Why chronic pancreatitis is rare in chile?
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extracted and pooled to estimate sensitivity, specificity and diagnostic odds ratios using Bayesian Hierarchical Summary ROC methods. Data are pre- sented as portions s(95% Confidence Intervals). Results: Of 1373 studies, 55 were suitable for inclusion (37 cohort studies, 18 case-control) evaluating 27 different tests. Forty-five percent (2453/5441) of individuals had a diagnosis of CP; the prevalence of CP within cohort studies ranged from 0.12 to 0.94. Diagnostic sensitivity ranged from 0.12 to 1 and specificity from 0.16 to 1. Endoscopic ultrasound (EUS) was the most extensively evaluated diagnostic test being the focus of 16 studies, using different diagnostic models; however, EUS showed the highest pooled sensitivity at 0.90 (0.78,0.96). The accuracy of MR was improved by the addition of secretin: sensi- tivity 0.81 (0.66,0.9) vs. 0.83 (0.56,0.95); specificity 0.8 (0.61,0.91) vs. 0.89 (0.76,0.96). Conclusion: A wide range of tests for CP have been evaluated in het- erogeneous populations making comparison challenging. EUS and secretin MR show good sensitivity and specificity, but specific diagnostic parame- ters have to be defined to ensure optimum diagnostic utility. W-076. Why chronic pancreatitis is rare in chile? Zolt an Berger a , Carla Mancilla a , Watkins Guillermo b a University of Chile, Gastroenterology, Chile b University of Chile, Surgery, Chile Background: Chronic pancreatitis (CP) is considered a rare disease in several Latin-American countries. Genetic factors and dietary habits do not explain this observation. Our experience of 20 years was analyzed in order to describe characteristics of Chilean patients. Aims: To search for differences as compared to other countries. Patients & methods: All patients were evaluated by a member of our group. Morphological proof of diagnosis (calcifications/calculi, alterations of ducts, local complication or histology) was obtained in every patient. History of acute pancreatitis was recorded, exocrine-endocrine function assessed. Medical records were analyzed. Results: 105 patients suffering CP were identified: 75 males and 30 females. The number of cases diagnosed per 5 years period increased markedly, from 6 to 36.Pancreatic calcification was seen in 84 , calcification became evident later in 6 of 21 originally no calcified forms. Severe pain or local complications occurred in 26 patients, requiring surgery (9) or endo- scopic treatment (17). 47 patients were free of symptoms. Exocrine (58) and endocrine (50) insufficiency was demonstrated and treated. Alcoholic eti- ology was evident in no more than half of the patients, only 28 consumed more than 80g alcohol/day. During the follow-up, 13 patients died, 3 of them due to diabetes complications, the others for unrelated causes. Conclusion: Frequently asymptomatic CP patients rarely consult gas- troenterologists. Late diagnosis is common: most of our patients presented advanced CP. Even when CP is increasingly diagnosed in our hospitals, the number of cases still remains far less compared to other countries. Underdiagnosis does exist but it cannot explain this difference by itself. W-077. Difficulties in diagnostics of small intestinal bacterial overgrowth in patients with chronic pancreatitis Dmitry Bordin, Yuliya Osipenko, Irina Voynovan, Galina Varvanina, Svetlana Silvestrova Moscow Clinical Scientific Center, Russia Background: Literature data shown that small intestinal bacterial overgrowth (SIBO) can be detected in 40-66% of patients with chronic pancreatitis (CP). SIBO related to exocrine pancreatic dysfunction and stagnation or dysmotility of small intestinal. Aims: evaluation of different modalities in diagnostics of SIBO in patients with chronic pancreatitis. Patients & methods: 101 patients with CP have been involved in study (55 male & 46 female), mean age 54.7 ± 12.5 years. SIBO was detected clinically (bloating, abdominal dyscomfort, diarrhea), by faecal content and spectrum of short-chain fatty acids (SCFA), and by hydrogen breath test with lactulose (in 55 patients). Results: Clinical signs of SIBO were founded in 71 (70.3%) cases. Sig- nificant decrease of level of butyric acid (<2.5 micromole/l) were in 89 (88.1%) patients, common level of SCFA (<13.6 micromole /l) was found in 87 (86.1%) patients. Hydrogen breath test was negative in 62% and positive in 31%. Also 7% of patients were considered as methane-producers. Conclusion: We found big dispersion of results of detecting of SIBO in patients with chronic pancreatitis by different methods. W-078. Leiomyosarcoma of the pancreas: A rare primary pancreatic tumor Anna Caterina Milanetto a , Valbona Liço a , Lucia Moletta a , Stella Blandamura b , Claudio Pasquali a a Clinica Chirurigica III - University of Padua, Italy b Pathology - University of Padua, Italy Background: First described by Ross in 1951, primary pancreatic leio- myosarcoma (PLMS) is a rare mesenchymal tumor of the pancreas (0.1%), with not specific clinical and radiological features and a poor prognosis, if unresectable. Aims: To evaluate clinical features, imaging, surgery and