Page 62 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

early stage. However, parameters indicative of early CP are and pseudocyst group (4802.48/mm vs 3865.87/mm vs
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still unknown. 3192.27/mm ; p=0.022 and p=0.004, respectively). No
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Aims: We aim to find measurable biomarkers and clinical correlation was found between the intracystic CEA levels and
signs of this early phase through the GOULASH-PLUS the analyzed cystic gray values.
follow-up study. Conclusion: The computer-aided diagnosis decision is
Methods: GOULASH-PLUS is a longitudinal study of AP being used increasingly due to the rapid development of the
with a 6-year follow-up of patients with a well documented information technology. The EUS image analysis process
episode of AP. Imaging, physical and laboratory testing is may have a potential to be a diagnostic tool for the evaluation
performed annually. To detect endocrine function, blood and differentiation of pancreatic cystic lesions.
glucose, HbA1C were measured, and oral glucose tolerance
test (OGTT) was performed; exocrine parameters were 76. ENDOSCOPIC STEP-UP APPROACH OF
measured by a stool elastase test. Chi-square test and Fisher SYMPTOMATIC PANCREATIC NECROTIC
exact test were used for statistical analysis. COLLECTIONS – A NEED FOR FINE-TUNING OF THE
Results: Of the first 133 patients, 57 (43%)were women, 76 GUIDELINES
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(57%)were men, and the average age was 55. 27 (20%) Keczer B. , Miheller P. , Horváth M. , Marjai T. , Harsányi
patients had moderate AP, 6 (5%) had severe AP, and 15 L. , Szücs Á. , Szijártó A. , Hritz I.
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(14%) had RAP in the first year. 13 (16%) patients were 1. Center for Therapeutic Endoscopy, 1st Department of
diagnosed with severe exocrine pancreas insufficiency, 17 Surgery, Semmelweis University
(15%) were diagnosed with diabetes and 23 (20%) with
impaired glucose tolerance (IGT). Exocrine abnormalities Introduction: Step-up approach is recommended in the
were present in 70% of patients with RAP, compared with management of pancreatic necrosis. Application of a lumen-
only 18% in the group without RAP (p <0.001). There was no apposing metal stent (LAMS) with cautery-enhanced delivery
difference in endocrine function between RAP and non-RAP system (Hot Axios, Boston Scientific Corporation) facilitates
groups. Based on OGTT, hyperinsulinemia was detected in the transmural endoscopic ultrasound (EUS)-guided
IGT and diabetic groups, and endocrine disruption (IGT, DM) drainage of symptomatic pancreatic necrotic collections
was not associated with AP severity. (PNCs). Subsequent debridement of necrotic material can be
Conclusion: One year after AP, exocrine and endocrine performed in a form of irrigation by a naso-cavital drain
insufficiency can be measured in the majority of patients. In and/or direct endoscopic necrosectomy (DEN). Whether to
RAP, exocrine abnormalities appear earlier, while the apply irrigation or DEN is unclear. Furthermore, when and
endocrine function is not affected. The development of IGT scheduled or “on-demand” DEN should be carried out is also
and DM is independent of the severity of AP. unknown. Timing of removal of LAMS is also in evolution.
Aims: Our aim was to fine-tune the recommendations in a
75. DIFFERENTIATION BETWEEN PANCREATIC CYSTIC form of a local protocol to improve the safety and clinical
LESIONS USING IMAGE PROCESSING SOFTWARE efficacy of the step-up approach.
(FIJI) BY ANALYZING ENDOSCOPIC Methods: 11 patients with symptomatic PNC who underwent
ULTRASONOGRAPHIC (EUS) IMAGES EUS-guided drainage with LAMS followed by debridement
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Keczer B. , Miheller P. , Horváth M. , Marjai T. , Harsányi were assessed. First group of patients (n=8) after LAMS
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L. , Szücs Á. , Szijártó A. , Hritz I. placement were treated routinely only with irrigation drain
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1. 1st Department of Surgery, Semmelweis University and released; DEN was performed only if septic
complications occurred. In second group of patients (n=3)
Aims: EUS is the most accurate imaging modality for irrigation and subsequent scheduled DEN was
evaluation of different types of pancreatic cystic lesions; accomplished. Clinical outcome was evaluated.
however, distinguishing between malignant and benign Results: In the first group in 5 patients PNC resolved with no
lesions remains challenging. Our aim was to analyze EUS need for DEN and the LAMS was removed after 6 weeks. In
images of pancreatic cystic lesions using an image 3 patients after discharge septic complications occurred and
processing software (FIJI). required readmission and DEN for debridement. In the
Methods: We specified echogenicity of the lesions by second group in all 3 patients PNCs resolved without septic
measuring the gray value of pixels inside the selected areas. complications and LAMS were removed within 5 weeks.
Besides the entire lesion, its cystic and solid parts were also Conclusion: Fine-tuning of the guidelines improves safety
separately selected for assessment. Following the software and clinical efficacy of the step-up approach.
analyzing process images were divided into groups (serous
cystic neoplasm /SCN/, non-SCN and pseudocyst) according 77. GRANULOCYTE AND MONOCYTE APHERESIS IS AN
to the cytology results of the lesions. Intraductal papillary EXCELLENT CHOICE AS AN ADJUNCTIVE THERAPY TO
mucinous neoplasms (IPMNs) and mucinous cystic INDUCE AND MAINTAIN REMISSION IN ULCERATIVE
neoplasms (MCNs) were classified as non-SCN category. COLITIS: A META-ANALYSIS OF RANDOMIZED
Results: EUS images of 33 patients (21 females, 12 males; CONTROLLED TRIALS
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mean age of 60.9±10.1 and 66.3±11.6 years, respectively) Kiss S. 1,2,3 , Németh D. , Hegyi P. 2,3,4 , Földi M. 1,2,3 , Szakács
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were assessed. Overall 73 images were processed by the Z. , Erőss B. , Tinusz B. , Sarlós P. , Alizadeh H. , Hegyi
software: 36 in non-SCN, 13 in SCN and 24 in the P.
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pseudocyst group. The mean gray value of the entire lesion 1. Doctoral School of Clinical Medicine, University of Szeged;
in non-SCN group was significantly higher than in SCN group 2. First Department of Internal Medicine, University of
(31.7 vs 25.5; p=0.022). The area ratio (area of cystic Szeged; 3. Institute for Translational Medicine, University of
part/entire lesion) in non-SCN, SCN and pseudocyst group Pécs Medical School; 4. Division of Translational Medicine,
was 42%, 55% and 70%, respectively; significantly lower in First Department of Medicine, University of Pécs Medical
non-SCN group than in SCN and pseudocyst group School; 5. Division of Gastroenterology, First Department of
(p=0.0058 and p<0.0005, respectively). The lesion density Medicine, University of Pécs Medical School; 6. First
(sum of the gray values/area of the lesion) was also Department of Medicine, University of Pécs Medical School;
significantly higher in non-SCN group compared to the SCN-
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60 Central European Journal of Gastroenterology and Hepatology
Volume 6, Supplementum 2 / November 2020