Recurrent Chronic Pancreatitis Research Articles

Assessment of the stomach and duodenal acidity dynamics at the patients with gastroduodenogenic chronic recurrent pancreatitis under the influence of complex treatment programs

Assessment of the stomach and duodenal acidity dynamics at the patients with gastroduodenogenic chronic recurrent pancreatitis under the influence of complex treatment programs

Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis.

Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health-related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP-related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health-related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.

Identification of genetic alterations associated with chronic pancreatitis and recurrent acute pancreatitis in Indian patients by whole-exome sequencing

Identification of genetic alterations associated with chronic pancreatitis and recurrent acute pancreatitis in Indian patients by whole-exome sequencing

Periampullary tumors in a patient with pancreatic divisum and neurofibromatosis type 1: a case report

IntroductionWe present a case of a male patient with neurofibromatosis type 1 diagnosed with pancreatic divisum and several gastrointestinal tumors. A 55-year-old man was admitted to the hospital with recurrent chronic pancreatitis, indicating a large mass in the ampulla. In addition, genetic testing revealed two unique germline mutations in the neurofibromin (NF1) gene, and their potential interaction in promoting cancer was further investigated.ConclusionThe first similar case was reported in 2020. The current case was distinct from other cases since an additional two NF1 mutations were found in the patient. In conjunction with prior case reports, our findings imply that genetic testing in patients diagnosed with neurofibromatosis type 1 could be helpful in the development of effective treatments.

Temporal Analysis of Inflammatory Bowel Disease and Pancreatitis Co-Occurrence in Children and Adults in the United States.

Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these 2 diseases. Truven Health MarketScan private insurance claims from 141,017,841 patients (younger than 65 years) and 7,457,709 patients from 4 academic hospitals were analyzed. We calculated the prevalence of Crohn's disease or ulcerative colitis (UC) with acute pancreatitis or chronic pancreatitis (CP) and performed temporal and descriptive analyses. Of 516,724 patients with inflammatory bowel disease, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis (AP) was 2-6x more prevalent than CP. In adults, AP occurred equally among Crohn's disease and UC (1.8%-2.2% vs 1.6%-2.1%, respectively), whereas in children, AP was more frequent in UC (2.3%-3.4% vs 1.5%-1.8%, respectively). The highest proportion of pancreatitis (21.7%-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of them, 22.1%-39.3% were on steroids during pancreatitis. Individuals with CP or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio = 1.52 or 1.72, respectively). Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively affect the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bidirectional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.

Medzinárodná autotransplantácia Langerhansových ostrovčekov do portálneho riečiska po totálnej pankreatektómii u pacienta s chronickou hereditárnou pankreatitídou – kazuistika a prehľad súčasnej literatúry

Summary: Chronic pancreatitis with repeated painful relapses is a severe multifactorial, fibroinflammatory syndrome that significantly affects the quality of life of patients, mainly in terms of pain, development of diabetes mellitus, and repeated attacks of acute pancreatitis. Autologous islet transplantation after total pancreatectomy is a potential option in selected patients with severe, recurrent painful episodes of chronic pancreatitis. In our case, we present a patient with severe recurrent chronic pancreatitis. The patient required frequent hospitalizations with repeated stenting of the pancreatic duct. After the confirmation of a genetic mutation, the members of the multidisciplinary session decided to perform a total pancreatectomy with islet autotransplantation. In this case, we present the first international islet cell autotransplantation of Langerhans islets in Slovakia after total pancreatectomy in a patient with chronic hereditary pancreatitis. Key words: hereditary pancreatitis – total pancreatectomy – autotransplantation of Langerhans islets

