705 Prophylasix of Post-ERCP Pancreatitis With Nafamostat Mesilate: Comparison of 24-Hour and 8-Hour Infusion of Nafamostat Mesilate: a Prospective Randomized Comparison Trial

Autor: Dae Hwan Kang, Su Bum Park, Hyung Wook Kim, Joon ho Jeon, Cheol Woong Choi, Hyeong Seok Nam, Wan Chul Kim, Jae Gyu Shin
Rok vydání: 2015
Předmět:
Zdroj: Gastrointestinal Endoscopy. 81:AB160
ISSN: 0016-5107
DOI: 10.1016/j.gie.2015.03.106
Popis: Results: The EC-CAD automatically output pathological predictions with “high confidence” (over 85% probability calculated by support vector machine) in 66% (164/248) of the subject images, providing sensitivity of 98%, specificity of 96%, accuracy of 97%, positive predictive value of 96%, and negative predictive value of 98%. On the other hand, the “low confidence” pathological predictions in the remaining 34% (84/248) of the subject images provided sensitivity of 68% and specificity of 49%. The EC-CAD also enabled instant diagnosis, taking only 0.2 seconds for each lesion with perfect reproducibility (KappaZ1). Conclusion: While the challenge of increasing the rate of “high-confidence” diagnostic output remains, the second-generation model of EC-CAD achieved almost perfect diagnostic performance in classification of colorectal polyps and therefore provides a powerful tool for supporting endoscopists’ decisions during colonoscopy. Acknowledgement: The present study was supported by JSPS KAKENHI Grant Number 25860564.Reference:1. Kudo S, et al. Diagnosis of colorectal lesions with a novel endocytoscopic classification a pilot study-. Endoscopy 2011;43:869-8752. Mori, et al. Novel computer-aided diagnostic system for colorectal lesions by using endocytoscopy (with videos). Gastrointest Endosc, in press 705 Prophylasix of Post-ERCP Pancreatitis With Nafamostat Mesilate: Comparison of 24-Hour and 8-Hour Infusion of Nafamostat Mesilate: a Prospective Randomized Comparison Trial Wan Chul Kim*, Joon Ho Jeon, Jae Gyu Shin, Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of) Background and Aims: Nafamostat mesilate is known to decrease the incidence of post-ERCP pancreatitis (PEP). The optimal duration of administration is unknown. We compare the effects of 24-hour and 8-hour infusion of nafamostat mesilate for the prevention of PEP. Patients and Methods: A total of 450 patients who underwent ERCP were randomly assigned to either the 24-hour or 8-hour infusion group. For 24-hour group, nafamostat mesilate 2mg/hr infused from 30 min before ERCP and last for 24 hours. For 8-hour group, nafamostat mesilate 50mg infused for 8 hours. Results: The overall incidence of pancreatitis was 6.5% (29/450). It occurred in 12 (6.2%) of 230 patients in 24-hour group and in 8 (5.4%) of 220 patients in 8-hour group (p Z 0.479). There was no significant difference between the groups in the severity of pancreatitis. Conclusion: Prophylactic treatment with Nafamostat mesilate (24-hour and 8-hour infusion) is effective in preventing post-ERCP pancreatitis. And there is no difference in the beneficial effects between the prophylactic administration of 24-hour and 8-hour group. 706 Change in Incidence RATES of Idiopathic Recurrent Acute Pancreatitis Following ERCP With Sphincter of Oddi Manometry: Post-Hoc Analysis With Long Term Follow-Up of a Randomized, Clinical Trial Jeffrey J. Easler*, Stuart Sherman, Glen A. Lehman, Evan L. Fogel, Lee Mchenry, James L. Watkins, Ihab El Hajj, Gregory A. Cote Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC AB160 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015 Background: Pancreatic sphincter of Oddi dysfunction (SOD) is frequently identified in individuals with idiopathic, recurrent acute pancreatitis (iRAP). However, the efficacy of biliary (BES) and dual endoscopic sphincterotomy (DES) in: 1) eliminating future episodes of acute pancreatitis (AP),2) reducing AP frequency, and 3) decreasing progression to chronic pancreatitis (CP), is uncertain. Aims: Measure the impact of BES and DES on the rate of recurrence of iRAP (episode frequency) and progression to CP in SOD patients, via post hoc analysis of a previously conducted randomized clinical trial. Methods: iRAP patients (nZ89) were randomized to sham, BES, or DES based on the results of pancreatic sphincter of oddi manometry (SOM): SOD pts (nZ69, pressure O40mmHg) were assigned to BES or DES. Non-SOD patients (nZ20) were assigned to BES vs sham . Patients were followed for subsequent AP episodes and new CP. Incidence rate (# episodes/ year) of RAP at baseline and after intervention, incidence rate ratio of RAP (incidence rate after ES/incidence rate at baseline) and new diagnosis of CP were compared between groups. Results: Eighty one (nZ81) patients had data for baseline incidence rate of RAP prior to intervention (Median 2 episodes, baseline incidence rate Z2.1/yr). SOD was found in 62 (76%); equally randomized to BES and DES. SOM was normal (non-SOD) in 19 (24%), of whom 12 underwent BES and 7 Sham. Across groups, after ES (90%) patients had a median of 1 AP episode, average incident rate RAP 0.22/yr and a relative decline in rate of RAP, with incidence rate ratio of 0.2 (20%). SOD vs non-SOD patients had a higher incidence rate of RAP at baseline (2.5 vs 1.0/yr, pZ0.0006), after BES (0.32 vs 0.1/yr, pZ0.04) and a trend after any ES (0.24 vs 0.1/yr pZ0.07). SOD compared to non-SOD patients managed with BES had similar incidence rate ratios of RAP after BES (0.27 vs 0.35, pZ0.79) and any ES (0.21 vs 0.35, pZ0.60). In SOD patients managed with BES vs DES, incidence rate of RAP (0.32 vs 0.16/yr, pZ0.11) and rate ratio RAP (0.27 vs 0.14, pZ0.15) were similar (Table 1). Non-SOD pts had no difference in efficacy for BES vs Sham. Across groups, sham, BES and DES interventions showed similar efficacy (Table 2). Repeat ERCP was performed in 37% and progression to CP was 27%. On univariate analysis AP (p!0.001) and incident rate RAP (p!0.015) following ES, but not SOD (pZ0.21) and post ERCP AP (pZ0.23) were associated with progression to CP. Conclusions: Relative rate of RAP decreased after ES for patients regardless of the presence of SOD. iRAP SOD patients have a higher baseline rate of AP which translates into higher rates of AP following ES. In SOD patients, DES does not offer significant efficacy over BES for decreasing rate of RAP. Any AP and a higher rate of RAP after ES is associated with progression CP and is indicative of an aggressive phenotype. Table 1. Characteristics and Outcomes Based on Manometry Findings and Interventions SOD Negative SOD Positive Intervention Group Sham (n[7) BES (n[12) p value (Sham vs BES) BES (n[31)
Databáze: OpenAIRE
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