Abstracts / Pancreatology

examination with bile from biliary tract or duodenum has been useful forthe diagnosis of microlithiasis.

Aims: We evaluated the reliability of bile samples collecteddirectly from the biliary tract during ERCP for polarized microscopicexamination.

Patients &methods: From April 2012 to December 2012, pure bile wascollected from biliary tract just before contrast injection in 91 patients whounderwent therapeutic ERCP for the first time. The collected bile sampleswere analyzed for the presence of microlith by polarized microscopy.

Results: In patients with CBD stones or sludge, positive results ofbile polarized microscopy were 36 and negative results were 16.Sensitivity, specificity, positive predictive value (PPV), and negativepredictive value (NPV) in bile polarized microscopy were 69.2%, 66.7%,73.5%, and 61.9%, respectively. In patients with only GB stone or GBsludge, positive results were 8 and negative results were 14. Sensitivity,specificity, PPV, and NPV in bile polarized microscopy were 36.3%,70.6%, 61.5%, and 46.2%, respectively. In overall patients, Positive resultswere 44 and negative results were 30. Sensitivity, specificity, PPV, andNPV were 59.5%, 70.6%, 89.8%, and 28.6%, respectively in bile polarizedmicroscopy.

Conclusion: Polarized microscopic examination of bile aspirated fromCBD showed moderate diagnostic accuracy. Bile polarized microscopicresult may not be considered as a reliable diagnostic test for the causativedecision of acute idiopathic pancreatitis.

PII-47 Abstract id: 291.

Effect of necrosis status at the time of intervention on the outcome ofsevere acute pancreatitis

Sorin T. Barbu 1, Nicolae Rednic 2, Dana Hazota 3, Mircea Cazacu 1.

1 IVth Surgical Clinic, University of Medicine and Pharmacy "IuliuHatieganu" Cluj-Napoca, Romania2 IVth Medical Clinic, University of Medicine and Pharmacy "IuliuHatieganu" Cluj-Napoca, Romania3 Intensive Care Unit, Clinical CF Hospital Cluj, Romania

Introduction: Although it is known that pancreatic and peripancreaticnecrosis may remain solid or liquefy, there are few available data aboutliquefaction timing and progression.

Aims: To assess the effect of necrosis status at the time of interventionon acute pancreatitis outcome; to identify factors favoring necrosisliquefaction.

Patients & methods: Fifty-eight patients managed by a step-upapproach or open necrosectomy in a tertiary referral center (2008 – 2012)were assigned to 3 groups, according to necrosis status at the interventiontime: G1 – 26patients with solid necrosis; G2 – 28patients - semisolidwalled-off necrosis (WOPN); G3 – 4patients - liquefied WOPN. Groupsoutcome were compared. Logistic regression was used to identify factorsfavoring necrosis liquefaction.

Results: Median timing of intervention was 27days (G1¼21, G2¼31,G3¼37days). Twenty patients died (34.48%): G1¼53.8%, G2¼21.4% andG3¼0%. Open necrosectomy was performed in all G1 patients. Percuta-neous catheter drainage (PCD) was primarily used in G2 and G3, with 41%and 100% success. When PCD failed, VARD or open necrosectomy followed.Mean hospital stay was G1¼89days, G2¼77days and G3¼51days. Factorsfavoring necrosis liquefactions were: time from pancreatitis onset, age >

55 years, hypertriglyceridemic etiology, high amylase content, antibioticprophylaxis > 2 weeks.

Conclusion: Interventional debridement should be postponed in solidnecrosis, where enzymatic debridement may be tried as suggested by oneof the found factors (high amylase content). Antibiotic prophylaxis > 2weeks favors liquefaction only by postponing necrosectomy. Time is thestrongest factor favoring necrosis evolution to semisolid and liquefiedWOPN status, when a step-up approach offers better survival and shorterhospital stay.

PII-48 Abstract id: 161.

Predictive markers for severe acute pancreatitis: A comparative pro-spective study within a representative cohort

Hanna Sternby, Hannes Hartman, Dorthe Johansen, StefanAppelros, Henrik Thorlacius, Sara Regn�er.

Department of Surgery, Sk�ane University Hospital Malm€o{, LundUniversity, Sweden

Introduction: In order to predict severity of Acute Pancreatitis (AP) alarge number of biomarkers have been studied retrospectively and indifferent cohorts.

Aims: In this study promising biomarkers will be studied prospectivelyin a representative cohort of patients with AP aiming to enable compari-sons of their predictive capacity in a clinical setting.

Patients & methods: Patients with AP admitted to the Malm€o Uni-versity Hospital were consecutively included in the study. Blood sampleswere obtained on admission and daily up to 72 hours. Socioeconomicfactors and information of importance for etiology and severity of AP wererecorded in a database. Cut off values were set by reviewing the literaturefor the predefined biomarkers.

