Cholestasis is independent risk factor for post endoscopic retrograde cholangiopancreatography...
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predictive serologic markers of AP severity, however, this characteristic remains controversial. BISAP score presents effective predictive value similar to APACHE II. Aims: Determine the value of Procalcitonin, Antithrombin III and BISAP score as prognostic factors in early risk stratification of severe AP. Patients & methods: Prospective study included 81 patients (16% with severe AP). In the first 24h and 48h of admission the procalcitonin, anti- thrombin III serum concetrations and BISAP score were determined. Results: A total of 81 patients were included (51% males) with a median age of 64.42 years. Etiology: 60.2% biliary, 19.8% alcoholic, 2,6% post-ERCP, 3.8% toxic, 1.2% autoimmune, 1.2% hereditary, 1.2% anatomic, 1.2% traumatic and 8.7% idiopathic. According to Atlanta Classification 84% were mild and 16% presented severe AP. 96.1% had no complications, there were 4 deaths from serious systemic complications. There was correlation between Procalcitonin and BISAP score and the severity of AP on admission (p¼0.008 and p¼0.002, respectively). BISAP score correlated with com- plications of AP (p¼0.019 on admission and p¼0.001 at 48h). Antithrombin III (p¼0.049) and BISAP score (p¼0.009) showed correlations with the mortalility (serious systemic complications). Conclusion: In our experience, Procalcitonin and BISAP score showed to be good early predictors of severe AP on admission and Antithrombin III in prediction of fatal outcome. PI-54 Abstract id: 293. Usefulness of serum calprotectin in the determination of the severity of acute pancreatitis Viktoria Terzin, Imre F€ oldesi, Rich ard R oka, Zolt an Szepes, Tibor Wittmann, L aszl o Czak o. Hungary Introduction: Calprotectin (Cal) is a calcium-binding protein secreted predominantly by neutrophils and monocytes. Serum Cal is thought not to be a useful marker for early prediction of severity of pancreatitis. Aims: To evaluate the role of serum Cal in the prediction of infected acute necrotizing pancreatitis. Patients & methods: Between November 2011 and December 2012 patients with acute necrotizing pancreatitis admitted to our clinic were recruited. Additionally positive controls with edematous pancreatitis and healthy negative controls were enrolled into the study. Serum samples were prospectively taken for the measurement of Cal, procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) count. Results: 13 patients with acute necrotizing pancreatitis were recruited in the study (11 male, 2 female, mean age: 50.318.8y). The serum Cal level on the first day of admission differed significantly between the groups of infected necrosis and necrotizing acute pancreatitis (p<0.006) and between the group of infected necrosis and acute edematous pancreatitis (p<0.03); however there was no significant difference between necrotizing acute pancreatitis and edematous acute pancreatitis. Analyzing the time-course changes of the in- flammatory parameters, in 70% of the cases Cal was the marker which elevated first. In 86% of the patients Cal elevation was followed by the increase in CRP level, while WBC count and/or PCT were slightly elevated or normal. Conclusion: Serum Cal is elevated in acute pancreatitis, but it is not able to differentiate between edematous and necrotizing pancreatitis. Cal determination may be a useful marker to predict infected necrosis. Further cases are needed to evaluate its role in the diagnosis. PI-55 Abstract id: 339. Cholestasis is independent risk factor for post endoscopic retrograde cholangiopancreatography pancreatitis? Goran Hauser, Marko Milosevic, Vanja Giljaca, Nikolina Benic, Davor Stimac. KBC Rijeka, Department of gastroenterology, Rijeka, Croatia Introduction: Acute pancreatitis is the most common major compli- cation of endoscopic retrograde cholangiopancreatography (ERCP). Its incidence has substantial variations ranging from 5,1% to more