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W-068.

A single-center analysis of surgical treatment for chronic pancreatitis:relatively rare and unevenly deployed

Catherine Yang, Lindsay Bliss, Steven Freedman, Sunil Sheth, Sing ChauNg, Tara Kent, Arthur Moser, Jennifer Tseng

Beth Israel Deaconess Medical Center, United States

Background: Management of chronic pancreatitis remains a challenge.Current strategies reserve surgery as a last-available option after medicaltherapy, lifestyle modifications, and endoscopy have failed. Some cliniciansadvocate early consideration of surgical treatment to prevent diseaseprogression and reduce the risk of opioid dependency.

Aims: The aim of this study was to describe the use of elective surgeryfor chronic pancreatitis in a high-volume, teaching hospital.

Patients & methods: Retrospective analysis of administrative patientdata for in-patients with chronic pancreatitis 2003 - 2013 inclusively.Demographic and clinical information, including number of admissionsand costs, was obtained through hospital decision support. Surgery ofinterest: Frey procedure, pancreaticoduodenectomy, total pancreatectomy,distal pancreatectomy, and Duodenum-Preserving Pancreatic Head Resec-tion. Debridements and emergent pancreatic operations excluded.

Results: Of 3,480 patients, 406 (11.7%) received surgery of interest. Bothnewchronicpancreatitisdiagnosesandproceduresperformedremainedstablethroughout this time period. Whipple and other pancreaticoduodenectomiescomprised the largestproportionofoperationswith48.8% (n¼198). 22.7%weredistal pancreatectomy, and 18.7%were pancreatojejunostomy including Frey’sprocedure. There was a non-significant decrease in use of pan-creaticoduodenectomy over time. The group receiving surgery was older(mean: 57.8 vs. 54.2 years <0.0001), more likely to be male (21.6% vs. 18.3%p¼0.017), white (OR: 1.88 95% CI: 1.4-2.5), married (OR 1.4, 95% CI: 1.1-1.7).

Conclusion: Only a minority of patients appear to undergo electivepancreas-directed surgery for chronic pancreatitis. There is heterogeneityin receiving resection across demographic groups. Further investigationwith patient risk adjustment comparing clinical outcomes of definitivesurgery is warranted.

Abstracts / PancreatolS40

W-069.

Long-term outcomes and quality of life in patients with chronic pan-creatitis (CP) after resection and parenchymapreserving operations.

Vladymyr Klymenko, Andrii Klymenko, Andrii Steshenko

Zaporizhzhya State Medical University, Hospital Surgery, Ukraine

Background: Modern methods of surgical treatment of patients withCP (resection surgery) reduced functional reserve of the pancreas.

Aims: to assess the long-term outcomes and quality of life in patientswith CP after resection and parenchymapreserving operations.

Patients & methods: Long-term outcomes (5 years) and quality oflife were assessed in 108 patients with CP after surgery: in 56 ewere madetotal parenchymapreserving operation (longitudinal total pan-creatowirsungoduodenopapyllotomy with longitudinal Roux-en-Y pan-creaticojejunoduodenostomy); in 52 - resection surgery was performed(Beger procedure, Frey procedure, pylorus preserving pan-creaticoduodenectomy - pPDR). Quality of life was assessed with EORTCQLQ-C30 and EORTC QLQ PAN-28 questionnaires.

Results: After parenchymapreserving operations exocrine function ofpancreas improved in 55%of patients, remained at thepreoperative level - 45%.After Begerprocedure andpPDRexocrine functionof thepancreasdeterioratedin all patients, after Frey procedure e in 46%. Endocrine function of pancreasafter parenchymapreserving operations improved in 16% of patients, deterio-ration - is not mentioned. After resection operations improved endocrinefunction was only in 10.3% of patients, decrease - at 31.0%, the onset of newcases of pancreatogenic diabetes observed in 15.5%. Quality of life afterparenchymapreserving operations remained significantly better.

Conclusion: Long-term outcomes and quality of life of patients with CPafter parenchymapreserving operations were much better than afterresection methods.

W-070.

