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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e137
Background and aim:
To assess the presence of pancreatic
hyperenzymemia in patients with pancreatic cystic lesions as
compared to other chronic diseases of the pancreas.
Material and methods:
Ninety-one patients were studied.
Thirty-two patients had mucinous cystic lesions, 35 had chronic
pancreatitis and 24 pancreatic ductal adenocarcinoma. Surgery was
carried out in 10 of the 32 mucinous cystic lesion patients (7 of them
had severe dysplasia), in 5 patients with chronic pancreatitis and in
9 pancreatic ductal adenocarcinoma patients.
Results:
Abnormally high serum pancreatic isoamylase activity was
present in 11 patients (34.4%) with mucinous cystic lesions, in 14
chronic pancreatitis patients (40.0%) and none of pancreatic ductal
adenocarcinoma patients (P=0.002) whereas serum lipase activity
was abnormally high in 8 mucinous cystic lesion patients (25.0%), in
17 (48.6%) chronic pancreatitis patients and in 3 (12.5%) pancreatic
ductal adenocarcinoma patients (P=0.009). In seven patients
with mucinous cystic lesions who had histologically confirmed
severe dysplasia, abnormally high levels of both serum pancreatic
isoamylase and lipase were present in 3 patients (42.9%).
Conclusions:
High serum concentrations of amylase and lipase
were found in no more than half of the patients with mucinous
cystic lesions, but high levels of these enzymes were not associated
with greater risk of malignancy.
P.02.9
ELASTPQ-POINT SHARE WAVE ELASTOGRAPHY (ELASTPQ®-
PSWE) IN CHRONIC PANCREATITIS. A PROMISING TOOL FOR
STAGING DISEASE SEVERITY
Pozzi R.*
1
, Parzanese I.
1
, Baccarin A.
1
, Conti B.
1
, Cantù P.
1
, Tenca A.
1
,
Casella G.
2
, Conte D.
1
, Fraquelli M.
1
1
Gastroenterology Unit, Fondazione IRCCS Cà Granda – Ospedale
Maggiore Policlinico, Department of Pathophysiology and
Transplantation - Università degli Studi – Milan, Milano, Italy,
2
U.O.
Medicina Interna, Ospedale di Desio, Desio, Italy
Background and aim:
ElastPQ®-pSWE, an emerging non-invasive
US technique developed to estimate tissue stiffness, has recently
been evaluated to stage liver fibrosis in patients with chronic
liver diseases whereas few data, mainly using strain imaging, are
currently available for the pancreas.
Present study was aimed at assessing both the feasibility and
reproducibility of pancreatic stiffness in a cohort of patients with
chronic pancreatitis of different etiology and at evaluating the
possible relation between this parameter and major clinical and
laboratory data in reflecting disease severity. Another aim was to
correlate ElastPQ®-pSWE to Fibroscan results for the assessment of
liver stiffness.
Material and methods:
45 consecutive patients (33 M, 12 F) mean
age ± SD 62 ± 25 years with chronic pancreatitis (CP) underwent
hepatic and pancreatic US scan and ElastPQ-pSWE (iU22, Philips)
(10 valid measurements). Liver stiffness was also measured by
transient elastography (Echosens, Paris) (10 valid measurements,
SR >60%, IQR <30%). 27 healthy subjects (10 M, 17 F) mean age ±
SD 39 ± 21 years served as controls (CRL). Interobserver agreement
for pancreatic ElastPQ®-pSWE was analyzed in 20 cases using the
intraclass correlation coefficient (ICC). The effect of some clinical,
laboratory and US data on pancreatic stiffness measurements will
be evaluated by fitting linear regression models.
Results:
ElastPQ-pSWE was feasible in all but one patient in the CP.
