Abstracts / Pancreatology 13 (2013) e1–e19 e7

the third indication for surgery in our center. Predominated in womenwith a ratio 6:4 and the average age was 68 years. The DPC with pylo-roplasty (5 cases) was the most common procedure, followed by 3 distalpancreatectomy (associated with splenectomy) and 2 total pancreatec-tomy. In one case it was not possible infiltration surgery. Of the 10completed resections, the 80% were R0. In a patient’s resected, there wasmicroscopic infiltration and the other remaining macroscopic vascularinvolvement. Almost 50% of patients were resected adenomas at histology,36.4% borderline tumors and in one case was confirmed malignancy.Postoperative morbidity was 36.4% (4 patients) and one patient died in thepostoperative by portal vein thrombosis. The average stay in the ICU was10 days and the total hospital stay was of 22 days.

Conclusions: The IPMN is an increasing problem in pancreatic surgeryunits. Diagnosis and a recent classification makes it an unknown entityrather uncommon. A high clinical suspicion and imaging techniques areessential for diagnosis. The indication for surgery is determined by thepotential injury risk of malignancy, where pancreatic resection plays a role.

P6.

Surgical results of cephalic pancreatoduodenectomy in patients over75 years

C. Rodríguez-Otero Luppi, M. Rodríguez Blanco, V. Artigas Ravent�os, J.A.Gonz�alez L�opez, G. Cerd�an Riart, M. Trias.

Unitat Cirurgia HBP-Oncol�ogica, Servei Cirurgia General i Digestiva,Hospital de la Santa Creu i Sant Pau, Universitat Autonoma Barcelona,Spain

Introduction: Therise in life expectancy entails higher number ofrespectable periampullary tumors in operable patients, being the cephalicpancreatoduodenectomy (DPC) in most cases, the only effective treatmentfor these patients.

Material and methods:In a 7 year period (2006-2012) 116 DPC wereperformed for periampullary tumors, being 52,5% of them pancreatic ad-enocarcinomas. Patients were divided in 2 groups according to age: group1 (patients under 75 years; n¼78) and group 2 (patients equal or greaterthan 75 years; n¼38) and perioperative mortality and morbidity werecompared between groups.

Results: The elderly group presents higher number of comorbidity(ASA II-III). Intraoperative, this same group presents higher incidence ofbleeding and transfusional need. Also, in group 2, the hospital length ofstay was longer, higher perioperative mortality was seen(18,4% vs 3,8%),higher number of reinterventions, postoperative complications (pancre-atic fistula and delayed gastric emptying) and medical complications.

Conclusions: Besides the high mortality and morbidity observed, DPCis still the only chance of cure for elderly patients with periampullary tu-mors. In the future, a better selection of these “fragile” patientswill be thekey of success for improve surgical results.

P7.

Pancreatic glucagonoma: A case report

M. Garay Sol�a, M. Rodríguez Blanco, J.A. Gonz�alez L�opez, G. CerdanRiart, J. Cadafalch Arpa, V. Artigas Ravent�os, M. Trias.

HBP-Oncologic Surgery Unit, General and Digestive SurgeryDepartment, Hospital Santa Creu i Sant Pau, Universitat Aut�onomaBarcelona, Spain

Objectives: Glucagonoma (GC) is a rare neuroendocrine pancreatictumor (1case/20 million) with systemic manifestations due to the secre-tion of glucagon.

Methods: A 63-year-old man with history of insulin-dependent DM,Fanconi syndrome and liver disease of unknown etiology, with emergingfatigue, cognitive impairment and pruritic skin eruption in lowerextremity.

Results: Anemia, glucosuria and proteinuria since 2002 (Fanconi syn-drome).Perivascular chronic nonspecific dermatitis in skin biopsies. CTdetected a solid tumor in pancreatic tail (88x58mm), an intraductal cystic

tumor (IPMT) and liver metastasis in segment VI. The positive Octreoscan,the positive chromogranin A (> 1000 mg/L) and glucagon levels (> 300 pg/ml) induced the diagnosis of GC. Total pancreatectomyandmetastasectomywas performed. The pathological study showed a neuroendocrine carci-noma (10x8.5cm) well-differentiated glucagon-positive. The cystic lesionconfirmed an IPMT. Liver injury corresponded to metastatic NETs.

Conclusion: GC is a rare alpha-cell tumor of the pancreatic islets ofLangerhans, with a characteristic clinical features by hypersecretion ofglucagon. This tumor has a high malignant potential (85% cases of me-tastases at diagnosis). The definitive diagnosis is given by pathologicconfirmation after radical surgery.

P8.

Pancreas giants mucinous cystoadenoma

F. Z�arate Moreno, R. Mato Ruiz, Ll Oms Bernard, A. Alzaga Maga~na,J. Pedr�os-Sala, F. Campillo Alonso.

Consorci Sanitari Terrassa, Spain

Objective: Diagnostic process, treatment and evolution of the pancreasgiant mucinous cystoadenoma in 2 patients.

