Pradeep K. Siddappa

Melanoma of Stomach

IntroductionMelanoma of gastrointestinal tract can be either primary or secondary to metastases from other sites like skin, mucous membranes, and uvea. Primary gastrointestinal melanoma is rare and still rarer is stomach involvement.Case ReportWe report a case of primary malignant melanoma of stomach in a 50-year-old female who presented with an axillary lymphadenopathy.ConclusionMelanoma of stomach is rare. It has characteristic endoscopic appearance. Differentiation of primary from secondary melanoma is possible on clinical behavior and histological characteristics.

Inflammatory gastric outlet obstruction after acute pancreatitis: a novel method of treatment

1. Standards of Practice Committee. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc 2014;80:221-7. 2. Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-38. 3. Harewood GC, Baron TH, Song LM. Factors predicting success of endoscopic variceal ligation for secondary prophylaxis of esophageal variceal bleeding. J Gastroenterol Hepatol 2006;21:237-41.

Sa1351 Neutrophil Gelatinase-Associated Lipocalin: An Early Biomarker for Predicting Acute Kidney Injury in Patients With Acute Pancreatitis

GTL alone. CONCLUSIONS: High concentrations of UFA, IL-1beta and IL-8 in necrosis fluid relative to NIC fluids supports these to be the potential culprits in necrotic cell death as evidenced by high DNA content in the post-necrotic fluid. The ability of orlistat to reduce serum lipase, NEFA, UFA, LA concentrations in rat serum demonstrates its efficacy as a lipase inhibitor in this model. The high mortality, necrosis, IL-1beta and IL-8 concentrations, distant organ injury in GTL infused rats, and reduction of these with orlistat supports lipolytic generation of UFAs to be the driver of inflammation and necrosis. Therefore, the combined data suggests that lipotoxicity may drive inflammation and necrosis in human acute pancreatitis. Table 1: Human Data

Differences between the outcome of recurrent acute pancreatitis and acute pancreatitis: Recurrent acute pancreatitis

Overall, a handful of studies are available on the outcomes of recurrent acute pancreatitis (RAP), in comparison to the first episode of acute pancreatitis (AP). We aimed to provide a more complete and updated picture of RAP and how it is different from the initial episode of AP.

Mo1340 Does the Site of Fluid Collection Alter the Clinical Course of Acute Pancreatitis? -A Prospective Observational Study

G A A b st ra ct s clear. Methods: Consecutive patients with symptomatic WOPN seen over last 7 months were prospectively included in the study. All the patients underwent EUS, MRI and abdominal ultrasoundwithin two days. On each of these investigations an attemptwas made to determine the site, size and the nature of contents of the WOPN. The echogenic material seen in the collection on EUS and abdominal ultrasound was considered as necrotic debris. On MRI, the hypo intense areas inside the collection on T2 weighted images were taken as solid debris. The solid debris was quantified by two independent observers for all three imaging modalities and the mean was taken as final value. Results: A total of 21 patients were included. There were 16 males (78.9%) and the mean age was 43.5 ± 11.13 years. The etiology was alcohol in 13 and gall stones in 6 patients. The imaging (EUS, MRI and abdominal ultrasound) was done at a mean of 12 ± 13.93 weeks of onset of abdominal pain. On EUS, 8 patients had a solid content of ≤10%, 11 had a content of 10-40% and 2 patients had a solid content of >40%. On MRI, 10 patients were noted to have a solid content of ≤10%, 9 patients had a solid content >10-40% and 2 had content of >40%. On abdominal ultrasound 9 patients had a content of ≤10% while nine patients had a solid content between 10-40%. WON could not be visualized on abdominal ultrasound in 3 patients, two of whom had a high content of solid debris on EUS/MRI. All patients in whom the collections were not visualized on abdominal ultrasound had presented within 6 weeks of onset of disease. All patients with disease duration of >6 weeks had WOPN well visualized on abdominal ultrasound. Conclusion: Trans abdominal ultrasound can help in diagnosis as well as characterization of majority of WOPN collections with comparable accuracy as that of EUS/MRI. However, collections early in the course of disease and with high content of solid debris may be difficult to evaluate on abdominal ultrasound.

