malnutrition increases the risk of surgery for chronic pancreatitis

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MALNUTRITION INCREASES THE RISK OF SURGERY FORCHRONIC PANCREATITISBhavesh Shah, M.D., Douglas L. Seidner, M.D.* and Darwin L.Conwell, M.D. Internal Medicine, Metro Health Center, Cleveland, OHand Gastroenterology and Hepatology, Cleveland Clinic Foundation,Cleveland, OH.

Purpose: Protein–calorie malnutrition (PCM) increases the incidence ofcomplications following major surgery. Most of the patients in thesestudies have cancer. The aim of this study was to determine if PCMadversely affects surgical outcomes in chronic pancreatitis (CP).Methods: Records from 85 patients with CP who had a surgical procedurefor CP between 1983 and 1999 were reviewed. Weight loss, albumin andNutrition Risk Index (NRI) (Buzby GP. ASCN 1988;47(2 suppl):366.) wasused to assess PCM. NRI �100 is abnormal. Results are shown asmean�SD.Results: Pancreaticojejunostomy (Peustow) and distal pancreatectomy wasdone (97.6% and 2.4%) for abdominal pain (92.4%). Operative time was304�35 min. Length of stay (LOS) was 11.5�16.2 d . CP was caused byalcohol (59%) or was idiopathic (33.7%). There were 55 men and 30women aged 33.6�23.9 yrs with weight 66.8�12.4 kg. Most had PCM byNRI 96.5�10.2, albumin 3.9�0.6 and weight loss 9.8�2.7%. Complica-tions occurred in 26 patients (32.1%) of which one third were consideredmajor. Univariable analyses showed albumin and gender to be associatedwith complications. NRI correlates negatively with LOS –0.244 (p�0.038)Spearman Correlation.Conclusions: Surgery for CP is adversely affected by malnutrition.Women also appear to be at greater risk for complications from theseprocedures. Whether preoperative nutrition support can improve outcomesis no known.

Association with complications

Effect Odds Ratio Conf Limits p value

albumin 0.413 0.180–0.952 0.032gender 2.666 1.010–7.042 0.045

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ENDOSCOPIC MANAGEMENT OF COMMON BILE DUCTSTRICTURES IN PATIENTS WITH CHRONIC PANCREATITIS:AN 8 YEAR RETROSPECTIVE REVIEWMazen Alsatie, M.D., Lee McHenry, M.D.*, Navjot Singh, M.D., MarioDeBellis, M.D., Evan Fogel, M.D., Thomas Howard, M.D., StuartSherman, M.D. and Glen Lehman, M.D. Department of Medicine,Indiana University School of Medicine, Indianapolis, IN and Departmentof Surgery, Indiana University School of Medicine, Indianapolis, IN.

Purpose: Endoscopic therapy for biliary strictures in chronic pancreatitis isa short–term alternative to surgery in patients with biliary obstruction. Theaim of this study is evaluate our experience with endoscopic therapy forbiliary strictures in chronic pancreatitis.Methods: A query of an existing ERCP database was performed forpatients with chronic pancreatitis (CP) and biliary (CBD) strictures whohad repetitive biliary stenting at ERCP. Records were reviewed for reso-lution of biliary strictures by ERCP, patient characteristics predictingresolution, and whether upsizing of biliary stents improved outcome. Res-olution of CBD strictures was defined as an improved stricture no longerrequiring stenting. Upsizing was defined as an increase of the initial stentsize by 10 Fr or greater at subsequent ERCP. Chi–Square test was used forstastical comparison.Results: Over an 8 year period (1994–2002), 87 patients had CP–inducedCBD strictures. 72 patients underwent repetitive stenting and 15 patientshad a single ERCP (6 sent to surgery and 9 lost to follow–up). Of the 72patients undergoing repetitive stenting, 22 patients (31%) had resolution ofthe CBD stricture. The duration of CBD stenting was similar in theresolution group (mean: 17.5 mos, range 0.5–54.6) and the non–resolution

