Mo1458 Endosonography-Guided Gallbladder Drainage With a Lumen Apposing Stent Reduced Recurrent Biliary Events After Acute Cholecystitis As Compared to Percutaneous Cholecystostomy

Abstract

Area under the ROC curve was 0.68 (95% CI 0.540.82), p-value 0.05 Mo1457 Endoscopic Ultrasound Correlates With Histology in Patients With Chronic Pancreatitis Undergoing Total Pancreatectomy Elham Afghani*, Amitasha Sinha, Michael Cruise, Mahya Faghih, Martin a. Makary, Kenzo Hirose, Marcia I. Canto, Mouen Khashab, Anne Marie Lennon, Vikesh K. Singh GI, Johns Hopkins, Baltimore, MD; Pathology, Johns Hopkins Hospital, Baltimore, MD; Surgery, Johns Hopkins Hospital, Baltimore, MD Background: Endoscopic ultrasound (EUS) is commonly used to diagnose chronic pancreatitis (CP). However, there have been few studies which have evaluated EUS with histology. Aims: To evaluate the association between EUS scoring with the degree of fibrosis in patients with CP who have undergone total pancreatectomy (TP). Methods: All consecutive adult patients with CP (ageR18 years) who underwent preoperative EUS followed by TP from 8/2011 to 10/2013 were included. EUS criteria were defined by the 9 ductal and parenchymal features. Surgical wedge biopsies were obtained from the head and body/tail during TP and histology was evaluated by a pathologist blinded to the results of EUS. Perilobular and intralobular fibrosis scores were determined from the wedge biopsy specimen for each patient and averaged. Mild fibrosis was defined as a fibrosis score (FS) of 0-6 and severe fibrosis was defined as FS of 7-12. The association between FS and EUS criteria was evaluated using Pearson’s correlation coefficient. The diagnostic accuracy of EUS for predicting severe fibrosis was assessed using the area under receiver operating characteristic curve (AUROC). Results: There were 29 patients (68.9% females, mean age of 44 12 years). All patients underwent EUS at mean time of 27.6 15.3 weeks prior to TP. There were 8 (27.5%) patients with calcifications. There were 13 (44.8%) patients with mild and 16 (55.2%) with severe fibrosis. There was a significant correlation between FS and EUS criteria (rZ0.57, 95% CI 0.28, 0.78, p!0.001) as seen in Figure 1. The diagnostic accuracy of EUS for predicting severe fibrosis by AUROC was 0.65 (95% CI 0.45, 0.85). An EUS cut-off of R6 criteria had a sensitivity of 37.5% but specificity and positive predictive value of 100% for severe fibrosis. Conclusion: EUS correlates with fibrosis but no criteria threshold is accurate enough to predict severe fibrosis. AB444 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 Mo1458 Endosonography-Guided Gallbladder Drainage With a Lumen Apposing Stent Reduced Recurrent Biliary Events After Acute Cholecystitis As Compared to Percutaneous Cholecystostomy Anthony Y. Teoh*, Takao Itoi, Philip W. Chiu, Raymond S. Tang, Charing C. Chong, Enders K. NG, Francis K.L. Chan, James Y. Lau Surgery, Chinese University of Hong Kong, Hong Kong, Hong Kong; Tokyo Medical University Hospital, Tokyo, Japan; Institute of Digestive Disease, Hong Kong, Hong Kong Background: Endosonography-guided gallbladder drainage (EGBD) has been shown to be feasible in previous studies. However, how the approach compares to percutaneous cholecystostomy (PTC) in patients who were unsuitable for surgery is uncertain. Methods: This was a retrospective case-controlled study of all patients who suffered from acute cholecystitis and were deemed high-risk for surgery, that were admitted to the Prince of Wales Hospital between January 2010 and November 2013. The patients that received EGBD were matched with those that received PTC based on sex, age and American society of anesthesiology grading. EGBD was performed using a linear echoendoscope (GF-UCT180 Olympus, Japan) and a lumen apposing stent (AXIOS, Xlumena, CA, USA) was used to drain the gallbladder in to the stomach or duodenum. Outcome measurements included technical and clinical success, morbidities, mortalities, the number of device-related events and unplanned admissions. Results EGBD was performed in 18 patients and they were case-matched with 18 patients who received PTC. There were no significant differences in background demographics between the EGBD and PTC groups(Table 1). All procedures were technically successful and clinical success was obtained in 88.9% and 94.4% of the patients respectively. 11 patients in the EGBD group underwent cholecystoscopy and all stones were removed in 81.8% of the patients. There were no differences in morbidities (33% vs 33.3%, P Z 1) and mortalities (11.1% vs 5.6%, P Z 1). Patients who underwent PTC suffered from significantly more device related events (61.1% vs 16.7%, P Z 0.015) and required more unplanned admissions (2.11 +/2.32 vs 0.11 +/0.47, P Z 0.002). The causes of device-related events in the PTC group included dislodgement, slipping of anchoring sutures and peri-tubal leak. Conclusion: EGBD and PTC were both effective means of obtaining gallbladder drainage. In the absence of a percutaneous tubing, EGBD was associated with reduced number of device-related events and unplanned admissions. Furthermore, EGBD allowed for removal of gallstones after the procedure. Comparison of outcomes between EGBD and PTC. EGBD N [ 18 PTC N [ 18