than 25% of all ERCP procedures. In some cases pancreatitis is followed by severe course with pancreatic necrosis and multiorgan failure. Risk factors for post ERCP pancreatitis (PEP) are not well established. Aims: We aimed to correlate influence of cholestatic parameters, eg total bilirubin, gamma-glutamyl transpeptidase (GGT), alkaline phos- phatase (AP) and liver transaminases (AST and ALT) on development of PEP. Patients & methods: During 2012 at the setting of tertiary care center, we conducted prospective study that included in-patients scheduled for ERCP. We recorded maximal values of above mentioned laboratory values before procedure and calculated correlation using t-test for independent samples. All patients received diclophenac sodium suppositories imme- diately before ERCP. Results: We included total number of 169 patients, 94 males (55%) and 75 females (45%), mean age was 70.58 13.77 years. We observed PEP in 24 out of 169 patients (14%), 13 males (54.2%) and 11 females (45.8%). Mean duration of procedure was 45 26.00min. Mean values of bilirubin in the PEP patients was 193 31.22 mmol/l. We found significant positive cor- relation between level of total bilirubin, t (df¼ 2.167; 1.93) p< 0.05 and GGT t (df 2.167; 2.35) p<0.02 with occurrence of PEP. There is no corre- lation between AP and incidence of PEP, t (df 2.167; -0.106). Conclusion: Higher values of cholestatic markers observed in patients who developed PEP may be independent predictor for development of PEP. PI-56 Abstract id: 221. Management of pancreatic pseudocysts - a single center experience- Category: Clinical science - chronic pancreatitis. Ivana Pavlovic 1 , Djordje Knezevic 1 , Marko Bogdanovic 1 , Slavko Matic 1 , Dragan Vasin 2 , Sanja Jovanovic 2 , Slavenko Ostojiaz 1 , Igor Ignjatovi c 1 , Zoran Djordjevic 1 , Srbislav Knezevic 1 . 1 Department for HPB Surgery, First University Surgical Hospital, Clinical Centre of Serbia, Belgrade, Serbia 2 Department of Radiology, First Univrsity Surgical Hospital, Clinical Centre of Serbia, Belgrade, Serbia Introduction: A pancreatic pseudocyst is a collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue located in the lesser sac of the abdomen, and is usually complications of pancreatitis. Treatment of pancreatic pseudocysts can be obtained either by surgical or percutaneuos procedures. Aims: Compare patients and outcome between surgicaly and non- surgically managed patients with pancreatic pseudocysts during 3 year period. Patients & methods: During the period from 2009 to 2012, a total of 83 patients were treated for pancreatic pseudocysts at First University Sur- gical Hospital, Clinical Centre of Serbia with surgical or percutaneous drainage procedures. They were retrospectively reviewed and followed up. There were 68% men (mean age 58,3 years). Data on demographics, clinical presentation, pseudocyst etiology and characteristics, diagnostic evalua- tion, management and outcome were obtained. Results: Dominating symptoms in most patients were epigastric pain, palpable mass, nausea, vomiting, fever and leukocytosis, and persistent elevation of serum amylase levels. Imaging studies, such as ultrasound, MDCT scan, MRCP and ERCP were used in establishing the diagnosis. Twenty patients were treated with percutaneous drainage procedures, with a 50% treatment failure. The rest 63 patients were treated surgically with internal drainage by using pseudocystojejunostomy. Patients treated by percutaneous drainage had a higher incidence or complications (50% vs 7%), a longer hospital stay (34 þ/-5days vs 11þ/-3days) and a higher morbidity rate. Conclusion: We determined that percutaneous drainage is less favourable procedure with high failure rate in comparison with conven- tional surgery as it resulted in longer hospital stay, higher morbidity rates and higher overall incidence of complications. Abstracts / Pancreatology 13 (2013) S2–S98 S35
Transcript of Cholestasis is independent risk factor for post endoscopic retrograde cholangiopancreatography...
