analysed Chi-square test was used to compare parametric variables and Student's t test to study corinnuous variables Statistical significance was assumed if p<O 05, Results: There were 202 episodes o f ABP in 1 (59 patients (67}&t)2F, mean age 57 +/- 16.07 yr); 160 patients were not cholecystectomized betbre the attack at kBP Thirty-six episodes of rectnTence wmz' detected in 33 paliems (195%), 8 cases (222%) in the first month after ABP, 6 (16 7~) in tbe second month and 4 (11.1%) in the third the median of recurrence being at 89 day's (range 8-870). No differences were obsepeed between groups A and B in gender, age, body mass index severity, Balthazar grade, presence of choledochohthiasis, presence of lever or analytical parameters The patients of group A were Photecystectomized with less frequency in the first month than those ol group B (3.2% vs 17.8%, p<O 05) In group A, recurrence was more frequently severe in patients whose first episode of ABP was severe compared with those who suttered a mild attack (62.5% vs 12.5%, p<0,05), Conclusions: Recurrence of ABP is a hequem, early event, Cholecystectomy after 30 days implies a greater risk ol recurrence, The risk of severe recurrence is greater when the first episode has been severe

M1695

Hemoconcentration Predicts Local Complications but not Organ Failure in Acute Pancreatitis Gouzalo Alvarez Dcl Real, Darwin L, Conwell, Farah Khandwala, Gregory Znccaro Jr,, Alqandro C. krroliga

Background, Acute pancreatitis is associated with a high morbidny and mortality rate. Severe disease is manttested by" organ failure and local complications. The early recognition at patients at risk of local complicmimrs and organ taflnre is tmportam. Hematocrit has been postulated to be a predictor of severity in acute pancreatitis, but published results are contlicting and other confounding variables may need to be considered Aim, To determine h e utility of admissicm hematocrit as a predictor of local complications and organ failure in acute pancreatitis and compare it to admission AEACttE 1I and admission Ranson's criteria Methods Retrospective study of patients with acute pancmatitis admitted flnm the years 1997 to 2000, We used a cutoff level of hematocrit as previously published: 43% [or males and 39% fi)r females, Results. 471 patients were included: 250 (53,1%)were female. The mean age was 53,2 ( • 190) years. Admission hematocrit was not superior to current prognostic scores to predict organ failm'e, Statistk'al diagnosucs for local complications with 95% confidence intervals (95 % C1) are shown in the table. Conclusions Hemoconcentratmn shows promise as an indicator of local complications but oat regas tailure A single admission hematocrit value compezes well ,anth APACHE IX score tha all diagnostics cmrsidered Hemo- concentration is an important variable to be considered when assessing acute pancreatitis severity, Cfink'al implication: Early aggressive tluid resucitation of patients with acute pancre- atitis may decrease the devdopment of local coruplications

StatisUcal diagnostics for local complications: % and (95% Cl)~

Admission Hemato- Admission APACHE Admh~n Ranson's crit II CHteria

S~$1t~lty 44.7 (30, 60) 447 {30~ 60) 14.9 (8 8) Spec~r 61.1 (56, 66) 54.5 (50, 59) 90.1 (87, 93) Po~ve Predic~e Value 11,3 (7, 17) 9,8 (8 15) 14,3 (6, 27)

