Extrahepatic ducts neoplasms are correlating with higher incidence of post endoscopic retrograde...
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PI-42 Abstract id: 35. Acute pancreatitis in obese patients Serge Chooklin, Mariya Shavarova. Medical University, Lviv, Ukraine Introduction: Obesity increases severity of acute pancreatitis by un- clear mechanisms. Recent clinical studies demonstrate that all major complications are more common and more severe in patients who are obese. Patients with higher body mass index have increased risk of local and systemic complications of acute pancreatitis and patients with android fat distribution and higher waist circumference are at greater risk for developing the severe acute pancreatitis (SAP). Aims: We investigated the relationship between visceral adipose tissue and acute pancreatitis. Patients & methods: We examined 13 patients with acute pancreatitis. In 6 patients BMI was more 30. Computed tomography was performed in all patients. Results: Pancreatitis induces the activation of peritoneal macrophages and a strong inflammatory response in mesenteric sites of adipose tissue. In obese humans, we found that an increase in the volume of intra- pancreatic adipocytes was associated with more extensive pancreatic ne- crosis during acute pancreatitis and that acute pancreatitis was associated with multisystem organ failure in obese individuals. Patients with SAP had higher BMIs and more intrapancreatic fat than those with mild AP. Conclusion: The results confirm the involvement of adipose tissue on the progression of systemic inflammatory response during acute pancre- atitis. However, there is a considerable diversity in different adipose tissue sites. These differences need to be taken into account in order to under- stand the progression from local pancreatic damage to systemic inflam- mation during acute pancreatitis. Therapeutic approaches that target unsaturated fatty acid-mediated lipotoxicity may reduce adverse out- comes in obese patients with critical illnesses such as severe acute pan- creatitis. PI-43 Abstract id: 324. Extrahepatic ducts neoplasms are correlating with higher incidence of post endoscopic retrograde cholangiopancreatograpy pancreatitis Goran Hauser, Marko Milosevic, Goran Poropat, Nikolina Benic, Davor Stimac. KBC Rijeka, Croatia Introduction: Post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retro- grade cholangiopancreatography (ERCP). Causes of PEP are not completely established but there are several risk factors. Aims: The aim of this study was to investigate correlation between various diagnoses and occurrence of PEP. Patients & methods: All patients with indication for ERCP at our ter- tiary care center from January to December 2012 were included. All pa- tients received diclophenac sodium suppositories immediately before procedure. We used Spearman correlation coefficient in order to detect possible significant correlation. 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 26.00 min. Among others, the most common reasons for ERCP were choledocholithiasis (57.6%) and pancreatic carcinoma (12.9%). We found significant correlation of PEP only with extrahepatic ducts neoplasms, r¼0.185, p<0.05.There were no correlation among PEP and pancreatic carcinoma, choledocholithiasis, acute or chronic pancreatitis. Conclusion: Extrahepatic ducts malignancies are correlated with higher incidence of possibly due to difficult cannulation and prolonged procedure. PI-44 Abstract id: 298. Acute pancreatitis and the role of BISAP score in the early prediction of severity and mortality in acute pancreatitis Floreta Kurti 1 , Dorina Osmanaj 2 , Jovan Basho 2 , Adriana Babamento 2 . 1 F1. Faculty of Medical Technical Sciences, Medical University of Tirana, Tirana, Albania 2 Service of Gastroenterology&Hepatology, University Hospital Centre Mother Teresa Tirana, Albania, Albania Introduction: Acute pancreatitis (AP) is a sudden inflammation of the pancreas. A variety of scoring systems are available to evaluate the severity of AP. Aims: To evaluate the accuracy of bedside index for severity in acute pancreatitis (BISAP) in predicting the severity and prognosis of AP. Patients & methods: We retrospectively studied 109 cases admitted at the UHC during one year. AP was classified as mild or severe according to the 1992 Atlanta classification. BISAP was calculated using data within the first 24 hours following admission, and the Ranson score was calculated using data from the first 48 hours following admission; CTSI score within 3 days following symptom presentation. Results: We had 78 males (71.56%) and 31 females (28.44%), mean age 43.74 Std þ_ 12.05 years. 