Abstract gastroenterology

Page 1

S50

Abstracts

Results: K-ras gene mutation was analyzed in 40 cases (31%). Of these, 18 (45%) were positive, 21 (53%) were negative, and 1 (2%) was non-diagnostic. Of the 40 patients who were tested for K-ras mutation, 5 went on to have a definitive diagnosis. All 5 cases had pre-malignant lesions - three of which were in patients with a detected K-ras mutation. The remaining two cases tested negative for the mutation, but had cyst fluid CEA values of 11,000 ng/ ml and 2,690 ng/ml. Of the 87 cases where K-ras was not analyzed, 47 (54%) went on to have surgery. Of these, the final pathological diagnoses included 13 (28%) benign lesions and 34 (72%) pre-malignant or malignant lesions. Of the 57 cases where cytology was unavailable or not diagnostic, K-ras analysis was performed 21 times, 6 of which tested positive for the mutation. Conclusion: All five cases that were analyzed for K-ras mutation and came to a definitive diagnosis showed pre-malignant pathology. Although two of these cases did not detect K-ras mutations, their CEA levels were elevated to well over ten times the upper limit of 192 ng/ml accepted for predicting mucinous cysts. On the other hand, 28% of cases that were not tested for K-ras and came to a definitive diagnosis had benign lesions. The data shown here is insufficient to draw any large-scale conclusions, and further studies on a larger scale are needed. Following these set of patients into the future may also elucidate the behavior of different cysts. Disclosure: Dr. Wahid Wassef: Boston Scientific - Honorarium

protein antigen, hpaA gene, 0.86-kb DNA fragment, and DNA sequences of 16S ribosomal RNA were used as amplification targets. The IHC was evaluated by a single experienced pathologist. Results: Prevalence studies in the 325 patients showed 26 patients (8%) were positive for HP on IHC, while 64 patients (19.7%) were positive on PCR testing (p<0.0001, Fisher’s test). Although the IHC testing showed 100% specificity, its sensitivity was a mere 40.63%. PCR testing captured all 26 patients (100% sensitivity) of patients positive on IHC, with no false negatives (100% specificity). Conclusion: Advances in PCR diagnostics allows a much greater proportion of patients with HP to be diagnosed at the time of EGD. Indeed, IHC only had a sensitivity of 40.6% in diagnosing low-level HP infection, possibly due to changes in HP morphology associated with widespread PPI use. The majority of HP patients, i.e., 38 patients of 64 (59.4%) would have been missed on IHC, and likely labeled FD. Indeed, 38 of the 325 patient cohort (11.7%) would have been misdiagnosed, and be at risk of HP associated complications. Nearly all of these patients experienced significant improvement after standard HP treatment.

PANCREATIC/BILIARY 124 Pancreatic Cysts - A Retrospective Analysis of Our Experience at UMMHC with Focus on Utility of K-Ras Gene Mutation Analysis Edward Belkin, MD, Lloyd Hutchinson, PhD, Ediz Cosar, MD, Jaroslav Zivny, MD, Wahid Wassef, MD, FACG. University of Massachusetts Medical Center, Worcester, MA.

125 Chronic Pancreatitis: What Determines Resource Utilization? Salman Nusrat, MD, Dhiraj Yadav, MD, MPH, FACG, Klaus Bielefeldt, MD, PhD, FACG. University of Pittsburgh Medical Center, Shadyside, Pittsburgh, PA.

Purpose: Pancreatic cysts, which could represent malignant, pre-malignant, or benign lesions, are being detected more frequently due to improvements in imaging techniques. Although the natural history of cysts is not fully ­understood, accurate characterization of cysts is paramount to optimize patient care. Cyst fluid cytology, CEA marker, and more recently, K-ras gene analysis, have all been used in an attempt to characterize cysts. In this study, we undertook an analysis of our experience at UMMHC over the past seven years with different methods of predicting pancreatic cyst type, focusing specifically on the utility of K-ras gene analysis in improving clinical decision making. Methods: We requested the medical record numbers of all patients seen at UMMHC over the last seven years who were coded with ICD-9 code 577.2, which represents the diagnosis of pancreatic cyst or pseudocyst. We received 1066 unique cases from October, 2003 through February, 2011. Of these, we included in our study those cases that had K-ras analysis and/or came to a definitive diagnosis (surgical specimen), which included 85 unique cases. Some of these patients had one or more follow-up EUS exams, which was often accompanied by cyst fluid analysis, for an additional 42 cases. This provided us with 127 total cases.

Purpose: Pain is the hallmark symptom of chronic pancreatitis (CP) and the main reason for physician visits and hospitalizations. We thus tested the hypothesis that pain severity correlates with resource utilization (RU). Methods: Records of patients with established pancreatitis seen at least twice between 4/2008 and 12/2009 at the University of Pittsburgh Digestive Disorder Clinic were retrospectively reviewed. Results: During 123 patient-years of follow up in 116 patients, we recorded 187 emergency room visits (n = 46 patients), 140 hospitalizations (n = 51 patients) amounting to a total of 774 inpatients treatment days. 10 patients accounted for 51% of the inpatient days and only 5 patients were responsible for 54% of the emergency room visits. Neither subjective pain ratings nor the average daily opioid use differed between high and low resource users. However, significantly more patients with higher RU had alcoholic pancreatitis (n = 7; χ2 =  4.82, P<0.05). Imaging studies of the pancreas were obtained in 97 of these 116 patients (235 CT, 28 MRCP, 37 abdominal ultrasound examinations, 20 endoscopic ultrasound examinations and 70 ERCP). Thirteen patients were responsible for 40.67% of the CT scans (figure 1). The cumulative exposure diagnostic radiation was 23.3±3.0 mSv with 33 (28%) patients exceeding annual ­exposures

[124]  K-Ras gene mutation status and relationship to other clinical data Cytology   NA*

NonDiagnostic

Mucin

CEA (ng/ml)

Surgical Pathology

Malignancy

NA

> 192

< 192

NA

Benign†

PreMalignant††

Demographics Malignant†††

Age (average)

Male

Female

K-Ras Gene Mutation   NA

17

19

21

6

65

11

11

40

13

22

12

58.6

34

53

NonDiagnostic

1

0

0

0

1

0

0

1

0

0

0

57

0

1

Negative

0

14

0

0

5

2

14

19

0

2

0

51.4

11

10

Positive

0

6

7

2

7

4

7

15

0

3

0

66.6

8

10

Total

18

39

28

8

78

17

32

75

13

27

12

53

74

*NA - Not Available †Benign - benign cyst (1), chronic pancreatitis (1), abscess (1), pseudotumor (1), pseudocyst (2), non-pathologic (1), lymphoepithelial cyst (1), lymphangiectatic cyst (1), serous cystadenoma (4) ††Pre-Malignant - pseudopapillary tumor (1), pancreatic intraepithelial neoplasia (PanIN) (1), serous cystadenoma and PanIN (2), mucinous cystadenoma (2), mucinous cystadenoma with dysplasia (1), mucinous cystadenoma and PanIN(1), IPMN (7), IPMN with dysplasia (12) †††Malignant - neuroendocrine tumor (5), adenocarcinoma (5), mucinous carcinoma (2).

The American Journal of Gastroenterology

Volume 106 | supplement 2

| October 2011

www.amjgastro.com


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.