Pancreatic syphilis mimicking cancer

Since the incidence of syphilis is increasing, the number of pancreatic lesions is expected to increase too. Pancreatic syphilis can be congenital or acquired.
 The pancreas is affected in 10–80% of patients with congenital syphilis. Infection of the pancreas occurs most often during the second half of pregnancy. Morphologically, there are five types of congenital pancreatic syphilis: gummy; diffuse interstitial pancreatitis, which can be combined with multiple miliary gummas and atrophy of the pancreatic parenchyma; indurative fibrous type; with atrophy of the lobules (atrophic type); and with a predominant lesion of the pancreatic ducts —sialangitis pancreatica. In congenital syphilis, the pancreatic head is mostly affected. Early and severe damage to the islets of Langerhans is typical.
 Acquired pancreatic syphilis is less common than congenital syphilis. Morphologically, it has three types: the edematous-infiltrative type, in secondary syphilis; the gummy type (pancreatitis gummosa), in tertiary syphilis; and sclerotic pancreatitis, or pancreatitis sclerotica, or “syphilitic cirrhosis of the pancreas”. The latter type is usually the outcome of the first two morphological types. Clinically acquired pancreatic syphilis proceeds according to the type of recurrent chronic pancreatitis, i.e., with periodic exacerbations (pancreatic attacks), but the pain is rarely intense, and the phenomenon of “deviation” of enzymes into the blood is rarely observed. This clinical type more often corresponds to the edematous-infiltrative morphological type of syphilitic organ damage, and less often to the gummy type. It should be noted that acquired pancreatic syphilis occurs against the background of specific damage to the liver, heart, aorta, kidneys, skin, stomach, central nervous system, etc. The differential diagnosis of gummy pancreatic lesions and pancreatic cancer is especially complicated.
 Antisyphilitic treatment should be administered. Due to a toxic-allergic reaction, the symptoms of pancreatitis may exacerbate at the start of a specific therapy. 

Combined SPINK1 mutations induce early-onset severe chronic pancreatitis in a child with severe obesity.

SummaryThe most frequent causes of pancreatitis classically have been known to be gallstones or alcohol. However, genetics can also play a key role in predisposing patients to both chronic and acute pancreatitis. The serine protease inhibitor Kazal type 1 (SPINK 1) gene is known to be strongly associated with pancreatitis. Patients with these underlying genetic mutations can have severe diseases with a high morbidity rate and frequent hospitalization. We report an Arab girl who presented with acute pancreatitis at the age of 7 years progressing to recurrent chronic pancreatitis over a few years. She had severe obesity from the age of 4 years and developed type 2 diabetes at the age of 12. She had a normal biliary system anatomy. Genetic analysis showed that she had combined heterozygous mutations in the SPINK1 gene (SPINK1, c.101A>G p.(Asn34Ser) and SPINK1, c.56-37T>C). Her parents were first-degree cousins, but neither had obesity. Mother was detected to have the same mutations. She had type 2 diabetes but never presented with pancreatitis. This case is the first to be reported from the Arab region with these combined mutations leading to recurrent chronic pancreatitis. It illustrates the importance of diagnosing the underlying genetic mutation in the absence of other known causes of pancreatitis. Considering the absence of pancreatitis history in the mother who did not have obesity but harboured the same mutations, we point out that severe obesity might be a triggering factor of pancreatitis in the presence of the mutations in SPINK1 gene in this child. While this is not an assumption from a single patient, we show that not all carriers of this mutation develop the disease even within the same family. Triggering factors like severe obesity might have a role in developing the disease.Learning pointsAcute recurrent pancreatitis and chronic pancreatitis are uncommon in children but might be underdiagnosed.Biliary tract anomalies and dyslipidaemias are known causative factors for pancreatitis, but pancreatitis can be seen in children with intact biliary system.Genetic diagnosis should be sought in children with pancreatitis in the absence of known underlying predisposing factors.SPINK1 mutations can predispose to an early-onset severe recurrent pancreatitis and acute pancreatitis.

Recurrent chronic pancreatitis with intractable pancreatolithiasis.

