bluuebunny/crossref_metadata_2025_split huggingface dataset:
86 Acalculous Cholecystitis: Changing Trends From 2004 to 2014
Authors: Kakked Gaurav , Herman Michael , Persaud Alana , Smith Michael S. , Lung Edward 
Published: October 2019

INTRODUCTION:
Acute acalculous cholecystitis (AAC) which accounts for 10% cases of cholecystitis is associated with high morbidity and mortality rates. The management options for AAC range from surgical removal of the gall bladder to emergent drainage either by percutaneous means or endoscopically. Data about the in-hospital outcomes of AAC is sparse.

METHODS:
The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. We analyzed the National Inpatient Sample Database (NIS) for all patients in which acute acalculous cholecystitis (ICD-9 codes: 575.0, 575.1) was the principal discharge diagnosis from 2004 to 2014. We further looked at procedure codes Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Percutaneous transhepatic cholangiography (PTC), open and laparoscopic cholecystectomy. The outcome variables were in hospital mortality, length of stay and total hospital charge. Univariate and multivariate analysis was performed adjusted for multiple confounder.

RESULTS:
In 2014 there were 35865 hospital admissions with the principal diagnosis AAC which increased significantly from 23485 in 2004 (P < 0.001). The mean length of stay for acute cholecystitis decreased by 21.6% between 2004 and 2014 (i.e., from 5.1 days to 4.0 days; (P  <  0.05). During the same time period, however, mean hospital charges have increased by 190.5% from US$24 514 per patient in 2004 to US$46847 per patient in 2014 (P  <  0.001). There were no cases of EUS guided drainage in 2004 while in 2014 there were 485 cases. A significantly higher proportion of patients received PTC, ERCP and laparoscopic cholecystectomy in 2014 compared to 2004 (P = 0.001). The in-hospital mortality declined from 1.4% in 2004 to 0.9% in 2014. Factors associated with in-hospital mortality were Diabetes mellitus (OR = 1.76, P = 0.004), presence of Chronic kidney disease (OR = 2.36, P = 0.003), hematologic malignancy (OR = 4.5, P < 0.001) and metastatic cancer (OR = 14.56, P < 0.0001).

CONCLUSION:
The number of cases of acalculous cholecystitis has shown a gradual increase from 2004 to 2014. However there has been a gradual reduction in mortality and length of stay in these patients. While it is associated with increased utilization of ERCP and EUS, causality cannot definitively be established.
90 Factors Associated With Increased Opioid Use in a Retrospective Cohort of 14,140 Acute Pancreatitis Patients
Authors: Twohig Patrick , Sandhu Dalbir S. 
Published: October 2019

INTRODUCTION:
Pain management is a critical component of treating acute pancreatitis (AP). No guidelines exist on optimal pain management strategies. Opioids have become a mainstay in the treatment of pain in AP, but there are uncertainties regarding their effectiveness and concerns about their safety. The risk of subsequent opioid dependence (OD) after developing AP has not been well-studied. Our aim is to 1) Investigate the risk of developing OD after having AP, and 2) Evaluate whether patient factors such as age, gender, race, and insurance status affect the risk of developing OD after AP.

METHODS:
We performed a retrospective analysis in the IBM Explorys database (1999–2019), a pooled, de-identified clinical database of over 63 million unique patients across the United States. At the time of analysis there were 63,566,840 patients. Patient populations were identified using SNOMED and ICD codes. Odds ratios were calculated to determine the relationship between AP and OD for the population subgroups outlined above.

RESULTS:
316,450 patients had AP from 1999–2019. 14,140 of these patients also were OD. The odds of being OD after AP was 11.06 (95% CI 10.87, 11.25). Patients under the age of 65 years had the highest risk of developing OD. Patients with Medicaid had the highest risk of any type of medical insurance. Females were more likely to develop OD than males. Caucasian and African American patients had a similar risk of becoming OD. Asian patients were least likely to develop OD. Full results are listed in Table 1. Corresponding Forrest plots of this data are illustrated in Figure 1.

CONCLUSION:
Our results are consistent with what has been observed previously, as an evaluation of opioid use among inpatients with AP also found a significant variation in opioid use among hospitalized patients. High doses of opioids have been shown to result in longer hospitalizations and more adverse outcomes. Prospective trials and systematic reviews have not found that any particular analgesic is superior for pain control in AP patients. There is currently a lack of clinical guidance on the utility and efficacy of using opioids in managing pain from AP. We hope that our results can inform clinicians of different patient factors that may increase the risk of OD after having AP. Future use of drug monitoring systems and electronic health record utilization may help further analyze factors associated with persistent opioid use.
93 Variations of Diagnosis and Management of Immune Checkpoint Inhibitor Pancreatic Injury (ICIPI) and Immune Checkpoint Inhibitor Pancreatitis: A Single Institution Experience
Authors: Shah Ravi , Sleiman Joseph , Simons-Linares Roberto , Faisal Muhammad , Song Jung-Min , Philpott Jessica , Funchain Pauline 
Published: October 2019

INTRODUCTION:
Immune checkpoint inhibitors (ICI) have revolutionized the treatment of malignancies, but are limited by immune-related adverse events (iRAE). Pancreatic iRAEs, broadly defined by asymptomatic lipase elevation to complicated pancreatitis, lack clear management. We seek to report rates of varying definitions, evaluations, and management of pancreatic iRAEs, classified as immune-checkpoint inhibitor pancreatic injury (ICIPI) and ICI pancreatitis.

