Abstracts / Pancreatology 14 (2014) S1eS129 S27

Material from clamp biopsy was processed standardly and embedded towax blocks. Volume of tumor tissue obtained from clamp biopsy washigher in comparison to EUS FNA.

Conclusion: Sensitivity and specificity of both methods are almost thesame. EUS FNAmethod is limited by smaller volume of tumor tissue, that islimitation for accurate definition of biological behavior of tumor, especiallymitotic rate.

Statistical analysis will be part of poster presentation.

W-020.

A Comparative study between a 22-gauge Aspiration needle and a 25-gauge biopsy needle for EUS-guided sampling of pancreatic masslesions

Jin-Hong Kim, Byong-Moo Yoo, Jae-Chul Hwang

Department of Gastroenterology, Ajou Medical Center, South Korea

Background: EUS biopsy needles have recently been developed inorder to obtain both histologic and cytologic specimens.

Aims: To compare 22-gauge (G) aspiration needles (FNA) and 25Gbiopsy needles (FNB) for EUS-guided sampling of solid pancreatic masses.

Patients &methods: Thirty-four patients with solid pancreatic massesunderwent EUS-guided sampling with a 25G FNB from June 2012 to April2013, and thirty-four patients with solid pancreatic masses, who under-went EUS-guided sampling with a 22G FNA from June 2011 to May 2012,served as the historical control group. EUS-guided sampling was performedusing the standard technique without an on-site cytopathologist.

Results: The diagnostic rates of cytology were 97.1% (33/34) with 22GFNA needles and 85.3% (29/34) with 25G FNB needles (P ¼ 0.197). Thediagnostic rates of histology were 23.5% (8/34) with 22G FNA needles and41.2% (14/34) with 25G FNB needles (P ¼ 0.194). There was no significantdifferences in themean number of needle passes (5.09 vs 5.76, P¼ 0.089) orneedle malfunctions (2.9% vs 11.8%, P ¼ 0.356) between 22G FNA and 25GFNB needles, respectively. No complications were identified in eithergroup.

Conclusion: The 25G FNB needle was not superior to the 22G FNAneedle in the diagnostic yield of histology for EUS-guided sampling ofpancreatic mass lesions, as the diagnostic yield, technical performance, andsafety profiles were comparable between both of them.

W-021.

The role of obesity as a risk factor for a hyperechogenic pancreas onendoscopic ultrasound

Hyeongseok Nam, Daehwan Kang, Cheolwoong Choi, Byeongjun Song, SuBum Park, Su Jin Kim

Department of Internal Medicine, Pusan National University School ofMedicine and Medical Research Institute, South Korea

Background: Identification of hyperechogenic pancreas (HP) is notuncommon during endoscopic ultrasound (EUS). However, the clinicalsignificance of HP is still unclear. We hypothesized that HP is related toobesity in a similar way to its relationship with fatty liver.

Aims: The aim of this study was determine the incidence of HP inpatients undergoing EUS and to assess the relationship between HP andobesity.

Patients & methods: 524 adults who underwent EUS were included.240 patients with a history of pancreatic disease or with hepatobiliary oradvanced gastrointestinal cancer were excluded. 284 patients were inclu-ded in the analyses. We performed subgroup analyses according to visceraladipose tissue (VAT) in 132 patients who underwent abdominal computedtomography scans.

Results: On univariate analysis, obesity (body mass index > 5m kg/m2),fatty liver, diabetes mellitus, hypercholesterolemia, age older than 60 yearswere identified as risk factors associated with HP (P < 0.05). On multi-variate analysis, fatty liver (p ¼ 0.008, odds ratio ¼ 2.219) and age older

than 60 years (p¼0.001, odds ratio ¼ 2.874) were significantly associatedwith HP. In the subgroup analysis, VAT was a statistically significant riskfactors for HP (p ¼ 0.010, odds ratio ¼ 5.665).

Conclusion: HP is correlated with hepatic steatosis and age older than60 years. VAT is positively correlated with HP regardless of BMI. HP may beone of the phenotypes of metabolic syndrome likewise fatty liver.

W-022.

Intraductal papillary mucinous neoplasm presenting as long standingidiopathic chronic pancreatitis

Samuel Fernandes a, Luis Correia a, Teresa Antunes a, Rui Esteves b, AfonsoGonçalves c, Helena Cortez Pinto a, Jos�e Velosa a

a Hospital Santa Maria, Serviço Gastrenterologia e Hepatologia,PortugalbHospital Santa Maria, Serviço Cirurgia, Portugalc Hospital Santa Maria, Serviço Imagiologia, Portugal

Background: Intraductal papillary mucinous neoplasms (IPMN) arerare pancreatic neoplasms (7.5%) characterized by cystic dilation of themain pancreatic duct or its branches. IPMN are often mistaken with othercauses of chronic pancreatitis.

Aims: We report a patient with occult IPMN manifested as chronicidiopathic pancreatitis.

Patients&methods: A 67-year old man, with no alcohol consumption,and a history of recurrent pancreatitis of unknown etiology since age 37,pancreatic-jejunal bypass at age 40 for pain relief and radiological evidenceof chronic pancreatic since age 48 was admitted with abdominal pain,melaena and asthenia.

Results: Endoscopy revealed a lesion below D2 occupying half thecircumference and a third of the lumen with histology of high-grade epi-thelial papillary neoplasm. Computed tomography showed enlargementand heterogeneity of the pancreatic head with calcifications. We assumedthe diagnosis of pancreatic cancer and the patient was submitted to aWhipple procedure. Histology revealed IPMN with foci of invasive adeno-carcinoma with negative margins of resection.

Conclusion: Our report illustrates the difficulty in diagnosing IPMN.Over three decades the patient’s findings were interpreted in the context ofthe natural history of chronic pancreatic, with a correct diagnosis only afterestablished disease. Changes in regional morphology following surgicalbypass may have contributed to the delay in diagnosis. Surgery remains thetreatment of choice owing to itsmalignant potential, with excellent survivalat 5 years in local disease (90%). Although uncommon, IPMN should beconsidered in the differential diagnosis of idiopathic pancreatitis.

W-023.

Intraductal papillary mucinous neoplasm associated with pancreaticcalcification. Case report and review of the literature

Vyacheslav Egorov, Natalia Starostina, Tatiana Silina, Natalia Ratnikova,Olga Kosheleva, Roman Petrov

5th Moscow City Hospital, Moscow, Russia, Russia

Background: Intraductal papillary mucinous neoplasm (IPMN) asso-ciated with pancreatic calcification is a rare and important event because ofthe different therapy for the diseases.

Aims: To show the difficulties in diagnostics of two pancreatic con-ditions, which can lead to wrong treatment

Patients & methods: A 50-year old woman suffering with recurrentabdominal pain and diabetes mellitus was admitted to our hospital afterendoscopic, CT and EUS examinations. There was no previous history ofacute pancreatitis and patient was treated for chronic calcific pancreatitis.Radiologically, calcifications were seen diffusely throughout the gland andthere were no mucus entry through the major papilla.

Results: After work up the diagnosis was unclear, but the dilation of themain pancreatic duct and abdominal pain syndrome made surgery the best