Mo1342 Natural History of GI Fistulae in Acute Pancreatitis-A Prospective & Retrospective Analysis

G A A b st ra ct s clear. Methods: Consecutive patients with symptomatic WOPN seen over last 7 months were prospectively included in the study. All the patients underwent EUS, MRI and abdominal ultrasoundwithin two days. On each of these investigations an attemptwas made to determine the site, size and the nature of contents of the WOPN. The echogenic material seen in the collection on EUS and abdominal ultrasound was considered as necrotic debris. On MRI, the hypo intense areas inside the collection on T2 weighted images were taken as solid debris. The solid debris was quantified by two independent observers for all three imaging modalities and the mean was taken as final value. Results: A total of 21 patients were included. There were 16 males (78.9%) and the mean age was 43.5 ± 11.13 years. The etiology was alcohol in 13 and gall stones in 6 patients. The imaging (EUS, MRI and abdominal ultrasound) was done at a mean of 12 ± 13.93 weeks of onset of abdominal pain. On EUS, 8 patients had a solid content of ≤10%, 11 had a content of 10-40% and 2 patients had a solid content of >40%. On MRI, 10 patients were noted to have a solid content of ≤10%, 9 patients had a solid content >10-40% and 2 had content of >40%. On abdominal ultrasound 9 patients had a content of ≤10% while nine patients had a solid content between 10-40%. WON could not be visualized on abdominal ultrasound in 3 patients, two of whom had a high content of solid debris on EUS/MRI. All patients in whom the collections were not visualized on abdominal ultrasound had presented within 6 weeks of onset of disease. All patients with disease duration of >6 weeks had WOPN well visualized on abdominal ultrasound. Conclusion: Trans abdominal ultrasound can help in diagnosis as well as characterization of majority of WOPN collections with comparable accuracy as that of EUS/MRI. However, collections early in the course of disease and with high content of solid debris may be difficult to evaluate on abdominal ultrasound.

Mo1334 Validation and Comparison of the New Severity Classification Systems With Old Atlanta Classification for Severity of Acute Pancreatitis

Background Two new classification systems for the severity of acute pancreatitis (AP) have been proposed recently, the determinant based classification (DBC) and revised Atlanta classification (RAC). We aimed to validate and compare these classification systems with original Atlanta classification (OAC). Aims To validate and compare the DBC and RAC with original Atlanta classification (OAC) Methods 469 adult patients with AP admitted to a tertiary care center from January 2009-June 2013 were included in the study. The new classification systems were validated and compared in terms of outcomes (need for interventions, total hospital and intensive care unit (ICU) stay and mortality). Results The mean age of patients was 39.9±13.4 years (331 males) with the commonest etiology being alcohol (161, 34.3%) followed by gall stones (125, 26.6%). There were 119 (25.4%) patients with mild and 250 (74.6%) patients with severe AP as per OAC. Pancreatic necrosis was present in 66.1% and infected pancreatic necrosis in 23.1% patients. 126 (26.9%) patients underwent interventions (endoscopic n= 49, 10.4%, radiological n=95, 20.2% and surgical n=47, 10%). 93 (19.8%) patients died. As per DBC, 97(20.7%), 172 (36.7%), 152 (32.4%), and 48(10.2%) patients were determined to have mild, moderate, severe, and critical AP, respectively. As per RAC, 119 (25.4%), 160 (34.1%), and 190 patients (40.3%) were determined to have mild, moderately severe, and severe AP, respectively. Higher grades of severity were associated with worse outcomes in DBC, RAC and OAC. Predictive accuracies were evaluated using area under the receiver operator characteristics curve (AUROC) and Somers D co-efficient. The DBC, RAC and OAC were comparable in predicting the need for interventions (AUROC 0.53, 0.55, 0.54, p=0.36) and length of hospital stay (Somers D, 0.27, 0.26, 0.23, p=0.41). However, both DBC and RAC had comparable but better accuracy than OAC in predicting need for ICU admission (AUROC 0.73 for both vs. 0.62 for OAC, P<0.001), length of ICU stay (Somers D, 0.35 for both vs. 0.24 for OAC, p<0.001) and mortality (AUROC 0.78 for both vs. 0.61 for OAC, p<0.001). Conclusion Determinant based classification and revised Atlanta classification categorize patients into subgroups that reflect clinical outcomes. Both have comparable and higher predictive accuracy than old Atlanta classification for need for ICU admission, length of ICU stay and mortality.