histology of PLMS. Patients & methods: A 60-year-old woman presented with abdominal pain, but previous US were negative. Abdominal MRI and CT scan detected a dishomogeneous egg-shaped 8-centimeter-mass, arising from the pan- creatic head, with compression on the third duodenal part, without alter- ations of the Wirsung duct. 18F-FDG PET-CT showed a moderate tracer uptake, and the Endoscopic-US showed an ipoechoic dishomogeneous mass, with well-defined margins, apparently arising from the duodenal wall, then suspected to be a duodenal GIST (Gastro-Intestinal Stromal Tumor). Normal CEA, CA19-9, NSE and Chromogranin A. Results: Surgery: the 10-centimeter mass was totally excised. It was adherent to the anterior aspect of the pancreatic head, easily separable from the duodenal wall, and had a vascular pedicle draining into the gastro-colic trunk of Henle. Frozen intra-operative evaluation: mesenchimal tumor, with spindle-shaped cells, consistent with GIST. Uneventful post-operative course. Histology: well-differentiated leiomyosarcoma grade 2 (MIB-110%), with mitotic counts 5-6 per 10 HPF, negative CD117. Follow up: alive and asymptomatic after three months, without need for adjuvant therapy. Conclusion: In the English literature, only 64 cases of PLMS reported. The patients present mainly with abdominal pain and at imaging PLMS has a rare lymphatic spread. If a pancreatic mass suspected for PLMS has no adjacent organ/vessels invasion or distant metastases, surgical resection is the therapy of choice. W-079. Rare tumor of the pancreas - report of a case and review of the literature Tamas Marjai a , Balazs Tihanyi a , Laszlo Nehez a , Katalain Borka b , Marcell Szasz b , Jozsef Timar b , Laszlo Harsanyi a , Tibor Tihanyi a a 1st Department of Surgery, Semmelweis University, Budapest, Hungary, Hungary b 2nd Department of Pathology, Semmelweis University, Budapest, Hungary, Hungary Background: Among poorly differentiated carcinomas of the pancreas, the basaloid cell carcinoma is an extremely rare entity. It can occur on various anatomical sites, including breast, uterine cervix, prostate, lung, colon, esophagus, larynx and thymus. Aims: Our aim is to present a case, which represents the second documented example in the literature of the basaloid carcinoma of the pancreas. Abstracts / Pancreatology 14 (2014) S1eS129 S42
Transcript of Why chronic pancreatitis is rare in chile?
Abstracts / Pancreatology 14 (2014) S1eS129S42
extracted and pooled to estimate sensitivity, specificity and diagnostic oddsratios using Bayesian Hierarchical Summary ROC methods. Data are pre-sented as portions s(95% Confidence Intervals).
Results: Of 1373 studies, 55 were suitable for inclusion (37 cohortstudies, 18 case-control) evaluating 27 different tests. Forty-five percent(2453/5441) of individuals had a diagnosis of CP; the prevalence of CPwithin cohort studies ranged from 0.12 to 0.94. Diagnostic sensitivityranged from 0.12 to 1 and specificity from 0.16 to 1.
Endoscopic ultrasound (EUS) was the most extensively evaluateddiagnostic test being the focus of 16 studies, using different diagnosticmodels; however, EUS showed the highest pooled sensitivity at 0.90(0.78,0.96).
The accuracy of MR was improved by the addition of secretin: sensi-tivity 0.81 (0.66,0.9) vs. 0.83 (0.56,0.95); specificity 0.8 (0.61,0.91) vs. 0.89(0.76,0.96).
Conclusion: A wide range of tests for CP have been evaluated in het-erogeneous populations making comparison challenging. EUS and secretinMR show good sensitivity and specificity, but specific diagnostic parame-ters have to be defined to ensure optimum diagnostic utility.
W-076.
Why chronic pancreatitis is rare in chile?
Zolt�an Berger a, Carla Mancilla a, Watkins Guillermo b
a University of Chile, Gastroenterology, ChilebUniversity of Chile, Surgery, Chile
Background: Chronic pancreatitis (CP) is considered a rare disease inseveral Latin-American countries. Genetic factors and dietary habits do notexplain this observation. Our experience of 20 years was analyzed in orderto describe characteristics of Chilean patients.
Aims: To search for differences as compared to other countries.Patients & methods: All patients were evaluated by a member of our
group. Morphological proof of diagnosis (calcifications/calculi, alterationsof ducts, local complication or histology) was obtained in every patient.History of acute pancreatitis was recorded, exocrine-endocrine functionassessed. Medical records were analyzed.
Results: 105 patients suffering CP were identified: 75 males and 30females. The number of cases diagnosed per 5 years period increasedmarkedly, from 6 to 36.Pancreatic calcification was seen in 84 , calcificationbecame evident later in 6 of 21 originally no calcified forms. Severe pain orlocal complications occurred in 26 patients, requiring surgery (9) or endo-scopic treatment (17). 47 patients were free of symptoms. Exocrine (58) andendocrine (50) insufficiency was demonstrated and treated. Alcoholic eti-ology was evident in no more than half of the patients, only 28 consumedmore than 80g alcohol/day. During the follow-up,13 patients died, 3 of themdue to diabetes complications, the others for unrelated causes.