Results: 202 patients with AP, 111 men and 91 women, with a medianage of 66 years (19-97) were included in the study. 13,4% of the patientshad severe AP according to the Atlanta -92 criteria while the corre-sponding figures for the Revised Atlanta-12 were 5,4%. 15, 3% were clas-sified as Moderately Severe AP. Etiology was biliary in 51,5%, alcohol in15,8%, unknown in 23,3% and of other origin in 9,4%. CRP on Day 3 had amedian value of 377 mg/l in patients with SAP and 111 mg/l in patientswith mild AP.

Conclusion: The clinical data shows that the cohort has a represen-tative composition in order to obtain reliable results concerning patientswith AP. Preliminary data shows a significant difference in IL-6 and IL-8between mild AP and severe AP. Further blood samples will be analysedduring the first half of 2013.

PII-49 Abstract id: 68.

New classifications of severity of acute pancreatitis: Validation ofdeterminant-based and revision of the Atlanta classification

Enrique de-Madaria, Nelly G. Acevedo-Piedra, Neftalí Moya-Hoyo, M�onicaRey-Riveiro, Inmaculada Lopez-Font, Juan Martínez, Martínez Lluís.

Unidad de Patologia Pancreatica, Hospital General Universitario deAlicante, Spain

Introduction: The Atlanta classification was published in 1993; defi-nitions were given regarding local and systemic complications, as well asseverity of acute pancreatitis (AP). After 2 decades we have learned newconcepts about the natural history of AP that have prompted a revision ofthe Atlanta classification. Two new classifications have been proposed.

Aims: Our aim was to validate both new classifications.Patients & methods: We analyzed a prospective database which

included every adult patient with AP admitted to a third level hospitalbetween December 2007 and January 2013. Every CT scan was retro-spectively reviewed according to new definitions. The classifications werevalidated in terms of outcomes: length of hospital stay, need for ICUadmission, nutritional support, invasive treatment and mortality.

Results: We analyzed 543 episodes of AP. The most frequent etiologywas gallstones (59.5%), followed by alcohol (13.6%). Pancreatic necrosiswas present in 66 (12.2%) of the patients, peripancreatic fat necrosis in 109(20.1%), acute necrotic collections in 106 (19.5%), walled-off necrosis in 61(11.2%), peripancreatic fluid collections in 98 (18%) and pseudocysts in 19(3.5%). Transient organ failure was present in 31 patients (5.7%) andpersistent organ failure in 21 (3.9%). Sixteen (2.9%) patients died. Deter-minant-based and Revised Atlanta classifications were associated to sta-tistically and clinically relevant differences in length of hospital stay, need

13 (2013) S2–S98 S67

Abstracts / Pancreatology 13 (2013) S2–S98S68

for ICU admission, nutritional support, invasive treatment and mortality,classifying subgroups of patients with different natural history.

Conclusion: Both classifications, based in current literature and theopinion of experts, describes accurately different subgroups of patientswith AP.

PII-50 Abstract id: 337.

Preliminary data of a clinical survey on acute pancreatitis based onthe Hungarian national registry

Lajos V. Kem�eny 1, Tam�as Tak�acs 1, Anita Bal�azs 1, Gyula Farkas, Jr. 2, �AkosPap 3, J�ozsef Mal�eth 1, Andrea Geisz 1, L�aszl�o Czak�o 1, Ella Szab�o 1, JuditGervain 4, Zolt�an Szepes 1, Andr�as Roszt�oczy 1, L�aszl�o Rudas 5, J�anosFogas 5, J�ozsef Kiss 1, Barnab�as Bod 6, Tam�as Moln�ar 1, Kriszti�anSepp 1, Judit Czelecz 7, Attila P�alv€olgyi 1, Rich�ard R�oka 1, Istv�anHritz 4, DezsT Kelemen 8, Tam�ar Forster 9, Ferenc Izb�eki 4, Gy€orgyL�az�ar 2, Tibor Wittmann 1, P�eter Hegyi 1, Zolt�an Rakonczay, Jr 1.

1 First Department of Medicine, University of Szeged, Hungary2Department of Surgary, University of Szeged, Hungary3National Institute of Oncology, Budapest, Hungary4 Fej�er Megyei Szent Gy€orgy Hospital, Sz�ekesfeh�erv�ar, Hungary5Department of Anesthesiology and Intensive Care Unit, University ofSzeged, Hungary6Dr. Bugyi Istv�an Hospital, Szentes, Hungary7 Bethasda Childrens Hospital, Budapest, Hungary8Department of Surgary, University of P�ecs, Hungary9 Second Department of Medicine, University of Szeged, Hungary

Introduction: The Hungarian Pancreatic Registry was established in2012.

Aims: To investigate the etiological factors, clinical severity andoutcome of acute pancreatitis (AP) in our recently established multicentricHungarian Pancreatic Registry.

Patients & methods: Retrospective analysis of 189 AP patientsadmitted to gastroenterology wards, ICUs and surgery wards between2008 and 2013 focused on the etiology and clinical outcome.

