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- W2008217900 abstract "s / Pancreatology 299 pylorus-preserving PD (PPPD). Thirty-seven cases were combined with resection of additional organs or major vessels. Data were reviewed and analyzed in retrospective way. Results: There were 612 male and 398 female patients in this group, with mean age of 57.3 11.8 year-old. The most common pathological diagnosis were pancreatic adenocarcinomas (392/1010, 38.8%), ampullary adenocarcinomas (262/1010, 25.9%) and duodenal adenocarcinomas (144/1010, 14.3%). Intraoperative data showed a mean operation time of 312 73min and a mean estimated blood loss of 575 307mL. The most frequent postoperative complications were grade BþC delayed gastric emptying (226/1010, 22.4%), hemorrhage (102/1010, 10.1%), pancreatic fistula (101/1010, 10%), chyle fistula (71/ 1010, 7.0%), and intraabdominal infection (49/1010, 4.9%). Reoperation occurred in 38 patients (38/1010, 3.8%). Thirty-days mortality rate was 0.6% (6/1010). Length of postoperative hospital stay was 19.7 10.5 days. Conclusion: Though its mortality rate dropped to less than 1%, PD or PPPD remains a challenging procedure for surgeons, for its substantial postoperative complication rates. Technique proficiency may improve the outcomes. O-32 Abstract id: 218. Pancreatic Exocrine Insufficiency (PEI) in chronic pancreatitis (CP) and cystic fibrosis (CF) patients: Combining clinician insights and existing literature to develop a conceptual model to aid in the identification and management of PEI Markus Lerch , Philippe Levy , David Sanders , Linda AbetzWebb , Mathias Schifflers , Jean-Marc Haeusler . University Medicine Greifswald, Ernst-Moritz-Arndt University, Germany University Denis Diderot-Paris VII, Beaujon Hospital, Paris, France 3 Royal Hallamshire Hospital & the University of Sheffield, Sheffield, United Kingdom Adelphi Values, Cheshire, United Kingdom Abbott Products Operations AG, Allschwil, Switzerland Introduction: PEI occurs when pancreatic exocrine secretions are inadequate to maintain normal digestive function, resulting in nutrient malabsorption. PEI is most commonly recognized in adults with CP and children with CF. Aims: To develop a conceptual model capturing the burden of PEI and explore clinicians’ experience of treating PEI. Materials & methods: A PEI conceptual model was developed through a literature search and review of patient-reported outcomes. 10 specialists in France, Germany and England were interviewed with open-ended questions exploring symptoms, diagnosis, treatment and consequences of PEI. Interviews were qualitatively analyzed and concepts were mapped against the conceptual model. Results: The most common diagnostic method used was the faecal elastase test. However, two clinicians stated that diagnostic tests were not always conducted due to costs or patients’ preference. CF patients were often diagnosed and treated immediately upon presenting with PEI symptoms. PEI was thought to be underdiagnosed in CP patients. Clinician reported symptoms and impacts mapped closely with the conceptual model. Six clinicians identified weight loss as the most important PEI symptom, and indicative of disease severity. Clinicians reported patients’ diet (n1⁄410) and social lives (n1⁄43) to be impacted by PEI. There were concerns about treatment adherence amongst adolescents with CF, and CP patients who continued to consume alcohol. Conclusion: Reliance on clinical signs and symptoms for diagnosis of PEI suggests a need for a specific tool to screen for symptoms in a standardized and reliable way. Adherence concerns indicate a need for a tool to aid clinician-patient communication and disease management. O-33 Abstract id: 316. Disruption of fractalkine/CX3CR1 signalling attenuates pancreatic pain in experimental chronic pancreatitis Jan G. D’Haese , Tom D. D’Haese , Hamza Sezgin , Timo Kehl , Ihsan Ekin Demir , Frank Bergmann , Helmut Friess , G€ uralp O. Ceyhan . Department of Surgery, Klinikum rechts der Isar, Technische Universit€at M€ unchen, Germany Department of Pathology, Universit€atsklinikum Heidelberg, Universit€at Heidelberg, Germany Introduction: Chronic pancreatitis (CP) is a chronic inflammatory condition of the pancreas leading to severe pain and fibrosis. Fractalkine is a chemokine that chemoattracts inflammatory cells through its highly selective receptor CX3CR1 and has been suggested to aggravate pancreatic inflammation. Fractalkine is moreover known to be expressed on spinal neurons and sensory afferents where it has shown major pain-modulatory effects in different experimental pain states. Aims: We aimed to investigate the course of experimental chronic pancreatitis in CX3CR1-/deficient mice and the potential therapeutic implications of a CX3CR1 small molecule inhibitor. Materials & methods: CP was induced in CX3CR1-knockout and wildtype mice by repetitive intraperitoneal cerulein injections. Treatment groups received an orally available small molecule CX3CR1 inhibitor. Hyperalgesia was assessed by systematic behavioural observation, locomotion analysis, and measurement of abdominal mechanical sensitivity. Pancreatic tissue was harvested after sacrifice for further analyses. Results: Both CX3CR1-knockout and CX3CR1-blocking treated mice showed significantly less pain related behaviour (p < 0.0001) and significantly less weight loss (p < 0.01) when compared to their wild-type controls, with a clear dose-response correlation in the treated mice. This reduction in pain related behaviour was confirmed in IHC andWB analysis of pain markers. Unexpectedly, there was no difference in inflammatory cell infiltrations, fibrosis, Amylase/Lipase levels, and Trypsin/MPO activity. Conclusion: Fractalkine/CX3CR1 signalling seems to be crucial in initiating chronic pancreatic hyperalgesia. It does however not seem to have a direct effect on inflammatory cell infiltration and fibrosis. Nevertheless, these novel findings reveal CX3CR1 as a promising new target for the treatment of chronic pancreatic pain. O-34 Abstract id: 215. The development of fibrosis in a novel model of chronic pancreatitis is mediated by complement factor C5 Matthias Sendler , Georg Beyer , Vivien Kauschke , Sandrina Maertin , Thomas Wartmann , Frank Ulrich Weiss , Walter Halangk , Markus M. Lerch , Julia Mayerle . Department of Medicine A, University Medicine, Ernst-Moritz-ArndtUniversity Greifswald, Germany Division of Experimental Surgery, Otto-von-Guericke-University Magdeburg, Germany Introduction: Chronic pancreatitis is accompanied with the loss of exocrine function and the development of fibrosis. Aims:We investigate the effect of complement factor 5 (C5) in a newly established murine model of chronic pancreatitis and compared it to repetitive caerulein injections. Materials & methods: Chronic pancreatitis was induced in C5þ/þ and C5-/mice by ligation of the pancreatic duct in the body of the organ (leaving the head unaffected) and a single supramaximal caerulein injection. Animals were sacrificed 21 days after ligation. As a second model we used repetitive supramaximal caerulein stimulation over 10 weeks. We used serum amylase and lipase as markers for pancreatic damage, collagen as a marker for fibrosis and histology for morphological evaluation. Isolated pancreatic stellate cells (PSCs) were stimulated with C5a in vitro. 13 (2013) S2–S98 S13" @default.
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- W2008217900 title "Pancreatic Exocrine Insufficiency (PEI) in chronic pancreatitis (CP) and cystic fibrosis (CF) patients: Combining clinician insights and existing literature to develop a conceptual model to aid in the identification and management of PEI" @default.
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