Negative Predictive 90,9 (87, 94) 89,9 (86, 93) 90,5 (87.93) Value

has been previously established at our centre and updated annually From this list we identified 167 phy'sicians and surgeons and mailed surveys to them. The survey consisted at five clinical scenanns: a case of mild acute idiopathic pancreatitis, two cases of presmned gallstone pancreatitis (mild and severe) and two cases of gallstone pancreatitis with evidence of biliary obstruction (mild and severe) Each case had multiple choice questions about the use aud timing of ERCP. RESUETS: We had an overall response rate of 112 / 167 (67%) The mean nuntber of years performing ERCP was 14.0+/-6A and the mean number of ERCFs per year was i85.9 +/-143,8. In mild acute idiopathic pancreatitis, only 18% would perform ERCP, whereas the majority (82%) would wait tar two or more episodes, or evidence of biliat 7 obstruction (p<0,0001). In mild gallstone pancreatitis with no biliat T obstruction, 40% would perform ERCP, whereas 60% would only it there was evidence of biliary obstruction (p=0,04). in severe gallstone pancreatitia with no hiliary obstruction, 70% would perform ERCP, whereas 30% would any if there was evidence of bfliary obstruction (p<0 0001). In mild gallstone pancreatitis with evidence of biliary obstruction, 51% would perform ERCP within 72 hours. In severe gallstone pancreatitis with evidence of biliaty obstruction, 72% wmdd perform ERCP within 72 hours ERCP was more likely to be pertormed within 72 hours of presentation in severe cases at pancr~atitis both with and without evidence of bihary Obstruction (p<0,001). CONCLUglON: These results outfins the current patterns of use of ERCP in acute idiopathic and gallstone pancreatitis among physicians and surgeons performing this procedure in Canada. ERCP is more likely to be perlormed v, dthin 72 hours in cases of severe gallstone pancmatitis with or without evidence of biliary obstruction.

M1698

ERCP Utilization In Acute Pancreatitis: A Survey of Canadian General Surgeons Roop K. Sandhu, Kenneth A, Leslie, James C. Gregor, Terry P. Ponich

The use and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute idiopathic and biliary pancmatins vary. We surveyed General Surgeons to determine cun'ertl practices with respect to ERCP. METHOD8: General Surgemrs were identified through the Canadian Association of General Surgeons and were each mailed a questionnait~ with of five climcal scenarios: a case of mild acute idiopathic panereatitis; miid and severe preslamed acute biliary pancreatitis, without proof of biliary obstruction; and mild and severe acute bfliary pancreatitis, with proof of biliary obstruction. Each case was followed by multiple- choice questions regarding management RESULTS: 340/1408 (24%)'of the questionnaires were remroed with 175 individuals declining for various reasons, the most common being retirement. There were 165 complete responses In mild acute idiopathic paacreatitis, 21 % would perform ERCP while 79% would wait for 2 or more episodes or for farther evidence of biliary obstruction before requesting ERCP (p<0,0001), In mild presumed biliary acute pancreatitis, 79% would proceed to performing only a cholecystectomy while 21% would first request ERCP (p<0 0001), In severe presumed acute bifiary pancreatitis, 52% would request ERCP of whom 36% would request ERCP ,aqthin 72 hours while 64% would wait after 72 hours or for further proof of obstruction (;o<0.0097). In mild acnte biliary pancreatitis, of the 90% that would request ERCP (p<0.0001), 48% would do so within 72 hours while 52% would wait after 72 hours or for more evidence of obstruction (p=0,05). In severe acute billary pancreatitis, 95% would t~zquest ERCP, of whom 64% would request ERCP within 72 ham's while 36% would wait after 72 hours or for more evidence of obstruction (p<0.0003). CONChUSION: Canadian Surgeons use ERCP in pancreatitis patiems in increas- ing amounts and at earlier intervals mtb more severe disease and with evidence of bifiary obstruction.

M1696

~n-Elastase: A Very" Accurate Test for the Early' Prognosis gvalnation of Acute Pancreatitis in Clinical Practice Augnsto Villanueva-Rodngoez, Julia Igksias-Gm'cia, Iose Larino-Noia, Manuel Barrmro-De acosta, Jose lglesias-Canle, Javier Femande>Castroagudin, Enrique Dommgnez-Munoz