Results: Out of the 189 AP patients, 88 were females and 101 weremales, the mean age at admission was 58.7�2.2 and 54.5�1.5 years,respectively. Regular alcohol consumption and smoking was present in51% and 30% of males, whereas in only 4.6% and 5.8% in female patients,respectively. The most common cause of AP in females was biliary disease(52.3%), whereas in men, it was alcohol (32.7%). AP was idiopathic in 24.4%of female and 11.9% of male patients. Furthermore, dietary problem wasidentified in 23.3% and 49.5% of female and male patients, respectively.According to the revised Atlanta Classification, AP was mild in 88.3% and73.3%, moderately severe in 5.8% and 10.9%, severe in 5.8% and 15.8% offemale and male patients, respectively. 1 female (1.2%) and 7 males (6.9%)died among AP patients. Only severe AP resulted in death with a totalmortality rate of 38.1%.

Conclusion: Our study indicates that the revised Atlanta Classificationis suitable for clinical practice, since it differentiates between the mortalityrates of moderately severe and severe AP. Furthermore, registry provides afoundation for prospective clinical investigations of AP.

PII-51 Abstract id: 203.

Early short-term continuous high-volume haemofiltration improvesclinical outcomes of severe acute pancreatitis

Wei Huang 1, Jia Guo 1, Xiao Yang 1, Tao Jin 1, Kiran Altaf 2, MuhammadJaved 2, Zi Lin 1, Zong Huang 1, Ping Xue 1, Marianne Johnstone 2, RobertSutton 2, Qing Xia 1.

1 Sichuan Provincial Pancreatitis Centre, Department of IntegratedTraditional Chinese andWestern Medicine, West China Hospital, China

2NIHR Liverpool Pancreas Biomedical Research Unit, Royal LiverpoolUniversity Hospital, United Kingdom

Introduction: Haemofitration was introduced to treat severe acutepancreatitis (SAP) with early short-term continuous high-volume hae-mofiltration (HVHF) reported to be the most effective modality, althoughthis has not been tested in randomised clinical trials (RCTs).

Aims: To conduct a single centre prospective trial of short-termcontinuous HVHF in patients with SAP.

Patients &methods: Consenting SAP patients with APACHE II scores>15 on admission to West China Hospital between January 2008 andDecember 2010 were allocated to receive either optimal standard therapyor 72 h of continuous HVHF on an alternate basis, beginning as soon aspossible after admission. Biomarkers and clinical outcomes werecompared between the two groups.

Results: A total of 61 patients received either conventional therapy (n¼ 29) or HVHF (n ¼ 32). HVHF treatment was associated with a significantreduction in the incidence of renal failure (P ¼ 0.013), infected pancreaticnecrosis (P ¼ 0.048), length of hospitalisation (P ¼ 0.005), mortality (P ¼0.033), as well as duration of renal (P < 0.001), respiratory (P ¼ 0.002) andhepatic failure (P ¼ 0.001). APACHE II score, C-reactive protein and inter-leukin-6 were significantly reduced after the start of HVHF on days 1, 3 and7 (all P < 0.05).

Conclusion: This prospective study suggests that HVHF reduces theincidence and duration of organ failure, complications, and mortality inSAP patients with APACHE II score > 15, although high quality, large RCTsare required to confirm this effect.

PII-52 Abstract id: 162.

Raised intestinal fatty acid binding protein correlates to severe acutepancreatitis

Hannes Hartman 1, Tomi Sippola 2, Juozas Kupcinskas 3, OutiLindstr€om 2, Colin Johnson 4, Sara Regn�er 1.

1 Department of Surgery, Skane University Hospital Malm€o, LundUniversity, Sweden2Department of Surgery, Helsinki University Central Hospital,Helsinki, Finland3Department of Gastroenterology, Lithuanian University of HealthSciences, Kaunas, Lithuania4 Cancer Sciences, University of Southampton School of Medicine,Southampton, United Kingdom

Introduction: Early fluid resuscitation in order to maintain sufficientcirculation to vital tissues is essential in the management of AcutePancreatitis (AP). Intestinal Fatty Acid Binding Protein (IFABp) is releaseddue to intestinal ischemia. S-IFABp was analyzed to evaluate the efficacy offluid resuscitation up to 3 days after admission in patients with AP.

Aims: Our aim was to analyze the relationship between early fluidresuscitation, levels of s-IFABp and severity during the first 3 days of acutepancreatitis.

Materials & methods: The study was designed as part of thePancreas2000 educational program. Patients with AP were consecutivelyincluded at 4 centers. Hydration status was assessed 0-3, ranging fromdehydration to fluid overload and the amount of fluids administered wasregistered. S-IFABp was analyzed at day 1 and 3.

Results: 372 patients (237 men, 135 women) were included. 64% hadno former history of AP at enrollment in the study. 16% were defined assevere (1993 Atlanta criteria) and 8% were treated at intensive care units.The number of patients undergoing drainage or surgery was 12 and 4%respectively. IFABp levels day 1 were significantly increased in patientswith severe AP compared to patients with mild disease. This statisticaldifference did not remain after 3 days of fluid resuscitation.

Conclusion: Preliminary data show that elevated levels of IFABpwithin24h of admission is associated with severe AP, suggesting that intestinalischemia may contribute to the pathogenesis of severe AP. The effects offluid resuscitation and rehydration remain to be analyzed in detail.