine on table cholangiogram (r-OTC) during laparoscopic Cholecystectomy (LC) remains a subject of debate. Advocates for r-OTC highlight the potential to reduce the risk of Injury to the common bile duct (CBD) in addition to visualising the biliary tree and facilitating the management of ductal stones. Aim: Based in a University teaching hospital performing r-OTC in all LC we aimed to test the hypothesis that r-OTC reduces the risk of CBD injury and improves the overall management of gallstone disease. Methods: We audited the results of r-OTC over a two year period (October 2013 to September 2015) the data was collected using the hospital coding system in addition to the operating theatre database. Data collection included diagnosis, emergency vs elective surgery, pre-operative radiological findings, liver function tests, operative findings, post-operative complications and the need for endoscopic retrograde cholangio-pancreatography following surgery (ERCP). Results: A total of 1005 patients (75.1% female, mean age 51) were included. 836 (83.2%) LC were performed electively compared to 169 (16.8%) emergency operations. There was no CBD injury in our study population. 4 (0.4%) cases were converted to open cholecystectomy. R-OTC showed ductal stones in 101 patients (10.1%) of which 86 (85.2%) patients underwent a CBD exploration and stone extraction during the same operation. Out of the remaining 15 patients with ductal stones 3 were managed by ERCP and 12 patients were successfully managed conservatively. In our study population there were only 3 (0.3%) re-admissions to the hospital with retained CBD stones. 6 patients (0.6%) returned to theatre for post-op complications (4 post-operative bleeding, 1 bile leak, 1 port site hernia). Conclusion: Our study suggests that high volume r-OTC is associated with a low of risk of bile duct injury and can be performed safely in emergency as well as elective patients. It also demonstrates the use of r-OTC in ductal stone detection and hence
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moderate, and 23 severe AC cases based on the TG13. The mortality rate was 0.9% (1/113) 2. The incidence of positive rates for fulfilling three SIRS criteria in the mild/moderate/ severe AC cases were 20% (9/45)/33% (15/45)/74% (17/23). The incidence of DIC in the mild/moderate/severe AC cases were 2.2% (1/45)/6.7% (3/45)/74% (17/23). 3. According to the TG13 severity assessment criteria, 3 DIC patients fulfilled both the Plt<100,000/µL and PT-INR>1.5 criteria, which are criteria for severe AC, while 10 DIC patients fulfilled only the Plt<100,000/µL criterion , and 3 patients fulfilled only the PT-INR>1.5 criterion. Seven of the 21 DIC patients fulfilled only the JAAM criteria for DIC.Conclusion:DIC was found to occur as a complication even in AC cases assessed as mild or moderate according to the TG13. It was concluded that using the acute-DIC diagnostic criteria (JAAM criteria) in addition to the severity criteria in the TG13 will make it easier to accurately diagnose coagulation disorders in AC and identify high-risk AC patients, and will improve management according to the TG13.
Tu1605 PCR Assay for the Detection of Clonorchis Sinensis DNA in Bile Duct Stones From Patients With CS Positive Serology Seon Mee Park, Eun Jeoung Lee, Joung-Ho Han Introduction/Aims: High prevalence of bile duct stones in Korea has been postulated to be associated with Clonorchis sinensis (CS) infection. This study describes the development of a PCR assay for the detection of CS DNA in bile duct stones from patients with CS positive serology. Materials and Methods: Twenty-six bile duct stones were obtained during ERCP from five hospitals, which were located at different regions in Korea. Patients revealed all CS (-) in stool exams and CS (+) in eleven patients and CS (-) in fifteen patients with serology. DNA was extracted from gallstones using QIAGEN DNA mini prep kit. We performed PCR with 5 primer sets for adult worm genes and 2 primer sets for egg genes. Results: Positive PCR data were obtained from three samples out of 11 patients with CS (+) serology. Positive data obtained in the assay using 2 primer sets for egg genes among 7 primer sets. All PCR (+) stones were obtained from patients, who were residents of CS endemic area in Korea. Another 8 samples obtained from patients, who lived in non-endemic area, revealed PCR (-) in spite of positive serology. All samples obtained from patients with negative serology were CS DNA (-) in bile duct stones Conclusion: CS eggs may be a nidus during stone formation in endemic areas. Detection of CS DNA from gallstones can be helpful to evaluate the pathogenesis of CS associated biliary diseases and to do diagnosis and treatment.
