Mo1646 REC8, a Novel EBV-Associated Hypermethylated Gene, Contributes to the Pathogenesis of EBV-Associated Gastric Cancer

Abstract

Acute biliary pancreatitis (ABP) is caused by common bile duct stones (CBDS) migration. In the majority of cases, the CBDS will pass spontaneously in the duodenum, but in some, could be retained and may lead to complications. Many studies evaluated pancreatic and liver enzymes as non-invasive predictors for rCBDS. These prior studies used variable timing for enzymes dosage and only few evaluated laboratory trends as predictors. Knowing that CBDS migration is a dynamic process, time should be considered in the interpretation of these tests. The aims of this study were to 1) identify the best timing for dosage of enzymes to predict rCBDS and 2) evaluate if trends of enzymes improve the prediction of rCBDS. Methods: A retrospective chart review was done for all patients with ABP who underwent an endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound (EUS), magnetic resonance cholangiography (MRCP) or intraoperative cholangiogram (IOC) for suspicion of rCBDS in our institution between January 2000 and December 2011. Retained CBDS was diagnosed if confirmed at ERCP, EUS, MRCP or IOC. Bilirubin, AST, ALT, alkaline phosphatase (ALP), GGT, amylase and lipase done at admission and during the 48h preceding the confirming test were collected. Blood samples done at 6:00 am (±6h) 2 days before, 1 day before and the day of ERCP/EUS/MRCP/IOC were identified respectively as T-48, T-24 and T0. Mann-Whitney was used for statistical comparison of median values and laboratory trends. Univariate analysis was performed. Results: One hundred and fifty patients were included, among which 41 had rCBDS. Median amylase at admission was significantly higher in patient with than without rCBDS (1970 vs 873 IU/L; p<0.05) but not at other times. Median ALP was significantly higher in patients with rCBDS at T-24 only (166 vs 127 IU; p<0.05). Median bilirubin was significantly higher in patients with rCBDS only at T-24 (24 vs 14 μmol/L; p<0.05) and T0 (24 vs 12 μmol/L; p=0.001). Median AST and median GGT were significantly higher in patients with rCBDS only at T0 (62 vs 36 IU/L; p<0.05 and 619 vs 191; p<0.05). Trends for each enzyme at different timing were evaluated to predict rCBDS, but none of them showed any specific pattern that could be predictive. Conclusion: This study evaluates laboratory tests in the prediction of rCBDS according to time. We found that trends of enzymes do not predict rCBDS. Predictors for rCBDS were amylase at admission, ALP at T-24, bilirubin at T-24 and T0, AST at T0 and GGT at T0. These observations suggest that timing should be considered in the interpretation of biochemical tests for suspected rCBDS in ABP.