Pancreatic stiffness was significantly higher in CP than CRL (4.2 vs
2.9 kPa, p<0.05). Moreover in CP group, those with longer disease
duration (>10 years) had significantly higher ElastPQ-pSWE value
than those with shorter one (7.0 vs 3.8 kPa; p<0.01), as those on
chronic analgesic drugs as compared to those not (5.9 vs 3.7 kPa,
p<0.05). Finally in both groups (CP and CTL) pancreatic stiffness was
significantly related to age and decrease in BMI. No correlation with
laboratory data was found. The ICC for pancreatic stiffness was 0.80.
As concerns hepatic stiffness a high correlation was found between
ElastPQ and Fibroscan (4,89 + 1,96 kPa and 5,9 ± 3,37 kPa) (p<0.0001,
r =0.74).
Conclusions:
ElasPQ has been proven to be promising and
reproducible in assessing pancreatic stiffness. Values at ElastPQ
reflected disease severity and length. Accordingly, this performance
could be of value in stratifying CP patients by identifying those with
more serious disease.
P.02.10
CLINICAL AND RADIOLOGICAL FEATURES OF 40 PATIENTS WITH
SEROUS CYSTADENOMA OF THE PANCREAS
Campagnola P.*
1
, Amodio A.
1
, Messina O.
1
, Moser L.
1
, Di Stefano S.
2
,
Costa D.
1
, Gabbrielli A.
1
, Frulloni L.
1
1
GAstroenterlogia Aoui Verona, Verona, Italy,
2
Italy
Background and aim:
Serous cystadenomas (SCA) are benign cystic
tumours of the pancreas and represents 10–16% of cystic pancreatic
lesions. Most of the patients are asymptomatic and surgical
treatment is indicated only for symptomatic patients or in case of
uncertain diagnosis.The aim of the study was to evaluate clinical,
radiological and laboratory findings in patients with SCA. We also
assessed the factors associated with a higher growth-pattern.
Material and methods:
Patients with SCA diagnosed on the basis
of magnetic resonance imaging (MRI) observed between 2010-2015
in our gastroenterological Unit were retrospectively enrolled and
classified in mycrocistic/mixed or macrocystic.
Results:
40 patients (33 females, 7 males, mean age 61.5±15.6 years
at diagnosis) were included. Symptoms reported by patients are
non-specific abdominal pain (22.5%), pancreatitis (2.5%), diabetes
(10%), none (65%). MR pattern was microcystic in 25 patients (62.5%)
and macrocystic in 15 (37.5%) Average follow-up was 2.7±1.4 years.
An increase in diameter was observed in 4 patients (10%) (growth
rate: 28 mm/year), 3 of whom with a macrocystic pattern.
Conclusions:
After 3 years follow-up, the majority of the patients
were asymptomatic, and only in a small percentage of these patients
size slowly increased. Macrocystic pattern seems associated with a
higher growth rate and these patients need a more accurate follow-
up.
P.02.11
EXOCRINE PANCREATIC INSUFFICIENCY IN INTRADUCTAL
PAPILLARY MUCINOUS NEOPLASM (IPMN) WITH WIDESPREAD
GLANDULAR INVOLVEMENT
Gambaccini D.*
2
, Bellini M.
2
, Luglio G.
2
, Russo S.
2
, Maltinti S.
2
,
Battaglia V.
1
, Giannotti S.
2
, Albano E.
2
, Pianadei S.
2
, Ricchiuti A.
2
,
Mumolo M.G.
2
, Costa F.
2
, Marchi S.
2
1
Azienda Ospedaliera Universitaria Pisana, Radiodiagnostica, Pisa,
Italy,
2
Azienda Ospedaliera Universitaria Pisana, Gastroenterologia
Universitaria, Pisa, Italy
Background and aim:
Pathological and radiological findings of
Intraductal Papillary Mucinous Neoplasm (IPMN) are characterized
by acinar and duct alterations, probably responsible for a significant
impairment of exocrine function. Similar alterations are present
in chronic pancreatitis and in the pathological process of aging in
which a certain degree of pancreatic exocrine insufficiency (PEI)
has been demonstrated. These changes may be responsible for
malabsorption and specific nutritional deficiencyand thus prompt
enzyme replacement therapy. Until now these aspects of IPMN have
scarcely been taken into account.