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British Society of Gastroenterology Gut: First Published As 10.1136/Gut.31.5.A589 on 1 May 1990 Gut, 1990, 31, A589-A628 A589 British Society of Gastroenterology Gut: first published as 10.1136/gut.31.5.A589 on 1 May 1990. Downloaded from The 1990 Spring Meeting of the British Society of Gastroenterology was held at the University of Warwick on 28-30 March under the presidency of Dr Roger Williams. Printed below are the abstracts of the 358 oral and poster communications that were selected by the Programme Committee for presentation to the Society. oped to provide a simple and inexpensive A C SMITH, V A CHANDIRAMANI, C C AINLEY, S J PANCREATICOBILIARY alternative to HPLC. WILLIAMS, B A THEIS, A R W HATFIELD, AND R C G Urinary conjugates of both acids were com- RUSSELL (Departments of Gastroenterology and pletely hydrolysed in 4 M NaOH at 100°C Surgery, The Middlesex Hospital, Mortimer within 30 min. Maximal Street, London WI) CPT are to Hilar cholangiocarcinoma: a 10 year fluorescence of PABA reported occur experience (Xex=300 nm, kem=340 nm) was obtained at in the distal pancreas, and rarely present with neutral pH in dimethyl sulphoxide solution, jaundice. During the last four years, 12 R H GOMPERTZ, I S BENJAMIN, A YIP, R while PAS fluorescence (Xex=297 nm, kem 394 patients (eight females, four males; median age O'SULLIVAN, L H BLUMGART, AND R C N nm) was maximal at pH 4 0 in aqueous media. 56 years, range 31-78) with CPTs were seen; WILLIAMSON (Department ofSurgery, Hammer- Relative fluorescence was proportional to con- seven occurred in the head of the pancreas and smith Hospital, DuCane Road, London W12 centration over a wide range (0-04-8 mM for five in the body or tail. Clinical presentation PABA, 0-05-12 mM for PAS) and neither acid included jaundice ONN) The experience of one decade and 194 (five), abdominal pain interfered in cases ofhilar cholangiocarcinoma presenting to significantly the converse assay. (seven), abdominal mass (six), weight loss Limited interference was (two), a single specialist unit is reported. The average observed with para- steatorrhoea (two), and fever (one). cetamol and in the PABA determi- age at presentation was 58 (range 21-58) years nitrazepam Ultrasound showed a median tumour size of and 6-5 cm with a male:female ratio of 10:7. After detailed nation, aspirin and vitamin B6 for PAS. (range 4-12 cm). At endoscopic retro- In 23 0 5 grade biliary imaging, with or without laparotomy, patients ingesting g N-benzoyl-L- cholangiopancreatography (ERCP) two 0-36 PAS and 25 79% of patients were deemed irresectable be- tyrosyl-PABA, g g casein, of eight patients had pancreaticoduodenal the PABA Excretion PABA and two had thick mucus cause of local tumour extent or metastasis. Of Index (PEI=% fistulas exuding these 152 patients, 68% underwent surgical dose excreted in urine/% PAS excreted) by from the papilla. Histological results showed decompression and 21% stent drainage be- fluorimetry was highly correlated with HPLC cystadenocarcinoma (five), cystadenoma (five), tween the years 1979 and 1983 and 26% (y=0-91x+0-07; r=0-987, p<0-001). villous adenoma (one), and one patient had underwent surgical drainage and 64% stent We conclude that fluorimetry offers simple, typical ultrasound and ERCP findings ofa CPT reliable, and low cost analysis for oral pan- but no was obtained. In three drainage between 1984 and 1989: drainage was histology patients thus established for 90% in each time period. creatic function testing in situations where the endoscopic stenting was attempted to relieve Forty three (22%) patients underwent tumour expense of HPLC is not justified. jaundice on four occasions but biliary drain- resection with 21 liver resections and 22 local age failed due to viscid mucus blocking the resections, with an operative mortality of 15%. prosthesis. A pancreatoduodenectomy was http://gut.bmj.com/ in two was com- In 19, clearance was found to be incomplete attempted patients; resection Minimal change chronic pancreatitis: a plete in one but a choledochoduodenostomy either on frozen section or on subsequent surgical dilemma paraffin section. (CD) was only possible in the other. A distal pancreatectomy was performed in four others Follow up of over four years is available for T N WALSH, J RODE, B A THEIS, AND R C G RUSSELL 12 patients with apparently complete tumour and one further patient had an elective CD. (The Middlesex Hospital, Mortimer Street, Five patients were treated All clearance who left hospital: seven have died non-operatively. London WI) Pancreatic pain appears to be patients are alive at a median follow up of 16 (one of unrelated causes) between 12 and 84 unrelated to the severity of changes on pan- months (median 19-7), and five remain alive at months (range 2-162). on September 28, 2021 by guest. Protected copyright. creatic imaging or histology, and some patients Cystic pancreatic tumours may occur in the 51 to 66 months (median 58 months). All 11 with severe pain have