84 patients (77.06%) had mild AP (MAP), while 22 patients (20.18%) had severe AP(SAP),3 patients died (2.75%). We found significant correlations between the scores of any two systems. BISAP performed similarly to other scoring systems in predicting SAP, pancreatic necrosis, mortality, and organ failure in SAP patients, in terms of the area under the receiver-operating characteristic curve. Conclusion: We compared BISAP scores with Ranson, and CTSI scores (when applicable) in predicting the severity and prognoses of AP in our patients. We demonstrated that BISAP has the advantages of simplicity and speed over traditional scoring systems and performed similarly to other scoring systems in predicting SAP and the prognoses of SAP. We confirmed that the BISAP score is an accurate method for risk stratification and pre- diction of prognosis in patients with AP. PI-45 Abstract id: 166. Acute necrotizing pancreatitis model Viktor Gorsky, Mikhail Agapov, Marina Khoreva, Igor Leonenko. Russian Pancreatic Club, Russia Introduction: There is no model that would ideally represent AP in humans. Since “cytokine storm” plays an important role in AP pathogen- esis, cytokine hyperproduction should be one of the factors of the exper- imental model. Aims: To develop the acute necrotizing pancreatitis model character- ized by increased cytokine levels in the peripheral blood. Patients & methods: 60 male outbred CD rats. Two models (cerulein-, alcohol-induced) were tested with no positive results. We proposed our own mechanical model. The cerulein-induced model included intreperitoneal injection of ~ Nerulein solution. The alcohol-induced AP was obtained by continuous administration of 10% ethyl alcohol solution. The mechanical model constituted a partial stenosis of the common bile duct. 9 rats were given 40 mg/kg cerulein as an additional pancreatitis inducer. Blood test for amylase, AST, ALT, and cytokines levels; tissue samples histological examination. Results: Cytokine levels in the intact animals group were used as a reference. No cases of pancreatic necrosis were observed after the cerulein and alcohol administration. These models were not associated with sta- tistically significant increase of cytokine levels. Increased IL-6 level (224.245 pg/ml) was observed only with alco- holþcerulein combination. The mechanical model demonstrated morphological signs of marked inflammatory and necrotic lesions of the pancreatic tissue in all animals. The additional cerulein administration led Abstracts / Pancreatology 13 (2013) S2–S98 S32
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PI-42 Abstract id: 35.
Acute pancreatitis in obese patients
Serge Chooklin, Mariya Shavarova.
Medical University, Lviv, Ukraine
Introduction: Obesity increases severity of acute pancreatitis by un-clear mechanisms. Recent clinical studies demonstrate that all majorcomplications are more common and more severe in patients who areobese. Patients with higher body mass index have increased risk of localand systemic complications of acute pancreatitis and patients withandroid fat distribution and higher waist circumference are at greater riskfor developing the severe acute pancreatitis (SAP).
Aims:We investigated the relationship between visceral adipose tissueand acute pancreatitis.
Patients &methods:We examined 13 patients with acute pancreatitis.In 6 patients BMI was more 30. Computed tomography was performed inall patients.
Results: Pancreatitis induces the activation of peritoneal macrophagesand a strong inflammatory response in mesenteric sites of adipose tissue.In obese humans, we found that an increase in the volume of intra-pancreatic adipocytes was associated with more extensive pancreatic ne-crosis during acute pancreatitis and that acute pancreatitis was associatedwith multisystem organ failure in obese individuals. Patients with SAP hadhigher BMIs and more intrapancreatic fat than those with mild AP.
Conclusion: The results confirm the involvement of adipose tissue onthe progression of systemic inflammatory response during acute pancre-atitis. However, there is a considerable diversity in different adipose tissuesites. These differences need to be taken into account in order to under-stand the progression from local pancreatic damage to systemic inflam-mation during acute pancreatitis. Therapeutic approaches that targetunsaturated fatty acid-mediated lipotoxicity may reduce adverse out-comes in obese patients with critical illnesses such as severe acute pan-creatitis.
PI-43 Abstract id: 324.
Extrahepatic ducts neoplasms are correlating with higher incidenceof post endoscopic retrograde cholangiopancreatograpy pancreatitis
Goran Hauser, Marko Milosevic, Goran Poropat, Nikolina Benic, DavorStimac.
KBC Rijeka, Croatia
Introduction: Post endoscopic retrograde cholangiopancreatographypancreatitis (PEP) is the most common complication of endoscopic retro-grade cholangiopancreatography (ERCP). Causes of PEP are not completelyestablished but there are several risk factors.