Due to low incidence rate of pancreatic duct stones，Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article reports the treatment of a young woman with chronic pancreatitis complicated with refractory multiple pancreatic duct stones, which provides clinical experience for treatment and provides a new way to study the pathogenesis of chronic pancreatitis complicated with pancreatic duct stones.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ГИПЕРТЕНЗИОННО-ПРОТОКОВОГО ТИПА ХРОНИЧЕСКОГО ПАНКРЕАТИТА, В СОЧЕТАНИИ С СИНДРОМОМ БИЛИАРНОЙ ОБСТРУКЦИИ

Background. The frequency of chronic pancreatitis and its complications is steadily increasing, which makes the problem of treating this pathology one of the most urgent and significant. Objective. Improvement of the results of surgical treatment of patients with hypertension-ductal type of chronic pancreatitis with extended stricture of the intrapancreatic part of the common bile duct. Material and methods. During the period 2006–2021, 328 operations were performed in the Grodno University Clinic due to chronic pancreatitis with pathology of the ductal system in combination with pancreatic cysts. The total number of complications was 5,1%. 18 patients with chronic recurrent pancreatitis, ductal hypertension in combination with a cyst of the head pancreas, also with extended stricture of the terminal part common bile duct and mechanical jaundice were operated on according to the methods developed in the clinic: 12 patients underwent choledochopancreatoejunostomy, 5 patients underwent choledochocystopancreatoejunostomy, choledochocystoduodenostomy was performed in 1 case. Results. The developed methods make it possible to perform adequate internal drainage of the ductal system of the pancreas and bile ducts, as well as cystic formations. Conclusions. The application of the developed methods improves the results of surgical treatment complicated chronic pancreatitis.

S3476 Workup of a Suspected Pancreaticopleural Fistula in a Young Male

Introduction: Pancreatic fistulas are an abnormal connection between the pancreas and an adjacent or distant structure or organ. These can be characterized as internal or external depending if the pancreatic duct communicates with the skin or not. The most common cause of an internal pancreatic fistula is pancreatitis associated with chronic alcohol. Pancreatopleural fistulas develop by leakage of pancreatic exocrine secretions through the openings in the diaphragm. Here we present a case, where there was concern for a pancreatopleural fistula. Case Description/Methods: A 31-year-old male with past medical history of chronic recurrent pancreatitis complicated by enlarging pseudocysts and portal vein thrombosis was transferred to our facility from outside hospital for hemorrhagic pancreatic pseudoaneurysm status post IR embolization. He had been bleeding from the hemorrhagic pseudoaneurysm at the previous hospital and had been treated with an initial IR embolization procedure for this 4-5 days before arriving at our facility. He underwent repeat IR embolization procedure with repositioning of the malpositioned coil 6 days after admission and subsequently underwent EGD with endoscopic ultrasound and cysgastrectomy for treatment of his associated pancreatic pseudocyst 12 days after admission. Pleural effusion seen on Xray was thought to be secondary to pancreatic fluid accumulation. Thoracentesis was subsequently performed due to patient complaints of dyspnea and analysis showed > 12,000U/L of amylase and black fluid concerning for a pancreatic pleural fistula (Figure A). Patient had a repeat X-ray the following day with accumulation of the pleural effusion (Figure B). Patient was started on TPN and Octreotide for treatment. Repeat thoracentesis yielded amber colored fluid and a CT chest, abdomen and pelvis did not show evidence of fistula formation. It was determined that the initial thoracentesis performed on the patient was actually placed into the pancreatic pseudocyst due to severe elevation of the hemidiaphragm. The patient was ultimately discharged with plans to follow-up with general surgery as an outpatient for possible pancreatectomy. Discussion: We believe that our findings during the care of this patient are important for Gastroenterologists as they provide an excellent opportunity to review both the common and obscure complications of pancreatitis. entity that can occur in patients with acute pancreatitis and is characterized by small, left sided pleural effusions.Figure 1.: Figure A. Thoracentesis fluid obtained from patient concerning for a pancreatic pleural fistula. Figure B. Repeat chest x-ray showing re-accumulation of large left-sided pleural effusion.

EUS in Pediatrics: A Multicenter Experience and Review.