Endoscopic treatment of chronic pancreatitis in children: Long termfollow up

Ivo Boskoski a, Matteo Napoleone a, Andrea Tringali a, Pietro Familiari a,Massimiliano Mutignani b, Vincenzo Perri a, Guido Costamagna a

a Digestive Endoscopy Unit, Catholic University of Rome, Italy, ItalybNiguarda Hospital, Milan, Italy, Italy

Background: Chronic pancreatitis (CP) in children is rare and experi-ence of ERCP in children with CP is limited.

Aims: Safety and efficacy of ERCP for the treatment of CP in childrenwere evaluated.

Patients & methods: Retrospective identification of CP pediatricpatients who underwent ERCP. Indications, findings, treatment modalities,adverse events/outcomes were recorded during long term follow-up.

Results: Of 125 children that underwent ERCP, 35(28%) had CP (16 boys,mean 11.6 yrs [2.5-17]). Indications to ERCP were recurrent bouts of pan-creatitis/pain.19(54.3%) had pancreatic stones/plugs,10(28.5%) had pancreasdivisum, 6(17.1%) had dominant Santorini duct anatomy, 17(48.5%) had genemutations related CP.Minor papilla sphincterotomywas done in 14 children;pancreatic Extracorporeal Shock Wave Lithotripsy had 3 children. Plasticstents were placed in 5 for duct strictures. ERCP complications (bleeding/pancreatitis) occurred in 2(5.7%). Mean follow-up 8 yrs (0.7-21).14(40%) hadonly one ERCP andwere pain-free during 6 yrs (0.7-15) of follow-up; 21(60%)had recurrence of pain aftermean4.6 yrs(0.8-20.4) and had additional ERCPs(75 re-interventions[1-14; 3.5/pt]). 13 children had re-sphincterotomy forsphincterotomy stricture, and were pain-free on follow-up (mean 3.6 yrs[0.3-5.6]). 16 had plugs on re-interventions; 1 boy had post re-sphincter-otomy bleeding. re-interventions were higher in females (p < 0.01), and inyounger than 8 yrs(p<0.01). Pain recurrences were not related to MPDanatomy or genetic mutations (p¼0.2 & p¼0.3 respectively).

Conclusion: ERCP in pediatric patients with CP is a safe and effective. Inmore than 1/3 of cases only 1ERCP can be resolutive. Symptom recurrencescan be easily managed with ERCP without major complications.

W-071.

Comparison of the clinical parameters of the m-annheim classifica-tion system in patients with alcoholic and non-alcoholic chronicpancreatitis

Nicolai H€arteol, Christel Weiss, Matthias Ebert, Alexander Schneider

Departmenht of Medicine II, Medical Faculty at Mannheim, Universityof Heidelberg, Germany

Background: The M-ANNHEIM classification (MC) represents a clinicalclassification system of chronic pancreatitis (cP). It stratifies all etiologicalrisk factors and defines different degrees of disease severity according toclinical parameters of a scoring system.

Aims: To analyse whether the different parameters of the MC correlatewith the disease duration, and to compare these parameters in patientswith alcoholic and non-alcoholic cP.

Patients & methods: Retrospective categorization of patients accord-ing to the MC. Patients with alcoholic and non-alcoholic cP were catego-rized according to disease duration (� 36 months, 37 to 108 months, > 108months).

Results: The disease duration in alcoholic (n¼244) and non-alcoholic(n¼190) cP patients was similarwithin the different disease duration groups(p¼0,1825). In the cohort of patients with alcoholic cP, the clinical pre-sentation according toparameters of theMC significantly correlatedwith thedisease duration (pancreatic pain, p¼0.0277; pancreatic surgery, p¼0.0001;exocrine insufficiency, p¼0.0002; endocrine insufficiency, p<0.0001;severity points, p<0.0001). These data appear in accordancewith the “burn-out-hypothesis”. In the group of patients with non-alcoholic cP, only pan-creatic surgery correlated significantly with disease duration (p¼0.0017),and trends were observed towards increased exocrine insufficiency(p¼0.0741) and enhanced severity points (p¼0.0706). Some parameters of

y 14 (2014) S1eS129