duct type. The size of the cystic lesion, the diameter of main pancreatic ductand the height of papillary tumor inside the cyst were measured by EUS andIDUS before operation. These preoperative clinical findings were com-pared with the postoperative pathological findings.Results: The details of 39 resected cases are summarized as follows: sevenpatients with main pancreatic duct type consisted of 6 with tumor(adeno-carcinoma,3; adenoma,3) and 1 with hyperplasia. On the other hand,thirty–two patients with branch duct type consisted of 28 with tumor(ade-nocarcinoma,7; adenoma,21) and 4 with hyperplasia. The diameter of thecystic lesion in case of tumor (adenocarcinoma, 44.0�21.6mm; adenoma,23.9�11.7mm) was larger than that in case of hyperplasia (14.9�7.7mm).The diameter of main pancreatic duct in case of tumor (adenocarcinoma,10.7�2.5mm; adenoma, 6.0�2.5mm) was larger than that in case ofhyperplasia (5.3�1.3mm). The height of papillary tumor inside the cyst incase of tumor (adenocarcinoma, 14.8�9.4mm; adenoma, 2.9�2.3mm) waslarger than that in case of hyperplasia (1.5�0.5mm). Hyperplasia was notfound in the following cases with cystic lesions of 30mm and over, mainpancreatic duct of 8mm and over, and papillary tumor inside the cyst of3mm and over. Based on these findings, we confirmed the following threeconditions to diagnose the tumor. ; (1)The size of the cystic lesion is 30mmand over. (2)The diameter of main pancreatic duct is 8mm and over. (3)Theheight of papillary tumor inside the cyst is 3mm and over.Conclusions: EUS and IDUS are useful tools in the differential diagnosisof IPMT, especially in the differentiation between tumor and hyperplasia.

195

ACUTE PANCREATITIS ASSOCIATED WITH INTERFERONAND RIBAVIRIN THERAPY IN PATIENTS WITH CHRONICHEPATITIS CSwati Chaudhari, M.D., James Park, M.D., Bhupinderjit S. Anand,M.D., Neville R. Pimstone, M.D., Douglas T. Dieterich, M.D., StevenBatash, M.D. and Edmund J. Bini, M.D., FACG*. Gastroenterology,NYU School of Medicine, New York, NY; Gastroenterology, BaylorCollege of Medicine, Houston, TX; Gastroenterology, UC–Davis,Sacramento, CA and Gastroenterology, Mt Sinai School of Medicine,New York, NY.

Purpose: Interferon (IFN) and ribavirin (RBV) are often used for thetreatment of hepatitis C (HCV). Although these medications have manyside effects, acute pancreatitis (AP) is uncommon, with only 2 casesreported in the English language literature (Gastroenterology 2000;119:230–3). The aims of this study were to determine the incidence, clinicalpresentation, and outcome of drug–induced AP in HCV–infected patientstreated with IFN/RBV.Methods: Consecutive patients with HCV who developed AP during IFNalfa–2b and RBV therapy were identified. None of the patients had a historyof pancreatitis, alcohol use, cholelithiasis on imaging studies, or othercauses of AP. Patients were diagnosed with AP based on the presence ofepigastric pain and elevated amylase and lipase levels.Results: AP was diagnosed in 7 of 1700 patients (0.4%) treated with IFNand RBV. The median age of the patients (4 M and 3 F) was 51 years (range45 – 60) and the median duration of IFN/RBV therapy prior to AP was 12weeks (range 4 – 31). Six patients received 3MU IFN SC TIW (4 patients)or QD (2 patients), and one patient was taking 1.5MU IFN 6x/week. Eachpatient received 1000mg (4 patients) or 1200mg (3 patients) of RBV QD.All patients presented with epigastric pain associated with nausea/vomitingand/or fever. The median amylase and lipase values at diagnosis were 330U/L (range 182 – 1,813) and 500 U/L (range 171 – 2,778), respectively. Sixof the 7 patients had evidence of AP on US, CT, or MRI, and one had anormal US. IFN/RBV was stopped in all patients at time of diagnosis ofAP, and 6 of the 7 patients were hospitalized; one patient refused hospi-talization. AP resolved in all 7 patients and one patient was restarted onIFN/RBV 4 weeks later; treatment was stopped within 1 month due todiarrhea and fatigue. No patient had recurrent pancreatitis after discontin-uation of IFN/RBV during a median of 18.0 months (range 3 – 27) offollow–up.