Background/Aim: Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. We also discuss the current and developing diagnostic and therapeutic uses for EUS in pediatrics such as in pancreaticobiliary disease, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.Methods: This is a retrospective review of EUS performed by two pediatric gastroenterologists trained as endosonographers between April 2017 and November 2020. Patient demographics, procedure indication, procedure characteristics, technical success, and complications were collected. Literature review was performed to describe current and future uses of EUS in pediatrics.Results: Ninety-eight EUS were performed with 15 (15.3%) including fine needle aspiration/biopsy and 9 (9.2%) cases being therapeutic. Most common indications include choledocholithiasis (n = 31, 31.6%), pancreatic fluid collections (n = 18, 18.4%), chronic and acute recurrent pancreatitis (n = 14, 14.3%), and acute pancreatitis characterization (n = 13, 13.3%). Notable indications of pancreatic mass (n = 6, 6.1%) and luminal lesions/strictures (n = 6, 6.1%) were less common. Complications were limited with one instance of questionable GI bleeding after cystgastrostomy creation. Ninety-eight of 98 (100%) cases were technically successful.Conclusion/Discussion: EUS has been shown to be performed safely and successfully in the pediatric population by pediatric endosonographers. This study and review support its use in pediatric practice and demonstrate the wide variety of indications for EUS such as pancreatic cystgastrostomy, celiac plexus neurolysis, and evaluation of chronic pancreatitis. This literature review also demonstrates areas of potential development for EUS within the practice of pediatric gastroenterology.

Transduodenal drainage of hard-to-reach pancreatic pseudocyst under endosonography control

The aim of the investigation was to demonstrate the possibility of modern technology of endoscopic drainage of difficultly accessible pancreatic pseudocyst of complex configuration using endosonography.Material and methods: a patient with a long history of recurrent chronic pancreatitis and a pseudocyst of complex configuration and anatomical location formed on this background was subjected to internal drainage of postnecrotic cyst under the control of endosonography in November 2020.Result: The surgical intervention and postoperative period were without complications. Control CT scan of the abdominal cavity organs after 3 months showed complete reduction and disappearance of the cyst. The follow-up period up to the present time is 5 months. The patient had no complaints at the moment.Conclusion: this clinical observation demonstrates the advantages of minimally invasive intraluminal transduodenal access. The used access permitted to perform surgery in maximum organ preserving variant with the best functional result.

СЕЛЕКТИВНАЯ ДЕВАСКУЛЯРИЗАЦИЯ ДНА ЖЕЛУДКА У ПАЦИЕНТОВ С ХРОНИЧЕСКИМ ПАНКРЕАТИТОМ И ПОДПЕЧЁНОЧНОЙ ПОРТАЛЬНОЙ ГИПЕРТЕНЗИЕЙ. Предварительное сообщение о серии случаев

Background. Making treatment / prevention decisions in bleeding from gastroesophageal varices in patients with subhepatic portal hypertension remains challenging and thus requires further research. Objective. To perform a preliminary analysis of the outcomes of selective devascularization of the gastric fundus in patients with chronic pancreatitis and subhepatic portal hypertension. Material and methods. Selective devascularization of the gastric fundus was performed in five patients (3 men and 2 women) aged 23 to 54 with chronic recurrent pancreatitis and subhepatic portal hypertension. In 2 patients, Roux-en-Y cystojejunostomy for pancreatic pseudocyst was performed as the main treatment, and in 3 patients - Frey's surgery. Selective devascularization of the gastric fundus was adjuvant to a draining surgery or a resection-draining one. Results. All patients underwent surgery successfully. The duration of the operation (Me [min; max]) was 205 [190; 255] min. The time spent in the Department of anesthesiology, resuscitation and intensive care comprised 1 [1; 2] days. Postoperative follow-up of these patients over the period of 17 - 58 months detected no recurrence of bleeding from gastric varices. Endoscopy performed a year after revealed a decrease in the size of esophageal varices in all patients. Conclusions. The proposed technique of selective devascularization of the gastric fundus is substantiated by numerous studies of the variant anatomy of venous outflow from the spleen in extrahepatic portal hypertension. This technique is regarded as adjuvant to a draining surgery or a resection-draining one in patients with chronic pancreatitis and subhepatic portal hypertension performed to prevent bleeding from gastric fundus varices. There should be noted the reproducibility of this surgical intervention, its effectiveness and safety. Further research on the efficiency of the technique using randomized controlled trials is required.

