Abstracts / Pancreatology 14 (2014) S1eS129S32

or protease anti-protease complexes in predicting severe disease fromMEDLINE, EMBASE or proceedings of major gastroenterology meetings. Arandom effects model was used to calculate the pooled estimates ofaccuracy of markers.

Results: Forty four studies comprising 2924 patientswith severe APweremeta-analysed. The global measures of test performance (diagnostic oddsratio and area under the summary receiver operating characteristic curve) forPMN elastase were (46.1 and 0.91) at 24 hours, urinary carboxypeptidaseactivation peptide (CAPAP,18.4 and 0.89) at 48 hours, serum CAPAP (18.0 and0.88) at 48 hours, trypsinogen activation peptide (TAP, 16.7 and 0.87) at 48hours and urinary trypsinogen-2 (T2, 12.8 and 0.85) at 24 hours respectively.

Conclusion: This study has revealed that PMN elastase, a leucocyte pro-tease marker at a level >300 mg/L within the first 24 hours predicts a severedisease. ThusPMNelastase compareswellwithothermore commonpancreasderived and inflammatory markers and also early in disease progression.

W-039.

Early warning score predicts severity, adverse outcome and mortalityin patients with acute pancreatitis

M.J. Jones, C.P. Neal, W.S. Ngu, A.R. Dennison, G. Garcea

UHL, United Kingdom

Background: Risk stratification in acute pancreatitis is a mainstay ofmanagement. Current prognostic scoring systems look at physiological,biochemical and imaging features or a combination of the above.

Aims:We examined anumberof scoring systems including earlywarningscore (EWS) and APACHE II as prognostic indicators in acute pancreatitis.

Patients & methods: Patient age, gender, ASA grade, Glasgow criteria,Ranson criteria, APACHE II scores,modifiedorgandysfunction scores andEWSwere recorded for patients presenting with acute pancreatitis between 2007and2011, for thefirst three days of admission. These variableswere comparedbetween survivors and non-survivors, patients with severe or mild pan-creatitis (based on the 2012 Atlanta Classification) and between patients witha favorable or adverse outcome, by calculating Receiver-Operator StatisticArea Under Curve (AUC) and by binary logistic regression analysis.

Results: A total of 629 patients were identified with a mortality rate of8.74%. EWS was the best predictor of severity amongst all of the variablesassessed (AUC values 0.81, 0.84 and 0.829 for days 1, 2 and 3 respectively.)EWS was the most accurate predictive variable in relation to mortality onboth day 2 and day 3 (AUC values 0.88 and 0.89 respectively.) Multivariableanalysis revealed that EWS >2 was independently associated with severityof pancreatitis, adverse outcome and mortality.

Conclusion: EWS has confirmed its usefulness in acute pancreatitis out-come prediction. It is a bedside scoring system than can be repeated hourlyand should become the mainstay of risk stratification in acute pancreatitis.

W-040.

Revised Atlanta classification of acute pancreatitis can predict clinicaloutcome better: a retrospective, multicenter study

Jimin Han a, Ho Gak Kim a, Min Kyu Jung b, Chang-Min Cho b,Kwangbum Cho c, Kook Hyun Kim d, Tae Nyeun Kim d, Dong Wook Lee e,Hyun-Soo Kim e, Chang Hun Yang f

a Catholic University of Daegu School of Medicine, Department ofInternal Medicine, South KoreabKyungpook National Univsersity School of Medicine, Department ofInternal Medicine, South Koreac Keimyung University School of Medicine, Department of InternalMedicine, South KoreadYeungnam Univsersity School of Medicine, Department of InternalMedicine, South KoreaeDaegu Fatima Hospital, Department of Internal Medicine, South KoreafDongguk University College of Medicine, Department of InternalMedicine, South Korea

Background: According to the 1992 Atlanta classification of acutepancreatitis (AP), patients with severe AP had chasms in length of hospital

stay and clinical outcome. The 2012 revision of the Atlanta classificationand definitions by international consensus has been published and in use.

Aim: This study investigated and compare clinical outome of patientswithAP stratified according to 1992 Atlanta classification and revised classification.

Patients & methods: Patiens iwth AP admitted to six referral hospitalbetween January 2012 and July 2013 were included. Medical records werereviewed retrospectively. In each patient, severity assessemnt according to1992 Atlanta classification and revised classification was done. Demographics,organ failure, local complications, length of stay, and clinical outcome wererecorded. Imagingstudiesatadmissionand/orduring follow-upwerereviewed.

Results: A total of 574 cases was included. Mean agewas 56.1±17.3 years.There were 377 males (65.7%). Two most comon causes of AP were alcohol(n¼238, 41.5%) and gallstone (n¼193, 33.6%). According to revised classi-fication, thereweremild (n¼356, 62%),moerately severe (n¼197, 34.3%), andsevere AP (n¼21, 3.7%). Concordance rate between two classification was51.7%. Length of stay was significantly shorted in mild AP and moderatedsevere AP compared to severe AP (7.6±7.1 vs. 12.3±23.7 vs. 44.3±109.7 days,P<0.001). All the patientswithmild andmoderately severe AP improved, butall the 11 cases without imiprovement belonged to severe AP.