minimal or equivocal pancreatic head, body, or tail. Treatment of patients with four year follow up who had findings pancreatic investigation. Forty incomplete tumour clearance have died at op obstructive jaundice, unlike conventional pan- three such patients were studied: 16 male creatic carcinomas, is better managed by sur- seven to 48 months (median 13-7). (mean age 30 years (range 13-59 at onset) and Patients with suspected hilar cholangiocar- gical biliary decompression rather than endo- 27 female (37, 14-65) patients described severe scopic stenting. In view of the prolonged cinoma should be assessed at a specialist centre. pancreatic pain, aggravated by food and Most patients have irresectable disease at the survival, attempted resection should only be alcohol, with nausea and vomiting. Analgesic undertaken if technically straightforward. time of presentation and for these patients requirements were mild in 28%, moderate in drainage can be established by percutaneous 42%, and heavy in 37%. Eleven had psychiatric or surgical means in most cases: recurrent assessment, of whom 10 were normal. Investi- jaundice and cholangitis are rarer after surgical gations which included endoscopic retrograde drainage but stenting now allows frail patients cholangiopancreatography (ERCP) and ultra- Extracorporeal shock wave lithotripsy of or those with advanced disease excellent sound showed pancreas divisum (seven) but pancreatic duct stones medium-term palliation. Complete resection, otherwise normal (21) or only equivocal where possible, offers prolonged survival and changes (22). Fifteen patients underwent re- H G T NIJS*, R DEN TOOM*, M VAN BLANKEN- the only hope of cure. section and two drainage only, resulting in STEINt, F H SCHRODER, AND 0 T TERPSTRAt improvement in nine, no change in seven, and (Departments ofGeneral Surgery*, Gastroentero- worse in one. Of those managed conservative- logyf, and Urology*, University Hospital Rotter- ly, 15 are improved, 10 unchanged, and one dam, The Netherlands) Chronic calcifying pan- worse. Histology showed subtle changes in all creatitis is a major clinical problem, often Fluorimetric assays for PABA and PAS in but one: chiefly mild periduct fibrosis, duct requiring extensive surgery. Extracorporeal oral pancreatic function testing proliferation and duct complex and adenoma- shock wave lithotripsy (ESWL) offers a new tous nodule formation. therapeutic option. We applied ESWL after P W PEMBERTON, P GAGJEE, R W LOBLEY, C It is suggested that a syndrome of minimal endoscopic sphincterotomy to seven patients CHALONER, AND J M BRAGANZA (University De- change pancreatitis exists with a distinct his- (three males, four females, mean age 42 (range partment of Gastroenterology, Manchester Royal tology. Treatment should if possible not be 22-55) years) with one or more impacted Infirnary, Oxford Road, ManchesterM13 9WL) by surgery as such patients respond badly pancreatic duct stones (diameter of largest In the bentiromide test of pancreatic exocrine to surgery. stone 22 (range 12-30) mm). The Siemens function urinary p-aminobenzoic acid (PABA) Lithostar (Erlangen, FRG) was used, with and p-aminosalicylic acid (PAS) are measured patients in a prone position under fluoroscopic by high performance liquid chromatography control; 4500 (1500-8000) discharges were (HPLC) in order to avoid drug interference. A Characteristics and management of cystic delivered in one or two sessions. fluorimetric procedure has now been devel- pancreatic tumours (CPT) Successful disintegration of stones was A590 TheBritish Society ofGastroenterology achieved in five of seven patients, relief of pain increased intestinal permeability. Twenty increased titre of Adl2 neutralising antibody in six, and total clearance ofthe pancreatic duct volunteers ingested 3-0-m-D-glucose (0-2 g), but not of specific anti-ElB-58 kDa antibody. in two. Mean serum amylase at discharge was D-xylose (0-5 g), L-rhamnose (1 g) and 51Cr They also have evidence of cell mediated 101 U/I v 180 U/i before ESWL (p<0 05). One EDTA (50 iCi) with five hour urine samples. immunity to synthetic peptides corresponding patient had an exacerbation of her pancreatitis Baseline permeability values (5'Cr EDTA/L- to the amino acid sequences implicated Gut: first published as 10.1136/gut.31.5.A589 on 1 May 1990. Downloaded from immediately after ESWL, which resolved with rhamnose) were mean (SE) 0-040 (0 004) and We sought evidence of persistent Ad12 medical management. None of the patients increased significantly after indomethacin infection by analysing DNA from small in- with fragmented stones had abdominal com- (50+75 mg) (0-153 (0 033) p<0-01) but not testinal mucosa using PCR with specific oligo- plaints at follow-up (mean six (range 1-16) after Indorise (0-068 (0 006) p<0-01). With nucleotide probes designed to amplify the months). In the two patients without stone dis- decreasing amounts of glucose and citrate to region of the Adl2 E1B gene involved.
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