Appalachian Constellation: Type 3C Diabetes as the Link Between Diabetes and Chronic Pancreatitis

Diabetes of the exocrine pancreas, also known as type 3c diabetes, is caused by a variety of underlying mechanisms, most commonly chronic pancreatitis. Type 3c diabetes leads to chronic inflammation of the pancreas and results in frequent episodes of hypo- or hyper-glycemia, and patients are commonly misdiagnosed as having type 2 diabetes. We report the case of a 52-year-old man from rural West Virginia (WV) who presented with a five-year history of chronic abdominal pain and recurrent pancreatitis. His physical examination, laboratory, and radiologic studies revealed an acute pancreatitis flare, and his elevated serum glucose level indicated new-onset diabetes, leading to a diagnosis of type 3c diabetes. Given the disproportionate rate of diabetes in WV, it is critical for healthcare providers to learn to recognize patients with diabetes with underlying pancreatic disease and to treat those patients appropriately.

A Treatable but Commonly Missed Etiology;An Unusual Presentation of Primary Hyperparathyroidism as Acute on Chronic Recurrent Pancreatitis- A Case Report

Introduction: Acute pancreatitis is an identified, but uncommon presentation of Primary hyperparathyroidism with prevalence of 3.6%. Hypercalcemia is a rare but known cause of pancreatitis as it leads to premature intra pancreatic activation of protease and destruction of pancreatic tissue leading to pancreatitis. Here we present a case of primary hyperparathyroidism that went undiagnosed for years, and was finally diagnosed after recurrent episodes of pancreatitis of unclear etiology. Case Presentation: A 46-year-old female with history of recurrent pancreatitis presented to the emergency department due to constant epigastric pain for 6 hours associated with nausea and vomiting. Patient reported recurrent episodes of pancreatitis over the past 4 years. Patient was told that etiology of pancreatitis is unclear despite workup. Patient was frustrated that her pancreatitis attacks were usually labeled as alcoholic pancreatitis as she works as a bartender. She strongly states she only drinks alcohol occasionally. She underwent cholecystectomy 2 years ago in attempt to prevent further pancreatitis attacks. Her vital signs were stable. Physical exam was remarkable for epigastric tenderness. CT abdomen and pelvis with contrast showed chronic pancreatitis, pseudocyst and free fluid in the pancreatic bed characteristic of acute pancreatitis. Abdominal US showed post cholecystectomy changes, with no biliary dilatation or stones. Initial labs showed: lipase 2001 U/L, Alcohol level < 10 mmol/L, Calcium 11.5 mg/dl, ionized calcium 4.9 mg/dl, phosphate 2.7 mg/dl, and Triglycerides 52 mg/dl. Subsequently parathyroid hormone was checked and was 116.8 pg/ml. Vitamin D was normal. NM parathyroid scan showed increased tracer activity demonstrating parathyroid adenoma. Patient was given IVF and supportive treatment and her symptoms improved. Endocrinology recommended parathyroidectomy. Patient elected to be discharged and undergoes parathyroidectomy outpatient. Discusion: In this case we emphasize the importance of considering PHPT in acute pancreatitis of unclear etiology especially when Calcium level is elevated. PHPT was missed as a treatable etiology despite mildly elevated calcium level in prior hospitalizations. It is reported that pancreatitis is frequently associated with hypocalcemia with prevalence of 15–88%. Moreover, hypocalcemia is a component of Ranson’s scoring system for severity of pancreatitis. This is explained by precipitation of calcium soaps, hypoalbuminemia and increased calcitonin secondary to glucagon release. PTHT induced pancreatitis management has the same general principles of supportive management. All these patients, once stable, should undergo parathyroidectomy for definitive treatment. Data suggests nearly 100% improvement in pancreatitis symptoms and prevention of recurrent pancreatitis episodes after the cure of PHPT.