Abstracts / Pancreatology 13 (2013) S2–S98 S35
predictive serologic markers of AP severity, however, this characteristicremains controversial. BISAP score presents effective predictive valuesimilar to APACHE II.
Aims: Determine the value of Procalcitonin, Antithrombin III and BISAPscore as prognostic factors in early risk stratification of severe AP.
Patients &methods: Prospective study included 81 patients (16% withsevere AP). In the first 24h and 48h of admission the procalcitonin, anti-thrombin III serum concetrations and BISAP score were determined.
Results: A total of 81 patients were included (51%males) with amedianage of 64.42 years. Etiology: 60.2% biliary, 19.8% alcoholic, 2,6% post-ERCP,3.8% toxic, 1.2% autoimmune, 1.2% hereditary, 1.2% anatomic, 1.2% traumaticand 8.7% idiopathic. According to Atlanta Classification 84% were mild and16% presented severe AP. 96.1% had no complications, there were 4 deathsfrom serious systemic complications. There was correlation betweenProcalcitonin and BISAP score and the severity of AP on admission(p¼0.008 and p¼0.002, respectively). BISAP score correlated with com-plications of AP (p¼0.019 on admission and p¼0.001 at 48h). AntithrombinIII (p¼0.049) and BISAP score (p¼0.009) showed correlations with themortalility (serious systemic complications).
Conclusion: In our experience, Procalcitonin and BISAP score showedto be good early predictors of severe AP on admission and Antithrombin IIIin prediction of fatal outcome.
PI-54 Abstract id: 293.
Usefulness of serum calprotectin in the determination of the severityof acute pancreatitis
Viktoria Terzin, Imre F€oldesi, Rich�ard R�oka, Zolt�an Szepes, TiborWittmann, L�aszl�o Czak�o.
Hungary
Introduction: Calprotectin (Cal) is a calcium-binding protein secretedpredominantly by neutrophils and monocytes. Serum Cal is thought not tobe a useful marker for early prediction of severity of pancreatitis.
Aims: To evaluate the role of serum Cal in the prediction of infectedacute necrotizing pancreatitis.
Patients & methods: Between November 2011 and December 2012patients with acute necrotizing pancreatitis admitted to our clinic wererecruited. Additionally positive controls with edematous pancreatitis andhealthy negative controls were enrolled into the study. Serum sampleswere prospectively taken for the measurement of Cal, procalcitonin (PCT),C-reactive protein (CRP) and white blood cell (WBC) count.
Results: 13 patients with acute necrotizing pancreatitis were recruited inthe study (11 male, 2 female, mean age: 50.3�18.8y). The serum Cal level onthefirst day of admission differed significantly between the groups of infectednecrosis and necrotizing acute pancreatitis (p<0.006) and between the groupof infected necrosis and acute edematous pancreatitis (p<0.03); howevertherewasno significant differencebetweennecrotizing acute pancreatitis andedematous acute pancreatitis. Analyzing the time-course changes of the in-flammatory parameters, in 70% of the cases Cal was the marker whichelevatedfirst. In 86% of the patients Cal elevationwas followed by the increasein CRP level, while WBC count and/or PCT were slightly elevated or normal.
Conclusion: Serum Cal is elevated in acute pancreatitis, but it is notable to differentiate between edematous and necrotizing pancreatitis. Caldetermination may be a useful marker to predict infected necrosis. Furthercases are needed to evaluate its role in the diagnosis.
PI-55 Abstract id: 339.
Cholestasis is independent risk factor for post endoscopic retrogradecholangiopancreatography pancreatitis?
Goran Hauser, Marko Milosevic, Vanja Giljaca, Nikolina Benic, DavorStimac.
KBC Rijeka, Department of gastroenterology, Rijeka, Croatia
Introduction: Acute pancreatitis is the most common major compli-cation of endoscopic retrograde cholangiopancreatography (ERCP). Itsincidence has substantial variations ranging from 5,1% to more than 25% ofall ERCP procedures. In some cases pancreatitis is followed by severecourse with pancreatic necrosis and multiorgan failure. Risk factors forpost ERCP pancreatitis (PEP) are not well established.
