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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e139
Material and methods:
From January 2011 to October 2014, all
consecutive patients with IPMN referred to our pancreatic disease
day service were enrolled and followed up with clinical visits, EUS
and/or MRI according to available guidelines.
Results:
A total of 41 patients, 16 males and 25 females (median
age: 68 years, range 35-87 years), with diagnosis of IPMN without
worrisome features were followed up for a median period of 38
months. At baseline clinical observation, all patients reported the
presence of abdominal pain and/or showed increased serum levels
of amilase and lypase. A family history of pancreatic cancer was
present in 3 patients whereas a personal history of malignancy
was present in 10 patients. Diagnosis of IPMN was reached by CT
scan in 14 patients, MRI in 20 patients, and EUS in 7 patients: 26
patients had a BD-IPMN, 6 patients a MD-IMPN, and 9 patients a
mixed type IPMN. During follow-up, 3/41 patients (7%) underwent
surgical resection due to a nodule (one mural intraductal and one
parenchimal) in two patients and an enlargement (>5 cm) of the
cystic lesion in another patient. IPMN features remained unmodified
in the remaining 38/41patients (93%). All three patients operated
had not family or personal history of malignancy.
Conclusions:
IPMN may progress toward pancreatic cancer. Patients
with IPMN should undergo careful surveillance, including EUS or
MRI, in order to promptly adopt a surgical strategy. Whether the
development and course of IPMN may be influenced by a family
history of pancreatic cancer and personal history of malignancy
remains to be clarified.
P.02.14
ACUTE PANCREATITIS IN ELDERLY PATIENTS: A RETROSPECTIVE
EVALUATION AT HOSPITAL ADMISSION
Losurdo G.*, Iannone A., Principi M., Barone M., Castellaneta N.M.,
Ranaldo N., Ierardi E., Di Leo A.
UO Gastroenterologia universitaria, Policlinico di Bari, Bari, Italy
Background and aim:
Acute pancreatitis (AP) in elderly may have
an aggressive course due to co-morbidity high rate and severe
presentation. We retrospectively evaluated AP severity and its
underlying factors in a group of elderly patients compared with an
adult population sample.
Material and methods:
Forty-two elderly patients (65-102 years)
and 48 controls (19-64 years) admitted at our Unit for biliary
or alcoholic AP were retrospectively enrolled. AP severity was
evaluated by Atlanta classification and Ransom score. Laboratory
investigations and demographic data were collected. Comparison
between the two groups was performed by t-test, ANOVA or Fisher’s
exact test. A multinomial logistic regression was used to determine
factors affecting AP severity.
Results:
Elderly patients showed more severe Atlanta score
(1.81±0.75 vs 1.29±0.46; p=0.007), as well as higher Ransom score
(2.52±1.57 vs 0.75±0.73; p<0.0001), even if no death was observed.
Elderly patients assumed more drugs than controls, and had a
higher rate of cardiovascular, pulmonary and renal co-morbidity.
They showed higher creatinine (1.09±0.41 vs 0.81±0.18; p=0.004)
and lower calcium levels (8.43±0.48 vs 8.88±0.44; p=0.002) than
controls. AP severity was influenced by white blood cell (WBC)
count (OR=1.94; 95% CI 1.14-2.86; p=0.048), aspartate-transaminase
(AST) levels (OR=1.97; 95% CI 1.91-2.18; p=0.02), serum lactate-
dehydrogenase (LDH) (OR=1.07; 95% CI 1.008-1.168; p=0.047) and
Ransom score (OR=70.4; 95% CI 45.7-134.8; p=0.036). The etiology
(biliary or alcoholic) did not influence the severity.
Conclusions:
Elderly patients usually undergo a severe AP course,
but without increase of mortality. High WBC, LDH, AST and Ransom
score at the onset may predict AP severity.
P.03 Endo/EUS 1
P.03.1
DIAGNOSTIC ACCURACY AND THERAPEUTIC IMPACT OF
EUS IN PATIENTS WITH INTERMEDIATE SUSPICION OF
CHOLEDOCHOLITHIASIS AND NEGATIVE MRCP
Grassia R.*
1
, Capone P.
2
, Staiano T.
1
, Rispo A.
2
, Iiritano E.
1
, Bianchi G.
1
,
Imperatore N.
2
, Buffoli F.
1
1
A.O. “Istituti Ospitalieri di Cremona”, Cremona, Italy,
2
A.O. Policlinico
“Federico II”, Napoli, Italy
Background and aim:
Endoscopic ultrasonography (EUS) and
magnetic resonance cholangiography (MRCP) are accurate proce
dures in diagnosing common bile duct stones, thus suggesting
the possibility to avoid invasive endoscopic retrograde cholangio
pancreatography. MRCP is non-invasive diagnostic procedure but its
accuracy decreases in presence of microlithiasis.
Aim:
To study the diagnostic accuracy and the therapeutic impact of
EUS in patients with intermediate likelihood of choledocholithiasis
and negative MRCP.
Material and methods:
Between January 2013 and August 2015,
all consecutive patients with clinical intermediate suspicion of
choledocholithiasis according to the ASGE guidelines and undergone
a negative MRCP for lithiasis, were retrospectively reviewed.
Sensitivity, specificity,
positive predictive value (PPV), negative
predictive value (NPV) and diagnostic accuracy of EUS, carried out
within 7 days of the initial clinical presentation, were determined.
Also, the clinicalimpactof EUS in the management of these patients
was assessed.
Results:
A total of 53 patients were included in the study. EUS
detected choledocholithiasis in 17 out of 53 patients with negative
MRCP. The subsequent ERCP confirmed lithiasis in 16 out of 17
patients (94%). Thus, EUS showed a diagnostic accuracy of 98% for
detection of CBD stones. Sensitivity, specificity, positive predictive
value, negative predictive value were: 100% (95% C.I. 74-100%), 97,3%
(95% C.I. 85-99%), 94% (95% C.I. 71-99%) and 100% (95% C.I. 90-100%),
respectively. The diagnostic gain of EUS compared to MRCP was 32%
with an EUS/MRCP agreement of about 70% (k=0.68, p <0.01).
Conclusions:
EUS is a highly accurate diagnostic tool for the common
bile duct stones detection. EUS findings change the management of
patients with intermediate suspicion of choledocholithiasis and a
negative MRCP allowing the diagnosis of lithiasis in 1/3 of them.
P.03.2
IS THERE A LINK BETWEEN PERIAMPULLARY DIVERTICULA AND
BILIOPANCREATIC DISEASES? AN EUS APPROACH TO ANSWER
THE QUESTION
Bruno M., Fasulo R.*, Gaia S., Marietti M., Ribaldone D.G., Risso A.,
Stradella D., Strona S., Rizzetto M., De Angelis C.
Gastroeneterologia ed Endoscopia Digestiva, Città della Salute e della
Scienza di Torino, Ospedale S. Giovanni Battista, Università di Torino,
Torino, Italy
Background and aim:
The prevalence of periampullary diverticula
(PAD) varies in literature from 0.16 to 27%. Many studies, all in
an ERCP setting, have been conducted to establish if a link exists
between PAD and biliopancreatic diseases but contradictory results
were obtained and the issue is still debated.
Material and methods:
We retrospectively reviewed our EUS
database from January 2001 to December 2014 enrolling patients
scheduled for EUS with an indication that entailed the exploration
of the second duodenum. Oblique viewing (50-55 degrees)
echoendoscopes from Olympus were employed. For each patient