ЭМБОЛИЗАЦИЯ СЕЛЕЗЕНОЧНОЙ АРТЕРИИ В СОБСТВЕННОЙ МОДИФИКАЦИИ У ПАЦИЕНТОВ С КРОВОТЕЧЕНИЕМ ИЗ ВАРИКОЗНО РАСШИРЕННЫХ ВЕН ДНА ЖЕЛУДКА ВСЛЕДСТВИЕ СЕГМЕНТАРНОЙ ПОРТАЛЬНОЙ ГИПЕРТЕНЗИИ

There is still no single point of view regarding the choice of the most effective method for treating left-sided portal hypertension, due to the difficulties in organizing the recruitment of patient groups for controlled studies on this topic. Aim. Preliminary analysis of the results of performing endovascular embolization of the splenic artery in our own modification in patients with left-sided portal hypertension. Materials and methods. Endovascular embolization of the splenic artery in our own modification was performed in three patients with chronic recurrent pancreatitis and left-sided portal hypertension (all males) aged 46 to 59 years after a repeated episode of bleeding from varices of the gastric fundus (2 to 3 relapses). A distinctive feature of our modification of X-ray endovascular partial embolization of the proximal segment of the splenic artery was that the criterion for stopping the process of reducing blood flow through the splenic artery was endoscopic confirmation of the fact of achieving reliable hemostasis. Results and discussion. All patients underwent successful surgery. Two patients were transferred after surgery to the Department of Surgical Pancreatology, Hepatology and Transplantation. In one case, it was required to stay in the intensive care unit for four days after surgery due to the severity of preoperative blood loss. The time spent in hospital in the postoperative period was (Me [min; max]) - 7 [6; 7] days. During the postoperative observation of these patients for the period from 22 to 60 months, no recurrence of bleeding from gastric varices was noted. In all patients, endoscopic examination after a year showed regression of the degree of expansion of gastric varices. Сonclusions. The method of endovascular embolization of the splenic artery presented in the article makes it possible to effectively achieve reliable hemostasis in bleeding from varices of the fundus of the stomach in patients with left-sided portal hypertension while maintaining blood flow through the splenic artery sufficient to minimize the risk of developing total necrosis and abscess of the spleen, necrotic changes in the fundus of the stomach and pancreas The reproducibility of the surgical intervention, its effectiveness and safety should be noted. It is advisable carry out further studies of the effectiveness of the technique in randomized controlled trials.

Аберрантная поджелудочная железа: диагностика и терапевтическая тактика. Клиническое наблюдение

Aberrant pancreas is a result of impaired embryogenesis. The clinical presentation varies and mimics different diseases. The diagnostics complexity makes specialists conduct the patients’ work-up more thoroughly. Chronic recurrent pancreatitis is one of pancreatic cancer risk factors. Tobacco and alcohol consumption significantly increases the risk of developing aberrant pancreas. The article presents a clinical case of a 37-year-old man with a 10-year history of chronic pancreatitis mainly highlighting the diagnostics of aberrant pancreas. The disease manifested with an episode of acute pancreatitis and pancreonecrosis treated in a hospital. Pancreatic pseudocysts were diagnosed four years later. However, only six years after, aberrant pancreas in stomach and cystic dystrophy of duodenal wall were diagnosed. Accurate diagnosis allowed tailored treatment and avoiding surgery.

Preoperative ERCP has no impact on islet yield following total pancreatectomy and islet autotransplantation (TPIAT): Results from the Prospective Observational Study of TPIAT (POST) cohort

Background and aimsMany patients undergoing total pancreatectomy with islet autotransplant (TPIAT) for severe, refractory chronic pancreatitis or recurrent acute pancreatitis have a history of endoscopic retrograde cholangiopancreatography (ERCP). Using data from the multicenter POST (Prospective Observational Study of TPIAT) cohort, we aimed to determine clinical characteristics associated with ERCP and the effect of ERCP on islet yield. MethodsUsing data from 230 participants (11 centers), demographics, pancreatitis history, and imaging features were tested for association with ERCP procedures. Logistic and linear regression were used to assess association of islet yield measures with having any pre-operative ERCPs and with the number of ERCPs, adjusting for confounders. Results175 (76%) underwent ERCPs [median number of ERCPs (IQR) 2 (1-4). ERCP was more common in those with obstructed pancreatic duct (p = 0.0009), pancreas divisum (p = 0.0009), prior pancreatic surgery (p = 0.005), and longer disease duration (p = 0.004). A greater number of ERCPs was associated with disease duration (p < 0.0001), obstructed pancreatic duct (p = 0.006), and prior pancreatic surgery (p = 0.006) and increased risk for positive islet culture (p < 0.0001). Mean total IEQ/kg with vs. without prior ERCP were 4145 (95% CI 3621-4669) vs. 3476 (95% CI 2521-4431) respectively (p = 0.23). Adjusting for confounders, islet yield was not significantly associated with prior ERCP, number of ERCPs, biliary or pancreatic sphincterotomy or stent placement. ConclusionsERCP did not appear to adversely impact islet yield. When indicated, ERCP need not be withheld to optimize islet yield but the risk-benefit ratio of ERCP should be considered given its potential harms, including risk for excessive delay in TPIAT.