Conclusion: Revised classification is a good predictor for clinical out-come pf AP. Concordance rate between two classifications was low. Pro-spective study would be helpful in validation of these findings.

W-041.

BISAP-eGFR could improve prediction of severity and mortality inacute pancreatitis. eGFR ? play the trump card.

Michal Lipinski a, Grazyna Rydzewska b

a Department of Gastroenterology, Central Clinical Hospital of theMinistry of Interior , PolandbDepartment of Gastroenterology, Central Clinical Hospital of theMinistry of Interior, Poland

Background: Low estimated glomerular filtration rate (eGFR) is alreadyknown to be unfavorable prognostic parameter in acute pancreatitis (AP),however it was never assessed as an element of multifactor score.

Aims: To determine whether replacing blood urea nitrogen (BUN) inBISAP score by eGFR (BISAPeeGFR score) improves prediction of severityand mortality in patients with AP.

Patients&methods: Cohort of 100 patients with AP were prospectivelyenrolled in the study. The BISAP and eGFR (abbreviated MDRD equation)were calculated using data from the first 24h from admission. Severe AP(SAP) was defined as the persistence of organ failure exceeding 48 hours.

Results: Twenty of the 100 patients (20%) were considered SAP. The bestcut-off value of GFR was 80ml/min/1,73m2. All 20 patients with SAP hadeGFR<80ml/min/1,73m2whileonly8ofpatientswithSAPhadBUN>25mg/dL(BISAP score cut-off for BUN). Overall,16% of the 100 evaluated patients had aBISAP score�3 while BISAP-eGFRscore �3 was reported for 23% patients. ABISAP score� 3 had a sensitivity, specificity, positive and negative predictivevalueof 65%, 96.1%, 81.2% and 91.3%, respectively comparing to 95.2%, 96.2%,86.9% and 98.7%, respectively for BISAP-eGFR score. The AUC for severitypredictedby BISAPwas 0.762 andby BISAP-eGFR scorewas0.942. Therewerestatistically significant trends for increasing severity (P<0.001) andmortality(P< 0.001) with increasing BISAP-eGFR score. Ten out of ten (100%) patientswith fatal AP had BISAP-eGFR�3, 6 of them (60%) reported BISAP�3.

Conclusion: eGFR replacing BUN in BISAP score provides higher sen-sitivity, specificity comparing to “traditional” BISAP score.

W-042.

Validation of three classification systems for acute pancreatitis

Andrey Litvin a, Aliaksandr Filatau b

a Gomel State Medical University, BelarusbGomel Regional Clinical Hospital, Belarus

Background: There are three classification systems for the severity ofacute pancreatitis (AP): the determinant-based classification (DBC), therevision of the Atlanta classification (RAC), the Atlanta classification (AC).

Abstracts / Pancreatology 14 (2014) S1eS129 S33

Aims: Our aimwas to validate and compare these classification systems.Patients & methods: We analyzed data from 534 adult patients with

AP who were admitted to Gomel Regional Clinical Hospital from January2010 to December 2013 [median age [Q1-Q3], 42 [34-54] years; 315 men].Management was standardized. Data were compared between groups forseverity and outcome.

Results: On the basis of the DBC, 282 (53%), 112 (21%), 108 (20%), and 32(6%) patients were determined to have mild, moderate, severe, or criticalAP, respectively. On the basis of the RAC, 277 patients (52%), 155 patients(29%), and 102 patients (19%) were determined to have mild, moderatelysevere, or severe AP, respectively. On the basis of the AC, 277 patients (52%),and 257 patients (48%) were determined to have mild or severe AP,respectively. Transient and persistent organ failures were present in 60patients (11%) and 97 patients (18%), respectively. Twenty seven patients(5%) died. The different categories of severity for each classification systemwere associated with statistically significant and clinically relevant differ-ences in length of hospital stay, need for admission to the intensive careunit, surgical treatment and mortality. In comparing similar categoriesbetween the classification systems, no significant differences were found.

Conclusion: The DBC, the RAC and the AC accurately classify theseverity of AP in subgroups of patients.

W-043.

Case report of a novel percutaneous transhepatic treatment of a pan-creatogenic bile duct stricture.

Orsolya Husz�ar, Attila Szíj�art�o, Tibor Tihanyi, L�aszl�o Hars�anyi, �Akos Szücs

SE 1.st Dep. of Surg., Hungary

Background: Surgery can commonly cause benign strictures. Since therisk of re-occlusion using ametal stent in a long-term follow-up is still high,other alternative method is needed to elaborate. Surveying the literaturelocal use of corticosteroids by mucosal approach could be a durable sol-ution for benign strictures. However, no data are available about applica-tion in pancreatogenic strictures.

Aims: Our goal was to provide in benign biliary strictures a new tech-nical approach.