(1) N(total)=2848, N(incident stones)=250, N(cholecystectomy)=6, N(stone free)=2592. (2) Adjusted for baseline sex, age, body mass index, units of alcohol per week, social group I+II - V, and cohabitant status. Model also includes changes in consumption of alcohol per week and interactions with sex (body mass index, age, and changes in consumption of alcohol units per week).
Tu1606 Abdominal Symptoms and Incident Gallstones in a Population Unaware of Gallstone Status - A Cohort Study Daniel M. Shabanzadeh, Lars T. Sørensen, Torben Jørgensen Background: Gallstone disease is a frequent cause of hospital admissions with high costs as a consequence of treatment and morbidity. Symptoms associated to newly formed gallstones have only been sparsely investigated and never in a population unaware of their gallstones. The objective of this population-based cohort study was to determine which abdominal symptoms were associated to newly formed gallstones. Material and Methods: A cohort study was performed of a general population random sample of Copenhagen. Participants had ultrasound examinations and answered questionnaires about abdominal symptoms at baseline and two re-examinations over 12 years. Inclusion criteria were no gallstones or cholecystectomy at baseline and attending a re-examination. Associations between incident gallstones and abdominal symptoms were investigated with logistic regression. Of 3785 participants, 2845 fulfilled inclusion criteria. Results: Incident gallstones were significantly associated to abdominal pain with projection, pain localized under right rib, epigastrium with projection, whole upper abdomen, longer duration, moderate intensity, dyspepsia of the nausea type, and the irritable bowel syndrome in multiple adjusted analyses. Of debuting symptoms only abdominal pain with projection, localization in the whole upper abdomen, and longer duration was significantly associated to incident gallstones. Sensitivity analyses excluding subgroup with gallstone awareness removed most significant associations but still showed a non-significantly association to the debuting symptoms. Conclusions: A new onset of abdominal pain with projection, localized in the whole upper abdomen, of higher intensity, and of longer duration is associated to newly formed gallstones. Gallstone patients should be selected for surgery based on these symptoms. Dyspepsia with nausea and the irritable bowel syndrome seem to be common in subjects with gallstones but unlikely related to gallstone formation. Logistic regression of changes in symptoms between baseline and follow-up in incident gallstones at ultrasound or incident cholecystectomy
AGA Abstracts
Study design and participant flow
Tu1607 Routine Cholangiography in the Modern Era Ahmed El Hadi, Stephanie Brown, Leyla Swafe, Sarah Ashford-Wilson, Jennifer S. Barwell, Imogen Koopmans, Alexis Sudlow, Michael Lewis Introduction: Performing routine on table cholangiogram (r-OTC) during laparoscopic Cholecystectomy (LC) remains a subject of debate. Advocates for r-OTC highlight the potential to reduce the risk of Injury to the common bile duct (CBD) in addition to visualising the biliary tree and facilitating the management of ductal stones. Aim: Based in a University teaching hospital performing r-OTC in all LC we aimed to test the hypothesis that r-OTC reduces the risk of CBD injury and improves the overall management of gallstone disease. Methods: We audited the results of r-OTC over a two year period (October 2013 to September 2015) the data was collected using the hospital coding system in addition to the operating theatre database. Data collection included diagnosis, emergency vs elective surgery, pre-operative radiological findings, liver function tests, operative findings, post-operative complications and the need for endoscopic retrograde cholangio-pancreatography following surgery (ERCP). Results: A total of 1005 patients (75.1% female, mean age 51) were included. 836 (83.2%) LC were performed electively compared to 169 (16.8%) emergency operations. There was no CBD injury in our study population. 4 (0.4%) cases were converted to open cholecystectomy. R-OTC showed ductal stones in 101 patients (10.1%) of which 86 (85.2%) patients underwent a CBD exploration and stone extraction during the same operation. Out of the remaining 15 patients with ductal stones 3 were managed by ERCP and 12 patients were successfully managed conservatively. In our study population there were only 3 (0.3%) re-admissions to the hospital with retained CBD stones. 6 patients (0.6%) returned to theatre for post-op complications (4 post-operative bleeding, 1 bile leak, 1 port site hernia). Conclusion: Our study suggests that high volume r-OTC is associated with a low of risk of bile duct injury and can be performed safely in emergency as well as elective patients. It also demonstrates the use of r-OTC in ductal stone detection and hence
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