diagnosis, and past biliary history. Subsequent laboratory data and com-puted tomogram were utilized to determine a concurrent diagnosis ofpancreatitis.Results: Average age of patients was 59, with a median age of 62. Fifty-sixpercent (26) were males and 70% (32) were Caucasian. Forty-three percent(20) had prior history of biliary disease. Only 9% (4) had a prior history ofacute pancreatitis. Thirty-seven percent (17) patients demonstrated intra-hepatic biliary dilatation. Fifty-four percent (25) showed dilatation of thecommon bile duct. Range of common bile duct dilation extended to 20mm.The most interesting finding was that only 15% of patients with cholido-cholithiasis in this study developed acute pancreatitis.Conclusions: In contrary to our common impression, acute pancreatitis isa relatively infrequent finding among patients with established cholidocho-lithiasis. Further studies are needed to determine whether interventionaltreatment is necessary for patients with “asymptomatic” cholidocholithiasis.

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GENDER AS AN INDEPENDENT PREDICTOR OF SEVEREACUTE PANCREATITISRanvir Singh, M.D., Tahir Mughal, M.D., Pankaj Singh, M.D.,Meher Madhoun, M.D., Angelo Fernandes, M.D., Simmy Bank, M.D.*.LIJMC, New Hyde Park, NY.

Purpose: It is unclear whether men are at a higher risk of developing severeacute pancreatitis as compared to women. Previous studies have revealedconflicting results. There is speculation that estrogens may be protectivetowards the pancreas, causing a diminished severity of pancreatitis. Basicscience experiments on male and female rats are currently underway toprove this hypothesis, To determine whether men are at a higher risk ofdeveloping severe acute pancreatitis as compared to women.Methods: Three hundred fifty seven patients with abdominal pain sugges-tive of pancreatic origin and elevated amylase level admitted to a tertiarycare center over the time period of 1995 to 2002 were identified. 237subjects with acute episode on chronic / recurrent pancreatitis were ex-cluded One hundred twenty subjects with first episode of acute pancreatitiswere included in the study. Data was extracted on the severity of acutepancreatitis. Atlanta International Symposium 1992, a clinically basedclassification for acute pancreatitis and Bank’s clinical criterion were usedto define the severity of acute pancreatitis. Information was gathered onage, sex, race, and etiology of pancreatitis, history of alcohol abuse, bodymass index, other pertinent clinical details, laboratory and radiologicaltests. Subjects with mild acute pancreatitis were compared with severeacute pancreatitis. Univariable logistic regression analysis was conductedto identify potential risk factors for severe acute pancreatitis. Multi-variablelogistic regression analysis was conducted to identify independent predic-tors of severe acute pancreatitis.Results: There was no significant difference in the proportion of women inpatients with severe and mild acute pancreatitis. Study group with severeacute pancreatitis were older and had higher proportion of obese subjectsand biliary pancreatitis as an etiology of acute pancreatitis. Multivariablelogistic regression analysis showed older age (p�0.05), male sex (0.01),obesity (0.06) as independent predictors of severe acute pancreatitis.Conclusions: Women are at lower risk of developing severe acute pan-creatitis as compared to men. Old age, male sex and higher body massindex are independent predictors of severe acute pancreatitis.

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RISING WBC COUNT PREDICTS CBD STONES IN PATIENTSUNDERGOING ERCPRajeev Jayadevan, M.D., M.R.C.P., Pramod Joseph, M.D.,Tanaya Nayak, M.D., Ajit Kokkat, M.D., Mario Ricci, M.D.,Nejat Kiyici, M.D., Edward Norkus, Ph.D.,Hilary Hertan, M.D., F.A.C.P., FACG*. Our Lady of Mercy MedicalCenter–New York Medical College, Bronx, NY.

