infusions of ED were compared to the responses during intravenous nutri-tion (TPN) in two groups of 5 healthy volunteers. The effect of AP on theED-secretory response was then evaluated in 4 patients with disease ofvariable severity (Ranson’s criteria, 0, 2, 4, & 7). Enzyme secretion wasmeasured by duodenal marker perfusion/aspiration technique while sub-jects were either fed at a constant rate by vein (TPN) or duodenum (ED).Nutrient infusion rates were matched to provide a mixed calorie source at30 Kcal and 1.5 g amino acids/kg/d.Results:Results are summarized on the Table. Statistics: group mean (SE),* 5 p , 0.0001 vs Normal-TPN, #5 p , 0.0001 vs Normal-ED byMann-Whitney NP testing. In the patients, there was no clear associationbetween the degree of enzyme suppression and disease severity measuredby Ranson’s criteria or serum lipase and amylase levels.Conclusions:Enteral infusions of elemental diets did not rest the pancreasin healthy subjects, but the enzyme secretory responses to EDs weresuppressed in all patients with acute pancreatitis. Further studies are re-quired to determine whether the suppression is due to failure to synthesizeor failure to secrete enzymes. Our results suggest that the beneficial effectsof ED in AP are due to their ability to maintain intestinal function andintegrity, rather than their direct effects on the pancreas.

Trypsin (u/h) Amylase (u/h) Lipase (u/h)

Normal-IV 177 (32) 1391 (342) 48469 (11553)Normal-ED 364 (27)* 5887 (602)* 373277 (4474)*Patients-ED 96 (37)# 51 (28)# 1962 (917)#

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Colchicin in the treatment of primary biliary cirrhosisOstoji R, Dubrav D, Had N, Vuceli B, S˘polijar-S̆ukanec M. Departmentof Gastroenterology, University Hospital Rebro, Zagreb, Croatia.

Aim: The aim of this trial was to evaluate the efficacy of Colchicin therapyin patients with primary biliary cirrhosis (PBC) based on liver biochem-istries and liver histology.Patients and methods:Eighteen patients (17 females, mean age 45.8 yrs;range 30–62) with PBC, proven by liver biopsy were treated with Colchi-cin 2 3 0.5 mg daily and followed 18–92 months (mean 40.2 ms).Pretreatment patients characteristics were as follows: bilirubin mean 39.4umol (range 12–108), alkaline phosphatase (AP) mean 280.6 U/l (range62–726). AST mean 70.2 U/l (range 10–228), ALT 74.2 U/l (range 12–262), gamma-globuline mean 20.9 g/l, IgM mean 6.44 g/l (range 2.19–17.40). Antimitochondrial antibodies were found in 14 out of the 18 pts.Results:After 18–92 ms of Colchicin treatment all patients had beneficialeffect on itching. Some of biochemical findings (bilirubin 39.4 vs 30.2umol/l, AP 280.6 vs 196.8 U/l, AST 70.2 vs 58.6 U/l, ALT 74.2 vs 62.4 U/l,IgM 6.44 vs 6.30 g/l) have improved, but not significantly. Gamma-globulin even raised (20.9 vs 22.4 g/l). A paired liver biopsy was performedin 11 pts after 2 years of treatment. In 6 pts histological finding wasunchanged but in the other 5 had deteriorated. We did not notice anyserious side effects of Colchicin treatment.Conclusion: In this study we did not find significant beneficial effect onbiochemical and histological finding in patients with PBC after mean 40.2ms of treatment with Colchicin 23 0.5 mg daily.

245

Non contrast spiral computed tomography (SCT) versus endoscopicultrasound (EUS) for suspected choledocholithiasis and common bileduct dilation: a prospective comparative studyPatel Pankaj, Barawi Mohammed, Khodadadian Edna, Katz Doug,Gress* Frank. State University of New York, Stony Brook, New York.

Purpose:To prospectively compare thin cut non-contrast SCT and EUS forevaluating patients with suspected biliary disease (ie; common bile ductdilation and choledocholithiasis).

Methods: Seventeen subjects were evaluated with EUS for suspectedbiliary disease. Fourteen of the subjects were confirmed with EUS to haveCBD stone. All patients underwent 3 mm cuts non-contrast SCT within 72hours EUS. Using EUS as the gold standard, the sensitivity, specificity andaccuracy for detecting CBD stones and bile duct dilation were calculatedfor patients in the SCT group.Results: When comparing SCT findings for CBD stone and bile ductdilation to the gold standard EUS, the accuracy for detecting CBD stone inthe SCT group was 17% (3/17 patients) and the sensitivity and specificitywere 51% and 40% respectively. However, the accuracy of identifyingductal dilation on noncontrast SCT was 58% and the sensitivity andspecificity were 68% and 32% respectively. There were no complicationsin either group. The medicare reimbursement for both tests were similar(EUS—$750 vs CT—$775).Conclusions:EUS appears to be a superior imaging modality for detectingCBD stones and ductal dilation compared to non-contrast SCT. Althoughboth methods (EUS and SCT) appear to be relatively safe and comparablein cost, EUS seems to be a preferred means of evaluating the diseasesassociated with the biliary system. This is an ongoing study and in thefuture, a larger sample will help delineate the best diagnostic modality forevaluating biliary disease.

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Is a dilated pancreatic duct at ERCP associated with a lowerincidence of post-ERCP pancreatitis (PEP)? An analysis of 3298patientsPatel MD RS, Mulcahy MD H, Mokhashi MD MS, Payne MD KM,Cotton MD PB, Cunningham MD FACG JT, Hawes MD FACG RH.Medical University of South Carolina, GI Division/DDC, Charleston,SC.

Background: A factor in the pathogenesis of PEP is impaired pancreaticduct (PD) drainage from edema.Hypothesis:Normal (smaller) diameter PDs are more likely to be occludedby edema and hence associated with PEP. The relationship between pan-creatic ductography and PEP is not known.Aim: Evaluate if there is an association between pancreatic duct dilatation(PDIL) and PEP.Methods: The MUSC GI Trac database was reviewed for consecutivepatients who had successful pancreatography. Patients with cancer, stric-ture, stones and prior pancreatic duct or orifice therapy were excluded. Theincidence of PEP was evaluated in patients who did or did not have PDIL.Patients were sub-grouped if they had a pancreatic stent (PST) placedand/or concomitant biliary sphincterotomy (BSx).Results: Of 3298 patients (mean age 49 yrs., range 10–89 yrs., M:F53:7), PEP occurred in 150 (5%). A dilated duct was noted in 801 (24%).PEP occurred in 3% (23/801) of patients with PDIL compared to 5%(127/2497) in those with no PDIL, p5 0.008. The incidence of PEP inpatients with and without BSx, PST and PDIL, is tabulated (*p5 0.02):

No Stent Stent

PDIL No PDIL PDIL No PDIL

BSx 5% (6/117) 7% (40/552) 3% (5/144) 4% (11/281)No BSx 2%* (7/368) 5%* (60/1274) 3% (5/172) 6% (16/290)

Of all patients who had a pancreatic stent placed (n5 887), there was nostatistical difference in the incidence of PEP in those with PDIL (3%,10/316) Vs. no PDIL (5%, 27/571).

Conclusions:1) The overall incidence of PEP is lower in the presence ofPDIL. 2) The presence of duct dilatation in patients who do not undergoBSx or PD stenting is associated with a lower incidence of PEP. 3)Pancreatic duct diameter is an important factor in PEP after diagnosticERCP.

2483AJG – September, 2000 Abstracts