Materials andmethods: We report 2 patients with tumors bigger than10 cm, diagnosed and treated in our hospital.

Results: Two women of forty years with palpable abdominal tumors,located in pancreatic body-tail. CT confirmed the diagnosis. Afterresection, the first patient had spleen preservation and benign diagnosisafter histological study. 16 months later, there was evidence of malig-nant disease progression with subsequent death. The second patient hadno signs of malignancy or tumoral recurrence 25 months after surgery.

Conclusions: The pancreas mucinous cystics neoplasms representnearly 50% of the pancreas cystics neoplasms. Within them, the mucinouscystadenoma is typical of women, and presence of ovarian stroma is arequirement for diagnosis. They contain mucin, septums and columnarepithelium that can be exposed discontinuously. That fact, combined withits large size, can confuse the histologic diagnosis, requiring great attentionto exclude invasive foci. Its treatment is surgery because of potential ma-lignant risk, seeking conservative excision surgery, if possible.

P9.

Development of a pancreas kidney transplant program: Evaluation ofthe influence of the learning curve. Results for 4 years

Alvaro Hern�andez P�erez, Esteban Velasco Carmen, Manuel Jos�e IglesiasIglesias, Luis Miguel Gonz�alez Fern�andez, Guadalupe TaberneroFern�andez, Pilar G�omez Fraile, Rosa Ana Iglesias L�opez, Luis Mu~nozBellvís.

Cirugía General y del Aparato Digestivo Complejo Asistencial deSalamanca, Spain

Introduction and objectives: The simultaneous pancreas-kidneytransplant (SPK) is the treatment of choice in patients with Type I DiabetesMellitus and advanced kidney failure. Interdisciplinary coordination,technical difficulties and fear of medical and surgical complications asso-ciated with the process, are, in many cases, major obstacles in the devel-opment of these programs. To this must be added the cost of thedevelopment of any new technique at a center in terms of learning curveand initial results. The main objective of this study is to present our 4 years’experience, andmake a comparison between our results and others groupsgreat experience.

Methods: A retrospective analysis by consulting prospective databasewas made. Descriptive statistics were presented along with analysis ofgraft survival and patient by KM curves. This statistics were compared tothe results published in international registrations. This study includes alltransplant patients from February 2009 to April 2013.

Results: We performed 30 transplants in SPK mode. The donor selec-tion criteria were: absence of personal / family history of DM, no history of

Abstracts / Pancreatology 13 (2013) e1–e19e8

surgery, trauma or pancreatitis acute or chronic, hemodynamic stability,weight over 30 kg and BMI <30, no previous history of alcoholism andabsence of infectious or transmissible tumor. The donor sample iscomposed of 16 males (53.3%) and 14 women (46’7%). The mean donor ageis 35.14 years (range 17-52 years). The main cause of death was acute ce-rebrovascular accident (13 patients) followed by head trauma (12 patients)

The receiver’s sample consisted of 26 males (86’67%) and 4 women(13’23%) with a mean age of 38.86 years (range 25-57 years). Allpatients received quadruple immunosuppression with thymoglobulinas induction and maintenance, tacrolimus, prednisone and micofeno-lato mofetil. Average cold ischemia time of the graft was 11 hours and40 minutes

Results: During the four years covered by this study, there was onedeath due to cardiac arrest

A total of three patients required reoperation (10%): a case of graftingperipancreatitis in fatty infiltration and two intestinal obstruction due toadhesions. In none of the patients vascular graft thrombosis occurred.

At 4 years, 29 patients were alive, all insulin-free with complete graftfunction and dialysis free.

Conclusion: The variety of SPK transplant is the treatment of choice inpatients with DM I in terminal renal failure. Our results allow us to affirmthat it is possible to start a program of this nature without having to pay ahigh morbidity and mortality associated with the learning curve

Endoscopy-Oncology

P10.

How and when should NSAIDs be used for preventing post-ERCPpancreatitis? A systematic review and meta-analysis

I. Puig 1, X. Calvet 2, M. Baylina 2, A. Isava 1, P. Sort 1, J. Lla�o 1, F. Porta 1, F. Vida 1.

1 Althaia Xarxa Assistencial i Universit�aria de Manresa, Spain2 Corporaci�o Sanit�aria Parc Taulí, Spain

Background: non-steroidal anti-inflammatory drugs (NSAIDs) mayhelp to prevent pancreatitis after ERCP. This study is aimed to evaluate itsefficacy by performing a systematic review and meta-analysis.

Methods: Multiple searches were performed in the main databases.Randomized controlled trials (RCTs) comparing NSAIDs vs. placebo in theprevention of post-ERCP pancreatitis were included. Primary endpoint ofthe study was pancreatitis prevention. Sub-analyses were performed todetermine the risk reduction in high and low risk patients, and to defineoptimal time, route of administration, and type of NSAID.