Purpose: To identify predictors of common bile duct (CBD) stones inpatients undergoing ERCP.Background: ERCP, the “gold standard” in the diagnosis of CBD stones,is also the therapeutic modality of choice for this condition. Appropriatepatient selection is critical for ERCP, a procedure associated with substan-tial complication rate. Towards this, it is important to identify noninvasivemarkers of CBD stones.Methods: A retrospective analysis of data was done at a University-affiliated teaching hospital, of 107 consecutive patients who underwentERCP for suspected CBD stones. Data were collected on demography,indications, comorbidity, laboratory parameters including blood counts,LFTs and imaging modalities including transabdominal as well as endo-scopic ultrasound, CT scan and MRCP, and correlated with ERCP findings.Patients with primary sclerosing cholangitis and pancreaticobiliary malig-nancy were excluded.Results: The patient population consisted of 74 women and 33 men, ofmean age 59.5 years (range 18–94). CBD stones were identified on ERCPin 48 of 107 patients (44.8%). We found a significant relationship betweena rising white cell count and the presence of CBD stones on ERCP(p�0.001). A rising WBC count was found in 39.1% of patients with CBDstones, compared to only 10% in patients without stones. This effect wasindependent of the presence of cholangitis (n�4). No relationship wasfound between any particular WBC count and CBD stones.

There was no relationship between CBD stones and common bile ductdiameter or individual liver test values including serum bilirubin, alkalinephosphatase, ALT, or “rising” trends for these lab tests. Logistic regressionanalysis was used in a model to explain the presence of CBD stones. In thisanalysis, age, gender, LFT and WBC count values and “rising trends” wereused as explanatory variables. We observed that a rising WBC countincreased the chances of finding a CBD stone by 4.7 fold (p�0.005). Noother variable proved to be predictive of CBD stones.Conclusions: The clinical suspicion of CBD stones may be strengthenedby a rise in WBC count even in patients who do not have overt features ofcholangitis. As an independent predictor of CBD stones, a rising WBCcount could positively influence the decision to proceed with an ERCP.

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SERUM AMYLASE, PANCREATIC STENTING, ANDPANCREATITIS AFTER SPHINCTER OF ODDI MANOMETRYSean Sheehan, M.D., Jeffrey H. Lee, M.D., Carolyn K. Wells, M.P.H.,Mark Topazian, M.D., FACG*. Yale University School of Medicine,New Haven, CT.

Purpose: To determine whether the serum amylase level drawn 2 hoursafter sphincter of Oddi manometry (SOM) predicts development of post-procedure pancreatitis in patients with or without pancreatic stents.Methods: Serum amylase values were measured 2 hours after ERCP withSOM in 88 cases. All patients with post-procedure abdominal pain wereadmitted to the hospital for observation. Post-SOM pancreatitis was definedper concensus criteria as abdominal pain and a serum amylase level at least3 times the upper limit of normal on the morning following SOM. “Possiblepancreatitis” was defined as abdominal pain with a less than 3-fold eleva-tion of serum amylase on the morning following SOM.Results: Of the 88 SOM cases, 52 (59%) felt well, were discharged tohome, and did not develop pancreatitis subsequently. 36 cases were hos-pitalized; 14 (16%) did not develop pancreatitis (normal serum amylaselevels the following morning), 11 (12.5%) developed possible pancreatitis,and 11 (12.5%) developed pancreatitis.

For the entire cohort, two hour (2H) serum amylase levels predictedpost-SOM pancreatitis, which occurred in 2 of 59 cases with normal 2Hserum amylase levels (3%), vs 9 of 29 cases with elevated 2H serumamylase levels (31%) (p�.0002). The predictive value of the 2H serumamylase was limited to the 36 patients who did not receive a temporarypancreatic duct stent: 0 of 24 with normal 2H serum amylase developedpancreatitis (0%) vs 8 of 12 with elevated 2H serum amylase levels (67%)(p�.0001). Among the 52 patients receiving a temporary pancreatic duct

S68 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003