Aims: We aimed to correlate influence of cholestatic parameters, egtotal bilirubin, gamma-glutamyl transpeptidase (GGT), alkaline phos-phatase (AP) and liver transaminases (AST and ALT) on developmentof PEP.
Patients & methods: During 2012 at the setting of tertiary care center,we conducted prospective study that included in-patients scheduled forERCP. We recorded maximal values of above mentioned laboratory valuesbefore procedure and calculated correlation using t-test for independentsamples. All patients received diclophenac sodium suppositories imme-diately before ERCP.
Results:We included total number of 169 patients, 94 males (55%) and75 females (45%), mean age was 70.58 � 13.77 years. We observed PEP in24 out of 169 patients (14%), 13males (54.2%) and 11 females (45.8%). Meanduration of procedure was 45 � 26.00min. Mean values of bilirubin in thePEP patients was 193 � 31.22 mmol/l. We found significant positive cor-relation between level of total bilirubin, t (df¼ 2.167; 1.93) p< 0.05 andGGT t (df 2.167; 2.35) p<0.02 with occurrence of PEP. There is no corre-lation between AP and incidence of PEP, t (df 2.167; -0.106).
Conclusion: Higher values of cholestatic markers observed in patientswho developed PEPmay be independent predictor for development of PEP.
PI-56 Abstract id: 221.
Management of pancreatic pseudocysts - a single center experience-Category: Clinical science - chronic pancreatitis.
Ivana Pavlovic 1, Djordje Knezevic 1, Marko Bogdanovic 1, SlavkoMatic 1, Dragan Vasin 2, Sanja Jovanovic 2, Slavenko Ostojiaz 1, IgorIgnjatovi�c 1, Zoran Djordjevic 1, Srbislav Knezevic 1.
1Department for HPB Surgery, First University Surgical Hospital,Clinical Centre of Serbia, Belgrade, Serbia2Department of Radiology, First Univrsity Surgical Hospital, ClinicalCentre of Serbia, Belgrade, Serbia
Introduction: A pancreatic pseudocyst is a collection of fluid rich inpancreatic enzymes, blood, and necrotic tissue located in the lesser sac ofthe abdomen, and is usually complications of pancreatitis. Treatment ofpancreatic pseudocysts can be obtained either by surgical or percutaneuosprocedures.
Aims: Compare patients and outcome between surgicaly and non-surgically managed patients with pancreatic pseudocysts during 3 yearperiod.
Patients &methods:During the period from 2009 to 2012, a total of 83patients were treated for pancreatic pseudocysts at First University Sur-gical Hospital, Clinical Centre of Serbia with surgical or percutaneousdrainage procedures. Theywere retrospectively reviewed and followed up.Therewere 68%men (mean age 58,3 years). Data on demographics, clinicalpresentation, pseudocyst etiology and characteristics, diagnostic evalua-tion, management and outcome were obtained.
Results: Dominating symptoms in most patients were epigastric pain,palpable mass, nausea, vomiting, fever and leukocytosis, and persistentelevation of serum amylase levels. Imaging studies, such as ultrasound,MDCT scan, MRCP and ERCP were used in establishing the diagnosis.Twenty patients were treated with percutaneous drainage procedures,with a 50% treatment failure. The rest 63 patients were treated surgicallywith internal drainage by using pseudocystojejunostomy. Patients treatedby percutaneous drainage had a higher incidence or complications (50% vs7%), a longer hospital stay (34 þ/-5days vs 11þ/-3days) and a highermorbidity rate.
Conclusion: We determined that percutaneous drainage is lessfavourable procedure with high failure rate in comparison with conven-tional surgery as it resulted in longer hospital stay, higher morbidity ratesand higher overall incidence of complications.
