Erik-Jan Wamsteker

Role of endoscopic ultrasonography in screening and treatment of pancreatic endocrine tumours in asymptomatic patients with multiple endocrine neoplasia type 1.

Patients with multiple endocrine neoplasia (MEN) type 1 risk premature death from pancreatic endocrine tumours (PETs). Endoscopic ultrasonography (EUS) is the most sensitive imaging modality for small PETs. A screening and therapeutic approach for asymptomatic patients is delineated in which EUS plays a pivotal role.

Advances in managing acute pancreatitis

This review highlights advances in acute pancreatitis (AP) made in the past year. We focus on clinical aspects of AP - severe disease especially - and risk stratification tools to guide the clinical care of patients. Most patients with AP have mild disease that requires a diagnostic evaluation, self-limited supportive care, and a short hospital stay. In patients with potentially severe AP, it is important for clinicians to use available risk-stratifying tools to identify high-risk patients and initiate timely interventions such as aggressive fluid resuscitation, close monitoring, early initiation of enteral nutrition, and appropriate use of endoscopic retrograde cholangio-pancreatography. This approach decreases morbidity and possibly mortality and is supported by evidence drawn from recent clinical guidelines, historical literature, and the highest quality studies published in the last year.

Recent advances in understanding and managing acute pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

S1370 Research Study Participation is Not Associated With Increased Complication Rates in Patients Undergoing Interventional Endoscopic Procedures

been used (ADVIA 2120, Siemens). Results: At day 1 (hospital admission) number of CD41 molecules on platelets was significantly (p<0.01) higher both in M-AP (58595±7322) and S-AP (62213±11740) patients, than in the control (46152±9262). At day 30, the number of CD41 molecules was normalized only in M-AP group. Measurement with TRAP showed significant increase of GPIIb at day 1 and 30, only in S-AP patients. At day 30, platelet reactivity expressed by the number of CD62P was higher than at day 1 (7227±2614 vs 6448±2541) and still significantly higher than in control group (1642±283) (p<0.001). Concentration of b-TG was significantly higher (p<0.001) in the M-AP patients (day 1: 120±74; day 30: 143±85 UI/ml) and S-AP (day 1: 137±54, day 30: 161±64 UI/ml) than in control group (62±14 UI/ml). The population of youngest, most active platelets (L-PLT) was significantly increased in both groups of AP patients (M-AP: 7200/μl±3300; S-AP: 8200/ μl±4600; control: 4500/μl±1700), but at day 30 L-PLT was significantly higher in S-AP patients, than in MAP (9400/μl±6200 vs 6000/μl±1600). Similarly, decrease of MPC correlated with platelet degranulation, was more evident in S-AP group at day 1 and day 30 (S-AP: day 1 23 g/dl±1.5; day 30 23 g/dl±2.3; MAP: day 1 24 g/dl±1.2; day 30 25 g/dl±1,9; control: 28±1.6). Conclusions: At the admission, platelets are highly activated in patients with both, M-AP and S-AP. At the day 30, despite normal resting activity in MAP, platelets of patients with M-AP and S-AP retained high potential for activation, expressed by increased level of P-selectin (CD62P) after TRAP activation. It is consistent with remained high level of b-TG and increased platelets turnover.