M.J. Jones

Imaging of indeterminate pancreatic cystic lesions: A systematic review

BACKGROUNDnPancreatic cystic lesions are an increasing problem and investigation of these cysts can be fraught with difficulty. There is currently no gold standard for diagnosis or surveillance. This review was undertaken to determine the present reliability of the characterisation, assessment of malignant potential and diagnosis of pancreatic cystic lesions using available imaging modalities.nnnMETHODSnA Medline search using the terms pancreatic, pancreas, cyst, cystic, lesions, imaging, PET. CT, MRI and EUS was performed. Publications were screened to include studies examining the performance of CT, MRI, MRCP, EUS and 18-FDG PET in the determination of benign or malignant cysts, cyst morphology and specific diagnoses.nnnRESULTSnNineteen studies were identified that met the inclusion criteria. 18-FDG PET had a sensitivity and specificity of 57.0-94.0% and 65.0-97.0% and an accuracy of 94% in determining benign versus malignant cysts. CT had a sensitivity and specificity of 36.3-71.4% and 63.9-100% in determining benign disease but had an accuracy of making a specific diagnosis of 39.0-44.7%. MRI had a sensitivity and specificity of 91.4-100.0% and 89.7% in assessing main pancreatic duct communication.nnnCONCLUSIONnCT is a good quality initial investigation to be used in conjunction with clinical data. MRCP can add useful information regarding MPD communication but should be used judiciously. PET may have a role in equivocal cases to determine malignancy. Further examination of CT-PET in this patient group is warranted.

Clinical risk scores in the current era of neoadjuvant chemotherapy for colorectal liver metastases.

Clinical risk scores (CRS) within the context of neoadjuvant chemotherapy for colorectal liver metastases (CRLM) has not been validated. The predictive value of clinical risk scoring in patients administered neoadjuvant chemotherapy prior to liver surgery for CRLM is evaluated.

Early warning score independently predicts adverse outcome and mortality in patients with acute pancreatitis

PurposeThe aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis.MethodsIn patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72xa0h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome.ResultsA total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality.ConclusionThis study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.

PWE-198 Enhanced recovery after hepatobiliary surgery

Introduction Enhanced recovery (ER) pathways are well established in colorectal surgery. Application of the ER methods are becoming more common place in the field of hepatobiliary surgery. Method A prospective database was maintained of patients undergoing liver or pancreas resections after implementation of an ER protocol. This data was compared with a historical cohort from before implementation of the protocol. Results One hundred and three liver resection patients (88 open and 15 laparoscopic resections) and 67 pancreas resection patients (all open) were compared with 100 historical patients (50 liver resections and 50 pancreas resections). The overall length of stay was significantly decreased from 10 to 7 days after liver resection (p = 0.0293) and from 14 to 10 days after pancreatic resection (p = 0.0002) in patients following the ER protocol. The readmission rate was similiar pre and post intervention in both liver and pancreas resection cohorts (6.0% to 5.6% and 8.0% to 7.5% respectively). The overall mortality rate after implementation of the ER protocol was 0%. Conclusion This series demonstrates a significant reduction in the overall length of stay following liver and pancreatic resections using an enhanced recovery protocol, without adversely affecting the readmission or mortality rate. Disclosure of interest None Declared.