Aims: The aim of this study was to investigate correlation betweenvarious diagnoses and occurrence of PEP.
Patients & methods: All patients with indication for ERCP at our ter-tiary care center from January to December 2012 were included. All pa-tients received diclophenac sodium suppositories immediately beforeprocedure. We used Spearman correlation coefficient in order to detectpossible significant correlation.
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 � 26.00 min. Among others, the mostcommon reasons for ERCP were choledocholithiasis (57.6%) and pancreaticcarcinoma (12.9%). We found significant correlation of PEP only withextrahepatic ducts neoplasms, r¼0.185, p<0.05.There were no correlationamong PEP and pancreatic carcinoma, choledocholithiasis, acute orchronic pancreatitis.
Conclusion: Extrahepatic ducts malignancies are correlated withhigher incidence of possibly due to difficult cannulation and prolongedprocedure.
Abstracts / PancreatS32
PI-44 Abstract id: 298.
Acute pancreatitis and the role of BISAP score in the early predictionof severity and mortality in acute pancreatitis
Floreta Kurti 1, Dorina Osmanaj 2, Jovan Basho 2, Adriana Babamento 2.
1 F1. Faculty of Medical Technical Sciences, Medical University ofTirana, Tirana, Albania2 Service of Gastroenterology&Hepatology, University Hospital CentreMother Teresa Tirana, Albania, Albania
Introduction: Acute pancreatitis (AP) is a sudden inflammation of thepancreas. A variety of scoring systems are available to evaluate the severityof AP.
Aims: To evaluate the accuracy of bedside index for severity in acutepancreatitis (BISAP) in predicting the severity and prognosis of AP.
Patients &methods:We retrospectively studied 109 cases admitted atthe UHC during one year. AP was classified as mild or severe according tothe 1992 Atlanta classification. BISAP was calculated using data within thefirst 24 hours following admission, and the Ranson score was calculatedusing data from the first 48 hours following admission; CTSI score within 3days following symptom presentation.
Results: We had 78 males (71.56%) and 31 females (28.44%), mean age43.74 Stdþ_ 12.05 years. 84 patients (77.06%) had mild AP (MAP), while 22patients (20.18%) had severe AP(SAP),3 patients died (2.75%). We foundsignificant correlations between the scores of any two systems. BISAPperformed similarly to other scoring systems in predicting SAP, pancreaticnecrosis, mortality, and organ failure in SAP patients, in terms of the areaunder the receiver-operating characteristic curve.
Conclusion: We compared BISAP scores with Ranson, and CTSI scores(when applicable) in predicting the severity and prognoses of AP in ourpatients. We demonstrated that BISAP has the advantages of simplicity andspeed over traditional scoring systems and performed similarly to otherscoring systems in predicting SAP and the prognoses of SAP. We confirmedthat the BISAP score is an accurate method for risk stratification and pre-diction of prognosis in patients with AP.
PI-45 Abstract id: 166.
Acute necrotizing pancreatitis model
Viktor Gorsky, Mikhail Agapov, Marina Khoreva, Igor Leonenko.
Russian Pancreatic Club, Russia
Introduction: There is no model that would ideally represent AP inhumans. Since “cytokine storm” plays an important role in AP pathogen-esis, cytokine hyperproduction should be one of the factors of the exper-imental model.
Aims: To develop the acute necrotizing pancreatitis model character-ized by increased cytokine levels in the peripheral blood.
Patients & methods: 60 male outbred CD rats. Two models (cerulein-,alcohol-induced) were tested with no positive results. We proposed ourown mechanical model.
The cerulein-induced model included intreperitoneal injection of~Nerulein solution. The alcohol-induced AP was obtained by continuousadministration of 10% ethyl alcohol solution. The mechanical modelconstituted a partial stenosis of the common bile duct. 9 rats were given 40mg/kg cerulein as an additional pancreatitis inducer.
Blood test for amylase, AST, ALT, and cytokines levels; tissue sampleshistological examination.
Results: Cytokine levels in the intact animals group were used as areference. No cases of pancreatic necrosis were observed after the ceruleinand alcohol administration. These models were not associated with sta-tistically significant increase of cytokine levels.
Increased IL-6 level (224.24�5 pg/ml) was observed only with alco-holþcerulein combination. The mechanical model demonstratedmorphological signs of marked inflammatory and necrotic lesions of thepancreatic tissue in all animals. The additional cerulein administration led
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