Zeeshan Ateeb

The HLA-DQβ1 insertion is a strong achalasia risk factor and displays a geospatial north–south gradient among Europeans

Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus. Most recently, we identified an eight-amino-acid insertion in the cytoplasmic tail of HLA-DQβ1 as strong achalasia risk factor in a sample set from Central Europe, Italy and Spain. Here, we tested whether the HLA-DQβ1 insertion also confers achalasia risk in the Polish and Swedish population. We could replicate the initial findings and the insertion shows strong achalasia association in both samples (Poland P=1.84 × 10−04, Sweden P=7.44 × 10−05). Combining all five European data sets – Central Europe, Italy, Spain, Poland and Sweden – the insertion is achalasia associated with Pcombined=1.67 × 10−35. In addition, we observe that the frequency of the insertion shows a geospatial north–south gradient. The insertion is less common in northern (around 6–7% in patients and 2% in controls from Sweden and Poland) compared with southern Europeans (~16% in patients and 8% in controls from Italy) and shows a stronger attributable risk in the southern European population. Our study provides evidence that the prevalence of achalasia may differ between populations.

Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer

BACKGROUND Few studies have investigated the outcome of pancreatectomy associated with artery resection (PAR). METHODS Retrospective analysis of a cohort of operated borderline or locally advanced pancreatic cancer patients with surgically confirmed arterial involvement. Short and long-term outcome were analyzed and compared in patients who underwent PAR (Group 1) and palliative surgery (Group 2). RESULTS Of 73 patients who underwent surgical exploration with intent of resection, 34 underwent PAR (±venous resection) (Group 1) and 39 underwent palliation (Group 2). 23 patients (67.7%) in Group 1 underwent combined artery-vein resection (AVR). Operation time was longer and blood loss higher in group 1 compared to group 2. There were no differences in post-operative mortality (2.9% vs 2.6%, p = 0.9) and post-operative surgical complications (38.2% vs 25.6%, p = 0.2). The 1, 3 and 5 years survival in Group 1 was superior to Group 2 (63.7%, 23.4% and Q3 23.4% vs 41.7%, 3.2% and 0, p = 0.003). CONCLUSION PAR seems to be safe and feasible in well selected patients and associated with an advantage of survival compared to palliation, in patients affected by locally advanced pancreatic cancer.

AB117. P092. Safety of intraoperative pancreatoscopy for the investigation of main pancreatic duct involvement and assessment of skip lesions in operated main duct (MD) involving IPMNs: a feasibility study

Background: Current management of main duct (MD)involving intraductal papillary mucinous neoplasm (IPMN) is driven by intra-operative frozen section. However, data regarding the clinical utility of this approach are discordant. In fact, frozen section of pancreatic resection margin can’t detect skip lesions within MPD and this might imply incomplete resections and short term recurrences after resection. Peroral pancreatoscopy is a promising tool to investigate the MPD but is technically highly skill demanding and therefore difficult to use on a large scale. The application of intraoperative pancreatoscopy might be able to bypass this problem but data about its safety are currently lacking. This study aims to assess the safety of intraoperative pancreatoscopy. Methods: Retrospective cohort analysis of patients undergoing surgical resection for MD-involving IPMN. All indications for surgery were decided according to the European Guidelines for the management of pancreatic cystic tumors. Data about characteristics of patients, type of surgery, mortality and length of hospital stay, overall complications and procedure related preoperative complications (pancreatitis, perforations) were recorded. Results: From 2015 to 2016 22 patients, 10 (45%) male, median age 67 (45–82 years) underwent surgical resection for MD-involving IPMN and intraoperative pancreatoscopy. Overall complications were reported in 9 (40%) of patients. 1 patient (4.5%) underwent reoperation for incisional hernia, 1 (4.5%) developed pancreatic fistula, 2 (9%) had GI bleeding requiring endoscopy. None of the patients developed procedure related morbidity and mortality. The mean length of hospital stay was 15.36 days. Conclusions: Intraoperative pancreatoscopy in the investigation of IPMN patients with dilated MPD is a feasible and safe procedure.