Abstracts / Pancreatology 14 (2014) S1eS129 S25

Aims: This study was conducted to compare sedation efficiency, safetyand satisfaction by endoscopist and assistants between CI and IB of pro-pofol for deep sedation during ERCP.

Patients & methods: A total of 212 patients undergone ERCP wererandomly assigned to either CI of propofol (n¼106, continuous group (CG))or midazolam plus IB of propofol (n¼106, intermittent group (IG)). In theCG, propofol was continuously administered via infusion pump and thedoses were determined by sedation assistants. In the IG, a loading dose of 2mg of midazolam and 0.4 mg/kg of propofol was initially injected andrepeated bolus injection of 20 mg of propofol was followed. Total dose ofpropofol, induction/recovery time, patients’ cooperation and adverseevents during the procedure were evaluated. Satisfaction scores bypatients/endoscopist and difficulty scores of maintaining the sedation byassistants were graded.

Results: Induction time and recovery time showed no statistically sig-nificant differences between two groups. Satisfaction score by endoscopistwas significantly higher in the CG than IG (9.62 vs. 8.06, p

Conclusion: Continuous infusion of propofol was more efficient tomaintain the constant level of sedation and more comfortable to endo-scopist and sedation assistants for deep sedation during ERCP.

W-013.

Minor endoscopic sphinterotomy plus large-balloon dilation for post-ERCP pancreatitis in patients with periampullary diverticula

Peel Jung, Daehwan Kang, Cheolwoong Choi, Byeongjun Song, Su BumPark, Su Jin Kim

Department of Internal Medicine, South Korea

Background: Whether large balloon dilation (LBD) has a higher risk ofacute pancreatitis than endoscopic sphincterotomy (EST) has remained acontroversial issue. Conflicting results have been also reported regardingthe impact of periampullary diverticula (PAD) on complications of ERCP.

Aims: The aims of this study were to investigate the PEP and effec-tiveness of minor EST plus LBD for removing choledocholithiasis in patientswith PAD.

Patients & methods: A total of 139 patients with common bile duct(CBD) stones were treated with LBD (10-20mm balloon diameter) afterminor EST. Of this total, 73 patients had PAD and 66 patients did not havePAD (control). The results of stone removal and complications were ret-rospectively evaluated.

Results: There is the trend of higher PEP in PAD group than in controlgroup (9.6% vs 3.0%, p ¼ 0.170). The incidence of PEP was significantlyhigher in type A PAD (papilla located inside or in the margin of the diver-ticulum) than in controls (16.1% vs 3.0%, p ¼ 0.047). There were no sig-nificant differences between the PAD and control groups in overallsuccessful stone removal (94.5% vs 93.9%).

Conclusion: Minor EST plus LBD was safe and effective procedure forremoving choledocholithiasis in patients with PAD. However, type A PADshould be managed with caution about PEP.

W-014.

Efficacy of endoscopic pancreatic sphincterotomy preceding extracor-poreal shock wave lithotripsy for pancreatolithiasis

Mieko Naruki, Shigefumi Omuta, Hiroaki Shigoka, Jyunya Tokuhisa,Kumiko Mito, Toshiyuki Makino, Atuko Takaki, Iruru Maetani

Toho University Ohashi Medical Center Div. of Gastroenterology andHepatology, Dept. of Internal Medicine, Japan

Background: Extracorporeal shock wave lithotripsy (ESWL) combinedwith endoscopic lithotomy for pancreatic dust stones (PDS) is well estab-lished. However, complete stone clearance was sometimes difficult withthe rate of 59% to 76%. Meanwhile timing of sphincterotomy before/after forESWL was unknown.

Aims: We retrospectively evaluated the efficacy and safety for pan-creatic sphincterotomy combined with indwelling endoscopic naso-pancreatic duct drainage (ENPD) or endoscopic pancreatic stent (EPS)followed by ESWL.

Patients & methods: Between February 2008 and July 2013, weintended for twenty patients (male, 18; average age 61.4 year) withnaive papilla who underwent ESWL combined with endoscopic lith-otomy. In general, the patients had three sessions per week and 3000 to4000 shocks at each session. We confirmed the efficacy of ESWL byabdominal computer tomography and performed endoscopic lithotomy.Successful procedure was defined as complete stone clearance deter-mined by ERP. We analyzed the success rate and the occurance ofadverse event.

Results: All patients successfully underwent pancreatic sphincter-otomy. Among them, ENPD or EPS was placed in 16 patients and ESWL wasaccomplished in 17 patients all of whom achieved complete stone clear-ance (17/17, 100%). In 5 patients, adverse events (four mild acute pan-creatitis and one subcutaneous hemorrhage) occurred due to ESWL. Threeof four patients who had pancreatitis did not receive placement of ENPD orEPS. There were no adverse events including pancreatitis, bleeding orperforation due to endoscopic therapy.

Conclusion: Pancreatic sphincterotomy followed by ESWL is safe andeffective.

W-015.

The safety and efficacy of transpancreatic sphincterotomy for difficultCBD cannulation during ERCP

John McGonigle, Vikram Mitra, Deepak Dwarakanath, Basant Chaudhury,Debasis Majumdar, John Hancock

North Tees University Hospital, United Kingdom

Background: Transpancreatic sphincterotomy (TPS) for difficultcommon bile duct cannulation during ERCP was first described in 1995.Since then its safety has been debated with some concerns regardingpost ERCP pancreatitis rates (PEP). The majority of TPS is carried out intertiary centres but it is a technique that we have adopted in ourhospital.

Aims: We wished to review the safety and efficacy of trans-pancreatic sphincterotomy in our hospital and compare our results tothe literature.

Patients & methods: We reviewed procedure notes from ERCPs thatbeen had been carried out from October 2011 - October 2013 . Any caseswhere transpancretic sphincterotomy was performed were identified. Wenoted any subsequent post ERCP pancreatitis, upper GI bleeding, perfo-ration or death.

Results: 31 patients were identified who had a TPS performed.Successful CBD cannulation was achieved in 25 patients (80%) and inthe 6 that failed it was subsequently successful at a later date in 4patients.

Complication Our standard ERCP Transpancreatic sphincterotomy

complication rate complication rate and cotton

classification

Perforation

0.18% 3% (1 patient) Fatal Bleeding 0.33% 3% (1 patient) moderate Post ERCP

pancreatitis

0.42% 6% (2 patients) both moderate

30 day mortality

0.23% 3% (1 patient)

Conclusion: Our results show that TPS can be carried out at a DGHwith similar levels of success as reported from tertiary centres. Asexpected our complication rates are higher that our units normal com-plication rates which reflects the challenging nature of the cases when PDSis attempted.