S0086 Impact of Image Quality on Single-Operator Pancreatoscopy-Guided Intraductal Lithotripsy for the Treatment of Main Pancreatic Duct Stones

INTRODUCTION: For large pancreatic duct (PD) stones (≥5 mm), ERCP with single operator pancreatoscopy (SOP) guided electrohydraulic lithotripsy (EHL) is an emerging technique. The SOP systems have been refined with interval advances in image quality, evolving from a fiberoptic (f-SOP) to a digital (d-SOP) platform. The aim of this study is to report our center’s experience in terms of effectiveness and safety of SOP-EHL for the management of MPDS and assess for technical benefits from interval advances in image quality. METHODS: This is a retrospective series of patients who underwent SOP-EHL for the treatment of large MPDS from 9/2013 to 9/2019. Technical success was defined as complete or near complete stone clearance based on final pancreatogram. Clinical success was defined by improvement in pain or exocrine insufficiency (EPI) (cessation of enzyme supplementation after EHL). RESULTS: 18 patients underwent SOP-EHL including 8 with the f-SOP platform and 10 with the d-SOP platform. Baseline characteristics (Table 1) are similar between platforms. Symptoms prompting MPDS therapy included chronic pain (94.4%) and recurrent acute pancreatitis (5.6%). Number of large MPDS ranged from 1 to 4. Stone size ranged from 5 to 33 mm. Patients managed with the d-SOP platform were more likely to have a prior failed attempt at stone extraction (60% vs 12.5%, P = 0.040). Intraprocedural therapies and outcomes are included in table 2. Overall technical success was seen in 89%. Patients treated with d-SOP trended towards a higher rate of technical success (100% vs 75%, P = 0.094), fewer total shocks (1633 ± 1708 vs 5997 ± 6356, P = 0.057) and shorter procedure duration (80.2 ± 35.8 vs 132.0 ± 87.8 minutes, P = 0.107). Both technical failures with f-SOP went on to successful lithotripsy with ESWL. Exocrine insufficiency clinically resolved in 38.5%. Patients that experienced technical success had on average fewer lithotripsy sessions (1.3 ± 0.5 vs 3.5 ± 2.1, P < 0.001), fewer shocks (1909 ± 1592 vs 15498, P < 0.001), and a lower total procedure duration (85.8 ± 30.8 vs 243 ± 138.6, P < 0.001). On univariate analysis, no baseline characteristics were associated with technical failure. CONCLUSION: SOP-EHL is safe and effective for clearance of MPDS and impactful for CP symptoms. The d-SOP compared to f-SOP platform is associated with fewer total shocks and lower procedure time, likely due to improved optics. Our data suggests that improved imaging of MPDS with d-SOP enhances procedure efficiency and may equate to an increased rate of technical success.Table 1.: Baseline characteristics of patients with large main pancreatic ductal stones who underwent single operator pancreatoscopy (SOP) with electrohydraulic lithotripsyTable 2.: Outcomes in patients with large main pancreatic ductal stones who underwent single operator pancreatoscopy (SOP) with electrohydraulic lithotripsyFigure 1.: (A) Second generation digital single-operator pancreatoscopy (d-SOP) view of the main pancreatic duct stone, followed by (B) Electrohydraulic Lithotripsy (EHL) with stone fragmentation.