WCIM 2014 SEOUL KOREA 569
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0973 Pancreatobiliary
Long Term Follow Up of Gallstone Associated Complication According to Management after Gallstone Pancreatitis
Hea Jung Sung1, Woo CHul Chung1, Kang-Moon Lee1, Chang Nyol Paik1, Dae Bum Kim1, Ji Min Lee1, Yoon Yung Chung1, Hyewon Lee1, Yeon Oh Jeong1
The Catholic University of Korea, St. Vincent Hospital, Korea1
Background: Gallstone pancreatitis (GSP) is a common condition, accounting for 30-40% of all pancreatitis cases. The recommended therapy for reducing the risk of recurrent attack is cholecystectmoy, and endoscopic sphincterotomy (EST) is another therapeutic option after GSP. We aimed to access the long term results of GSP using cholecystectomy and endoscopic sphincterotomy. In addition, characteristics were evaluated when recurrent biliary symptoms happened.
Methods: A consecutive series of patients who had GSP and more than 6 months follow up period were included. A total 171 episodes of AGP were enrolled in 148 pa- tients.
Results: Mean follow up period was 58 month (range 6-360 month). For prevention of recurrent biliary event, 30 (18%) had a cholecystectomy, 46 (27%) had an EST, and 25 (15%) had both procedures. 66 patients had no defi nitive treatment. Recurrent biliary events (pancreatitis, cholangitis, biliary pain) happened in 2 patients of cholecystecto- my following by EST and 3 patients of cholecystectomy group. In non-surgical group, 14 patients of EST group, and 22 patients of no treatment group suffered from recur- rent biliary symptoms (P<0.01). Recurrent pancreatitis was happened in 2 patients of EST group and 17 patients of conservative group (3% vs 26%, P=0.03). There was only one case of recurrent pancreatitis with previous cholecystectomy with EST, but, no signifi cant benefi t compared with cholecystectomy only group.
Conclusions: Cholecystectomy provide additional protection for recurrent GSP as well as other biliary events. In non-surgical patients, EST offers more protective effect for the further bouts of pancreatitis.
PS 0974 Pancreatobiliary
Endoscopic Papillectomy for Ampullary Tumor in a Single Center.
Jiwoong Kim1
Presbyterian Medical Center, Korea1
Background: Endoscopic papillectomy(EP) is increasingly performed for benign am- pullary tumor. But it’s complication rate was 9.8 to 20% and especially high rate of pancreatitis (13%). We evaluatite the risk factor for pancreatitis after EP.
Methods: From 2004 to 2013, total 36 patients undergone snare ampullectomy were enrolled. Pancreatic and biliary sphincterotomy by MTW pull type papillotome was done. After several days, we performed EP by TJF 240 duodenoscope.
Results: Mean age was 60y and mean size was 11mm. 15 patient was tubular ad- enoma and others are tubulobillous(2), serrated adenoma(6), adenocarcinoma(3), haramatoma(6) and infl ammatory(4). Initial sign and symptoms were abdominal pain(9 patient) and follow up duration after EP was 23 months. enblock resection was done on 31 patients and piecemeal resection was done only 5 patients. complication after EP was perforation (1 patient), bleeding (4 patients), cholangitis(1 patient) and acute pancreatitis (14 patients). The risk factor for pancreatitis after EP was only female gender(p<0.025). Pancreatic stent was not risk factor for pancreatitis(p=0.201).
Conclusions: Risk factor for pancretitis after EP was only female gender in our study.
Propylatic pancreatic stent couldn’t reduced the risk of acute pancreatitis after EP.It will be needed to large scaled study.
PS 0975 Pancreatobiliary
Early Laparoscopic Cholecystectomy without Relief of Jaundice after Ercp is Feasible in Acute Cholangitis and Cholecystolithiasis
Young Doo Kim1, Woo Hyun Paik1, June Sung Lee1, Kyung-Ah Kim1, Nam-Hoon Kim1, Won Ki Bae1, Jong Wook Kim1
Inje University Ilsan Paik Hospital, Korea1
Background: In patients with acute cholangitis and cholecystolithiasis, laparoscopic cholecystectomy (LC) is recommended after endoscopic clearance of choledocholithia- sis. We aimed to evaluate the optimal time of LC after ERCP
Methods: A retrospective review of electronic medical records in single center was performed for 166 patients who underwent elective LC after ERCP between January 2010 and April 2014. We compared the hospital stay, perioperative morbidity and the rate of surgical conversion to open cholecystectomy according to the resolution of jaundice before surgery.
Results: The mean age of enrolled patients was 58.6 ± 17.0 years. The enrolled pa- tients were divided into two groups; resolution of jaundice before surgery (group 1, n
=72) or not (group 2, n = 94). Initially, there were no signifi cant differences between the groups in terms of age, sex distribution, American Society of Anesthesiologists score, previous surgical history, white blood cell, c-reactive protein, operative time.
However, there was no signifi cant difference in postoperative hospital stay between two groups (4.6 ± 3.2 vs. 5.8 ± 4.8 days, p=0.069). Also, there were not statistical dif- ferences in conversion rate (1.3% vs. 4.2%, p=0.390) and perioperative morbidity (8.3%
vs. 12.7%, p= 0.454).
Conclusions: LC wound not be delayed until resolution of jaundice after ERCP since there were no signifi cant differences of perioperative morbidity and surgical conver- sion rate to open cholecystectomy. Early LC after ERCP may be feasible and safe in patients with acute cholangitis and cholecystolithiasis.