group (mean: 18.7 mos, range 0.5–84.5). Biliary stent upsizing was per-formed similarly in the resolution group in 13/22 patients (59%) and in thenon–resolution group in 23/50 patients (46%)(p�0.79). Alcohol was thecause of CP in 50/72 patients (69.4%) and was more common in thenon–resolution group (42/50; 84%) as compared to the resolution group(8/22; 36%) (p�0.001). Pancreatic calcifications were present in 32/50patients in the non–resolution group (64%) and in 7/22 patients in theresolution group (32%) (p�0.09).Conclusions: Repetitive endosocopic stenting for CP–induced CBD stric-tures leads to stricture resolution in 30% of patients. Resolution of the CBDstricture is more likely to occur in non–alcoholic patients without pancre-atic calcifications. CBD stent upsizing does not improve outcome.

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PRIMARY SCLEROSING PANCREATITIS (PSP): REVIEW OFPANCREATECTOMIES OVER 5 YEARSAhmad Cheema, M.D., Juan Flores, M.D., Saad Aziz, D.O., G.Hartman, M.D., K. Mehta, M.D., G. Aranha, M.D. and J. Leya, M.D.*.GI, Loyola University, Maywood, IL.

Purpose: PSP is a rare form of pancreatitis. Hardly any data exists on itsoccurrence in the U.S. Characteristics include autoantibodies, hypergam-maglobulinemia (HG) (especially IgG4), diffuse and/or focal enlargementof the pancreas, abnormal pancreatography, and specific histology in theabsence of malignant cells. We looked for cases resembling PSP amongpancreatectomies at Loyola in the last 5 years. Using available diagnostic/treatment modalities, a preoperative diagnosis of PSP can prevent unnec-essary pancreatectomies.Methods: The charts of 202 adults who underwent pancreatectomies (forpancreatic masses) at Loyola from 1/97–11/01 were reviewed retrospec-tively for age, sex, clinical history, abdominal CT and endoscopic retro-grade cholangiopancreatography (ERCP) findings. Pre–existing rheuma-toid arthritis, systemic lupus erythematosis, Sjogrens syndrome, primarybiliary cirrhosis, sclerosing cholangitis and inflammatory bowel diseasewere ruled out by chart review. Drug histories were reviewed. In casesunrelated to tumors, histopathology was reviewed for mononuclear infil-tration, fibrosis, acinar atrophy and narrowing of main pancreatic duct (PD)to separate chronic inflammatory (autoimmune diseases) from chroniccalcific and obstructive pancreatitis.Results: 185/202 (92%) pancreatectomies were related to periampullary/distal pancreatic tumors on final pathology. Of the remaining 17 (8%)non–tumorous cases, 3 cases (2 males/1female, mean age 72) displayeddiffuse pancreatic enlargement with evidence of chronic inflammatorypancreatitis, presented as painless obstructive jaundice and had pancreatic–head masses (2.5–5cm). Absence of PD dilatation was documented in 2cases by ERCP. HG could not be documented in these 3 patients; elevatedserum IgG4 had not been linked to this disease at time of surgery.Conclusions: 1) 8% (17/202) of resected masses were benign on finalhistology. 2) 1.5% (3/202) met most existing criteria for diagnosis of PSPand could have been candidates for a trial of steroids prior to pancreatec-tomy. 3) Lack of definitive diagnosis of PSP in our study warrants induc-tion of immune markers (IgG4, CA–II antibodies, etc) as diagnostic toolsto assist reduction of pancreatectomies for benign pancreatic masses.

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ASYMPTOMATIC COMMON BILE DUCT DILATION INPATIENTS ON CHRONIC METHADONEBabak Firoozi, M.D., Rosa Choung, M.D. and David Diehl, M.D.*.Gastroenterology, New York University School of Medicine, New York,NY.

Purpose: Opiates are known to induce spasm of the sphincter of Oddi.Dilation of the common bile duct in patients on chronic methadone hasbeen described. However, evaluation of this phenomenon by ERCP has notbeen reported. The aim of our study is to present ERCP findings on sixchronic methadone users referred for asymptomatic common bile duct

S72 Abstracts AJG – Vol. 97, No. 9, Suppl., 2002