Plasma levels at PMN-elastase have proved to be an acctxrate early prognostic marker of acute pancreatttis tAP) in research conditions. It has been however debated the accuracy and applicability of the test in conditions of clinical routine. Therefore, we aimed at evaluating tire accuracy of plasma PMN-elastase levels for the early prognostic evaluation of AP in clinical routine. Methods: 224 consecutive patients with AP admitted at our GI Department were included. In all of them, a sample of plasma tar PMN-elastase detemfination was taken on the first morning of hospital stay together with samples for routine hematological and biochemical attalysis, Plasma samples for PMN-elastase were sent to the lab and managed them according to muune protocols, AP was classified as mild or severe according to Atlanta Classification, while PMN-elastase results were kept blind, Res~alts are,shown as mean (SD) and compared by the Student's t test, Accuracy was calculated by drawing the conesponding ROC curve. Results: 50 (22,6%) patients sutfered from severn AP, Plasma levels of PMN- elastase were 2178 (93.48) in patients with severe AP and 681 (3268) in those with mild disease (p<O.001), Sensitivity and specificity* for an optimal cnt-off value of 110 micmgr/ L were 92% and 91% respectively The positive and negat,ve predicnve values for a prevalence of severe disuse at 20% were 78% and 96% respectively, The area under the ROC curve was 0,956, Conclusion: Quantification of plasma PMN-dastase levels is a very accurate method for the early prognostic evaluation of AP in climcal routine

M1697

ERCP Utilization In Acute Pancreatitis: A Survey of Canadian ERCP Practitioners Nitin V Khanna, James C Gregor~ Ten 3' P, Ponich

BACKGROUND: Tire use and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute idiopathic and gallstone pancreafitis remains controversial We surveyed Canadian physicians and surgeons who pertham ERCP to determine current practice patterns in this setting, METHODS: A list of Canadian physicians and surgeons performing ERCP

M1699

Pancreatic Gene Expression for Cytokiues, Nitric Oxide Synthase and for Tryptophan ltydroxylase in Human Pancreatitis (AP) .Jolanta Jaworek, joanna Bonior, Dar;uta Karcz, Jozefa Pan&, Wieslaw Pawlik, Stainslaw Konturek

AP is a serious disease with systemic complications and high mortality, The severity of AP and mnltiotgan t;~ilure is correlated to the changes of cytokine production. It has been shown that melatonin and nitric oxide protect the pancreas against the damage in experimen- tal models of acute pancreatitis, This study was undertaken to investigate the gone expression tar l.-tryptophan hydroxylase (HIOMY), an enz}cne converting L-tryptophan into melatonin, inducible (iNOS) and constitutive (eNOS) forms of nitric oxide synthase and for pro- inflammatory imerleukin 1B (1L-1B) and anti-inflammatory mterleukin 10 (ID10) m the pancreatic tissue taken from 12 patients with acute necmtizing pancreatins during surgery. Control samples were obtained from histologically normal pancreatic tissue taken from 5 patients with pancreatic cancer, Gone expression for both interleukins, cNOS, iNOS and HIOMT was measured by RT-PCR Bactm was determined in all samples as a housekeeping gone, Signal for HIOMT has been detected in the intact pancreas but was tound much stronger in all samples taken from patients with necrotizing pancreatitis. Gone expression [or IL-1B, IL-10 and for iNOS, has been present in the necmtizmg pancreatitis, but not in the control pancreas, whereas mRNA for eNOS has been fond in the control samples. We conclude that human acute pancreatitis tissue expresses mRNA signal for HIOMT, iNOS ILqB, Ib l0 , while intact pancreas exhibits eNOS and HIOMT expression.

M1700

Case-Control Study of the Outcome of Selenium and N-acetylcysteine-based intravenous Anti-oxidant Therapy in Severe Acute Panereatitis Inannis Virlos, Ajith Siriwardena

Introduction: Oxidative stress is an important mediator of acinar cell injury in experimental acute pancreatitis tAP). Serum anti-oxidant levels are depleted dunng the course of huumn AP with depletion corresponding to severity This study undertakes a case-control analysis of the outcome of intravenous anti-oxidam supplementation in an intensive care population of patients with severe tAP) defiued according to contemporary criteria. Methods: Forty

AGA Abstracts A-400