Patients & methods: Fifty-seven years old patient presented with anobstructive jaundice after two years of Frey’s procedure. In our caserecurrent biliary stricture was caused by the progressive fibrosis of theremaining pancreas tissue. Percutaneous transhepatic drainage and bal-loon dilationwas not chosen to solve the stricture, considering the previoushistory and the advanced portal hypertension, endoscopic stenting, norsurgery was an option for cure. Percutaneous balloon dilatations alone didnot provide long-term results. As the stricture was based on a localinflammatory response, collagen deposition and fibrosis developed, whichled to luminal stenosis. Aware of our technical background a percutaneoustranshepatic cholangiography and balloon dilation was combined with theinjection of the surrounding tissue with 40 ml triamcinolone (Inj. Kenalog)using flexible transluminal needle

Results: We have successfully developed the technical details. After thetreatment in short-term observation, no restenosis has occurred.

Conclusion: Percutaneous transhepatic corticosteroid injection e as analternative method e in combination with balloon dilatation could providean effective and durable result in the treatment of benign pancreatogenicstrictures. Further research and technical development is needed to pro-vide definitive evidence.

W-044.

Endoscopic therapy using self-expandable metal stents for walled-offpancreatic necrosis

Susana Lopes, Filipe Vilas-Boas, Francisco Baldaque-Silva, Pedro Pereira,Armando Ribeiro, Guilherme Macedo

Gastroenterology - Centro Hospitalar de S~ao Jo~ao, Portugal

Background: Pancreatic fluid collections (PFC) are important compli-cations of acute pancreatitis. In the case of necrotizing pancreatitis, necrosis

can become organized into well-circumscribed, encapsulated areas e

walled-off pancreatic necrosis (WOPN) - which can become infected.Endoscopic ultrasound-guided transluminal intervention gained accept-ance as an alternative treatment modality for PFC and allows the per-formance of drainage, irrigation and direct endoscopic necrosectomy(DEN).

Aims:Materials & methods: We report an innovative endoscopic approach

for the treatment of PFC using a new fully covered, 40mm length, 10mmdiameter, self-expandable metal stent (FCSEMS), with flares at both ends toprovide stability and minimize the risk of migration, and a retrieval sutureat the enteric end (Hanarostent® BCF, Diabolo shape).

Results: Seven patients (aged between 41 and 79 years, 5 male)underwent endoscopic drainage of WOPN complicating severe acutepancreatitis. EUS guided transgastric puncture was performed using a 19-gauge needle (EchoTip® Cook Endoscopy) with further puncture siteballoon dilation to 10mm, to allow DEN (2 per patient) and stent place-ment. Technical success was defined as the correct placement of FCSEMSand clinical success as resolution of fever and white blood cell countnormalization and complete shrinkage of fluid collection without sur-gery. In all 7 patients the insertion was successful, stents were fullyexpanded, and complete drainage was achieved in 5-10 days as con-trolled by CT scan.

Conclusion: Our preliminary experience shows that the endoscopicapproach using FCSEMS is a feasible, safe and effective alternative to sur-gery, in the treatment of PFC.

W-045.

Use of a novel self-expanding metal stent to allow for endoscopic drai-nage and necrosectomy of pancreatic fluid collections

Matthew Huggett a, Kofi Oppong a, Stephen Pereira b, Vikram Mitra a,Richard Charnley c, Manu Nayar a

a Department of Gastroenterology, Freeman Hospital, Newcastle-upon-Tyne, United KingdombUCL Institute for Liver and Digestive Health, University CollegeLondon, United KingdomcDepartment of Hepatobiliary Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom

Background: Post-inflammatory peri-pancreatic fluid collections arefrequent sequelae of severe acute pancreatitis. Recently, a novel flangedfully covered self-expanding metal stent (FCSEMS; NAGI stent, TaewoongMedical, Korea) has been developed, allowing for better EUS-guideddrainage of infected necrosis and easier endoscopic access into the cavity.

Aims: To determine the safety and efficacy of FCSEMS endoscopic cyst-gastrostomy in the management of complex/infected pancreatic fluidcollections.

Patients & methods: Patients were included if they had evidence of apancreatic fluid collection which was amenable for EUS- guided drainage.The collection was punctured using a cystotome and the FCSEMS insertedover a guidewire with fluoroscopic control. Repeat procedures were per-formed as necessary.

Results: A total of 11 patients (8 male, 3 female) were included.Median age was 57.3 years. The aetiology of the collection was gallstonesin 6 patients, idiopathic in 3, ischaemic in 1 and drug-induced in 1. Tenpatients had evidence of at least 30% necrosis within the collection. Meandiameter of the collection was 15cm and EUS-guided puncture was ini-tially performed in all patients. Ten patients underwent endoscopicnecrosectomy, with a median of 3 procedures (range 1-10). Significantreduction in the size of collection was achieved in all patients. Adverseevents included stent migration in 3 (2 spontaneously and 1 duringnecrosectomy). Two patients died of complications of severe acutepancreatitis.

Conclusion: FCSEMS insertion is feasible and safe for drainage ofpancreatic fluid collections. It allows repeated through the stentnecrosectomy procedures and is a major advance in the management ofinfected pancreatic necrosis.