Results: Nine RCTs enrolling 2133 patients were included. The risk ofpancreatitis was lower in the NSAID group than in the placebo group (RR0.51; 95% CI 0.39-0.66). The number needed to treat was 14. The risk ofmoderate to severe pancreatitis was also lower in the NSAID group. (RR0.46; 95% CI 0.28-0.76). No adverse events related to NSAID use were re-ported. NSAIDs were effective in both high-risk and unselected patients.Rectal administration of both indomethacin and diclofenac, either beforeor after ERCP, was the only effective route.

Conclusion: A single rectal dose of indomethacin or diclofenac before orimmediately after the procedure is safe and prevents post-ERCP pancreatitis.

P11.

Early blood predictors for post-ERCP pancreatitis

M. Concepci�on Martín, C. Guarner-Argente, C. G�omez-Oliva, A. JuanesBorrego, X. Torras Colell, S. S�ainz S�aenz-Torre, A. Farr�e Viladrich, C.Guarner Aguilar.

Hospital de la Santa Creu i Sant Pau Barcelona, Spain

Objectives: Acute pancreatitis is the most frequent complication ofERCP. Nowadays, most of the procedures are performed in an outpatientbasis. For these reason we pretended to evaluate early blood marker topredict this complication.

Methods: All consecutive patients who underwent an ERCP at ourinstitution from May 2009 until February 2013 were screened for inclu-sion. We excluded patients with CRP higher than 10, acute pancreatitis,chronic pancreatitis or previous sphincterotomy. Blood tests were acquiredfor IL-6, IL-10, TNF�a, CRP, amylase and lipase measurement before and 4hours after the procedure.

Results: We included 228 patients, 24 with post-ERCP pancreatitis(10.5%). No differences were observed in IL-6, IL-10, TNF�a or CRP levelsbetween patients with or without post-ERCP pancreatitis. Amylase andlipase were the only early markers for pancreatitis. Amylase was 788 U/L(289-1752) vs 88 U/L (60-178), p<0.001. Lipasewas 2136 U/L (975-4936) vs57 U/L (28-208), p<0.001.

Conclusions: Elevated amylase and lipase levels 4 hours after ERCP canpredict the appearance of post-ERCP pancreatitis, whereas IL-6, IL-10, TNF�aand CRP levels are not useful as early markers.

P12.

Endoscopic ultrasonography in the diagnosis of pancreatic ’smetastases

M.L Legaz Huidobro, R. Villanueva Hernadez, E. T�ebar Romero, O. RonceroGarcia-Escribano, P. Gonzalez Carro, F. P�erez Rold�an, E. BernardosMartín, N. S�anchez-Manjavacas Mu~noz, S. Aoufi Rabih, C. NavarroLopez, F. Ruiz Carrillo.

Servicio de Aparato Digestivo. Hospital General La Mancha CentroAlcazar de San Ju�an. Ciudad Real, Spain

Introduction/objectives: Pancreatic focal lesions are usually causedby inflammatory processes or primary tumors, being less frequentpancreatic metastases, representing 3-4% of malignant tumors of thepancreas. In most of the cases are metachronous appearance andrelacci�on late in the diagnosis of primary tumor. Ultrasonographic fea-tures and cytological material obtained by needle aspiration guided byendoscopic ultrasonography (EUS-FNA) are useful in differentiating theselesions Submit nuetra casuistry diagnosed with metastatic pancreaticcytologic material obtained by fine needle aspiration guided tourecoendoscopia.

Methods: A retrospective study of cases diagnosed by EUS-FNA ofpancreatic metastases in our Endoscopy Unit from January 2007 to July2012.

Results: During the study period were performed 125 echoendos-copies with FNA on pancreatic focal lesions Were diagnosed 7 cases ofpancreatic metastases of different origin: melanoma, renal clear cell car-cinoma, small cell lung carcinoma, colon adenocarcinoma, breast carci-noma , ovarian cystadenocarcinoma and medullary thyroid carcinoma. Ofthe 7 patients included, 4 were men and 3 women, mean age 69 years(range 56-81). in all cases the time interval from primary tumor diagnosiswas long (1-14 years.) The location of the lesions was: 3 in Isthmus, 1 head,1 body, 1 tail and 1 case with head and body injuries. In 6 of the 7 patientsthe tumor was unique and March 1 were detected focal lesions. Mediansize of the lesions was 6, 4 cm (limits between 2.5 and 14 cm) from theviewpoint of ultrasound. 6 cases in these lesions were well defined anddelimited, 5 homogeneous solid appearance, iso or hypoechoic and onefibrosis. EUS-FNA needle G 22 and 25 yielded adequate material forcytological diagnosis in all cases, as well as immuno histochemical de-terminations in cases where it was necessary for the complete character-ization of the lesion.

Conclusions: In patients with history of neoplastic disease, theappearance of a mass in the pancreas, proposed as a possible diagnosis:metastatic lesion or a new (2�) primary tumor of the pancreas, which isimportant the correct diagnosis to select the best treatment for each case.EUS findings, although distinctly not reliably distinguish between a pri-mary or metastatic lesion of the pancreas, being necessary to obtain a