Conclusions: IFN/RBV is a potential cause of drug–induced AP in patientswith HCV. In these individuals, AP is often severe enough to warranthospitalization, although symptoms resolve promptly after discontinuationof IFN/RBV. Studies to determine which of these two medications areassociated with drug–induced AP and the mechanisms of pancreatic injuryare warranted.

196

ENDOSCOPIC ULTRASOUND–GUIDED FINE NEEDLEASPIRATION BIOPSY OF PATIENTS WITH SUSPECTEDPANCREATIC CANCER: DIAGNOSTIC ACCURACY ANDACUTE AND 30–DAY COMPLICATION ASSESSMENTMohamad A. Eloubeidi, M.D., M.H.S., Victor K. Chen, M.D., Isam A.Eltoum, M.D., Darshana Jhala, M.D., David C. Chhieng, M.D., NiragJhala, M.D., Selwyn M. Vickers, M.D. and Charles M. Wilcox, M.D.*.Gastroenterology and Hepatology, University of Alabama atBirmingham, Birmingham, AL; Pathology, University of Alabama atBirmingham, Birmingham, AL and Gastrointestinal Surgery, Universityof Alabama at Birmingham, Birmingham, AL.

Purpose: To evaluate the diagnostic accuracy of EUS–FNA of patientswith suspected pancreatic cancer. To assess immediate, acute and 30–daycomplications related to EUS–FNA.Methods: All patients referred to our institution over a 22–month periodfor suspected pancreatic cancer, were prospectively evaluated A singlegastroenterologist performed all EUS–FNAs in the presence of a cyto-pathologist. Immediate (intra–procedural and in the recovery area) com-plications were evaluated in all patients. An experienced GI nurse calledpatients 24 to 72 hours and 30 days after the procedure to assess forcomplications. Reference standard for the classification of the final diag-nosis included: surgery (n�48), clinical and/or imaging follow–up (n�72),or death from the disease (n� 47).Results: One hundred fifty–eight EUS–FNAs were performed during thestudy period. Three procedures failed. The mean age of the patients was62.3 years (SD �/–12.0). Sixty six percent were male and 74% were white.The mass location was in the head/uncinate in 80% of the patients, orbody/tail in 20%. The mean tumor size was 32 mm x 26 mm. The mediannumber of passes was 3 (range 1–10). Forty four percent of these patientshad at least one failed attempt at tissue diagnosis prior to EUS–FNA. Ofthese, seventy–eight percent had failed brushings at ERCP and 16.2% hada failed CT–guided biopsy. Of all the solid pancreatic masses, 116 weretrue positives, 35 were true negatives, and 4 were false negatives. No falsepositives were encountered. Therefore, the sensitivity, specificity, positivepredictive value, and negative predictive value of EUS–FNA in pancreaticsolid masses were 96.7%, 100%, 100% and 89.7% respectively. Of themalignant lesions, 109 were adenocarcinomas, 7 were neuroendocrinetumors, 1 was a lymphoma and 3 were from metastatic cancer. Immediateself–limited complications occurred in 10 of the 158 EUS–FNAs (6.3%):hypoxia requiring reversal (1), abdominal pain (6), bleeding (2), and sorethroat (1). No perforations were encountered. Ninety patients were calledat 24 to 72 hours after the procedure. Eighty seven percent (78/90) of thepatients responded. Twenty two percent (20/90) of the patients reported atleast one symptom: abdomen pain/distention (n�10) (9 were self–limitedand one patient had mild acute pancreatitis and resolved with outpatientobservation) sore throat (n�9), nausea and vomiting (n�2), diarrhea(n�1), fever and chills (n�1), and hoarseness (n�1). Two patients wereevaluated in the emergency room. One patient was admitted for nausea,vomiting and dehydration; the other was evaluated for abdominal pain andthen discharged home. Eighty–three patients were contacted at 30 days,82% of the patients responded. No additional or continued complicationswere reported.Conclusions: EUS–FNA is highly accurate in diagnosing patients withsuspected pancreatic cancer. It is the modality of choice especially whenother modalities have failed to provide a definitive tissue diagnosis. Com-plications after EUS–FNA appear similar to that of upper endoscopy,although higher than previously reported in other EUS–FNA studies. Al-though rare, acute pancreatitis appears to be a real risk after EUS–FNA of

S65AJG – September, Suppl., 2002 Abstracts