Conclusion: Frequently asymptomatic CP patients rarely consult gas-troenterologists. Late diagnosis is common: most of our patients presentedadvanced CP. Even when CP is increasingly diagnosed in our hospitals, thenumber of cases still remains far less compared to other countries.Underdiagnosis does exist but it cannot explain this difference by itself.
W-077.
Difficulties in diagnostics of small intestinal bacterial overgrowth inpatients with chronic pancreatitis
Dmitry Bordin, Yuliya Osipenko, Irina Voynovan, Galina Varvanina,Svetlana Silvestrova
Moscow Clinical Scientific Center, Russia
Background: Literature data shown that small intestinal bacterialovergrowth (SIBO) can be detected in 40-66% of patients with chronicpancreatitis (CP). SIBO related to exocrine pancreatic dysfunction andstagnation or dysmotility of small intestinal.
Aims: evaluation of different modalities in diagnostics of SIBO inpatients with chronic pancreatitis.
Patients &methods: 101 patients with CP have been involved in study(55 male & 46 female), mean age 54.7 ± 12.5 years. SIBO was detectedclinically (bloating, abdominal dyscomfort, diarrhea), by faecal content andspectrum of short-chain fatty acids (SCFA), and by hydrogen breath testwith lactulose (in 55 patients).
Results: Clinical signs of SIBO were founded in 71 (70.3%) cases. Sig-nificant decrease of level of butyric acid (<2.5 micromole/l) were in 89(88.1%) patients, common level of SCFA (<13.6 micromole /l) was found in87 (86.1%) patients. Hydrogen breath test was negative in 62% and positivein 31%. Also 7% of patients were considered as methane-producers.
Conclusion: We found big dispersion of results of detecting of SIBO inpatients with chronic pancreatitis by different methods.
W-078.
Leiomyosarcoma of the pancreas: A rare primary pancreatic tumor
Anna Caterina Milanetto a, Valbona Liço a, Lucia Moletta a, StellaBlandamura b, Claudio Pasquali a
a Clinica Chirurigica III - University of Padua, Italyb Pathology - University of Padua, Italy
Background: First described by Ross in 1951, primary pancreatic leio-myosarcoma (PLMS) is a rare mesenchymal tumor of the pancreas (0.1%),with not specific clinical and radiological features and a poor prognosis, ifunresectable.
Aims: To evaluate clinical features, imaging, surgery and histology ofPLMS.
Patients & methods: A 60-year-old woman presented with abdominalpain, but previous US were negative. Abdominal MRI and CT scan detecteda dishomogeneous egg-shaped 8-centimeter-mass, arising from the pan-creatic head, with compression on the third duodenal part, without alter-ations of the Wirsung duct. 18F-FDG PET-CT showed a moderate traceruptake, and the Endoscopic-US showed an ipoechoic dishomogeneousmass, with well-defined margins, apparently arising from the duodenalwall, then suspected to be a duodenal GIST (Gastro-Intestinal StromalTumor). Normal CEA, CA19-9, NSE and Chromogranin A.
Results: Surgery: the 10-centimeter mass was totally excised. It wasadherent to the anterior aspect of the pancreatic head, easily separable fromthe duodenal wall, and had a vascular pedicle draining into the gastro-colictrunkofHenle. Frozen intra-operative evaluation:mesenchimal tumor,withspindle-shaped cells, consistent with GIST. Uneventful post-operativecourse. Histology: well-differentiated leiomyosarcoma grade 2 (MIB-110%),with mitotic counts 5-6 per 10 HPF, negative CD117. Follow up: alive andasymptomatic after three months, without need for adjuvant therapy.
Conclusion: In the English literature, only 64 cases of PLMS reported.The patients present mainly with abdominal pain and at imaging PLMS hasa rare lymphatic spread. If a pancreatic mass suspected for PLMS has noadjacent organ/vessels invasion or distant metastases, surgical resection isthe therapy of choice.
W-079.
Rare tumor of the pancreas - report of a case and review of theliterature
Tamas Marjai a, Balazs Tihanyi a, Laszlo Nehez a, Katalain Borka b, MarcellSzasz b, Jozsef Timar b, Laszlo Harsanyi a, Tibor Tihanyi a
a 1st Department of Surgery, Semmelweis University, Budapest,Hungary, Hungaryb 2nd Department of Pathology, Semmelweis University, Budapest,Hungary, Hungary
Background: Among poorly differentiated carcinomas of the pancreas,the basaloid cell carcinoma is an extremely rare entity. It can occur onvarious anatomical sites, including breast, uterine cervix, prostate, lung,colon, esophagus, larynx and thymus.
Aims: Our aim is to present a case, which represents the seconddocumented example in the literature of the basaloid carcinoma of thepancreas.