METHODS:
From a database of 1672 patients treated with ICI, data was collected on those with possible pancreatic injury. They were classified into four groups: ICIPI, as defined by either lipase elevation or imaging of pancreatitis due to ICI; ICI pancreatitis, as defined by fulfilling Atlanta criteria; non-ICI asymptomatic lipase elevation; non-ICI pancreatitis. Data on rates of diagnosed pancreatitis, lipase elevations, imaging evidence, symptomatology, treatment, management of ICI, and patient outcome after cessation of ICI were collected.

RESULTS:
Of 31/1672 (2%) patients with pancreatic injury, 7 had ICI pancreatitis, 14 had ICIPI, 6 had non-ICI pancreatitis, and 4 had non-ICI asymptomatic lipase elevations. In the 7 ICI pancreatitis patients meeting Atlanta criteria, 5/7 (71%) had follow up evaluation to rule out other etiologies of pancreatitis. In contrast, only 1/13 (8%) ICIPI patients had a follow up evaluation to meet Atlanta criteria or rule out other etiologies. Of the ICIPI patients, 6/14 (43%) were diagnosed as pancreatitis, 8/14 (57%) were asymptomatic, 9/14 (64%) had lipase >3x upper limit of normal (ULN), and only 1/14 (7%) ICIPI was due to imaging alone (Table 1). Most ICI pancreatitis, 5/7 (71%), and ICIPI, 10/14 (71%) patients received corticosteroids (CS). While 4/7 (57%) ICI pancreatitis patients received intravenous fluids (IVF), only 2/14 (14%) of ICIPI patients did. Of 6/7 (86%) of ICI pancreatitis patients that stopped ICI, 3/6 (50%) reinitiated them. In contrast, 7/14 (50%) of ICIPI patients stopped ICI and 5/7 (71%) reinitiated them (Table 2).

CONCLUSION:
Pancreatic injury is known to be associated with ICI. Efforts to identify and treat those with pancreatic iRAE are critical to avoid delay in ICI therapy. In our study, most patients with ICIPI and ICI pancreatitis received CS. Almost all ICI pancreatitis patients stopped ICI with half reinitiating them, while only half of ICIPI patients stopped ICI with most reinitiating them. Further characterizing outcomes to develop a diagnostic algorithm will enhance care.
94 Necrotizing Pancreatitis Does Not Increase Odds of Mortality: Insights From a National Cohort
Authors: Bhurwal Abhishek , Pioppo Lauren , Tawadros Augustine , Reja Debashis , Andalib Iman , Sarkar Avik , Shahid Haroon , Tyberg Amy , Kahaleh Michel 
Published: October 2019

INTRODUCTION:
Although most patients develop mild acute pancreatitis, some progress to necrotizing pancreatitis. Necrotizing pancreatitis has historically been associated with increased mortality as high as 30%. However, there are sparse studies reporting incidence of necrotizing pancreatitis from national cohort and its impact on patient related outcomes. Therefore, we aimed to analyze Necrotizing pancreatitis from a National cohort.

METHODS:
This was a retrospective study utilizing the 2016 National Inpatient Database Cohort for all principal discharges of acute pancreatitis in patients more than 18 years of age utilizing ICD 10 CM codes. Primary outcomes were incidence of necrotizing pancreatitis. Secondary outcomes were mortality, impact on healthcare utilization in terms of length of stay and hospitalization charges. These were then adjusted for confounders utilizing multivariate and Poisson regression analysis. All statistics were performed utilizing STATA software.

RESULTS:
Among total of 288,479 discharges with principal diagnoses of Acute Pancreatitis, 0.84% were necrotizing pancreatitis. Necrotizing pancreatitis significantly more frequent in young adults (49 years vs 51 years, P < 0.0001) and male population (52.69% vs 69.83%, P < 0.0001). As expected, presence of necrosis was associated with increased odds of complications such as Acute kidney injury and Acute respiratory distress syndrome. Approximately, 7% of the necrotizing pancreatitis cohort was associated with pancreatic resection. Acute necrotizing pancreatitis did not significantly increase the odds of mortality as shown in Table 2 after adjustment of confounders. Presence of necrosis was also associated with significantly longer length of stay in the hospital (4.31 days vs 12.10 days, P < 0.0001) and significantly higher total hospitalization costs (9,264$ vs 29,948$, P < 0.0001).

CONCLUSION:
Incidence of Acute necrotizing pancreatitis is approximately 8 per 1000 cases of acute pancreatitis. Even though, necrotizing pancreatitis led to significantly higher longer length of stay and hospitalization charges, mortality was not increased from necrotizing pancreatitis. No significant difference in mortality indirectly indicates aggressive IV fluid therapy, early recognition and resections when indicated. However, further studies are warranted to elucidate the reason explaining necrotizing pancreatitis in young and male population.
95 Prevalence of Intrapapillary Mucinous Neoplasm in Patients With Chronic Kidney Disease
Authors: Kapil Neil , Lamm Vladimir , Mulki Ramzi , Shah Rushikesh , Cai Qiang , Willingham Field , Keilin Steven 
Published: October 2019

INTRODUCTION:
The prevalence of intraductal papillary mucinous neoplasm (IPMN) in the general population ranges from 3.3%–9.8%. In patients undergoing liver transplant evaluation, overall prevalence is documented to be 6.6%. So far, the suggested risk factors for IPMN include diabetes, family history of pancreatic adenocarcinoma, and tobacco use. We aim to study the prevalence and risk factors for IPMN formation in patients with chronic kidney disease (CKD).

METHODS:
We performed a retrospective cross-sectional study of patients with CKD who had MRIs of the abdomen performed between the dates of 1/2018 and 12/2018. Independent chart review was conducted and various demographic, clinical, and imaging metrics were extracted. Overall, the prevalence of IPMN was calculated. A student's t-test and chi-square test were used to compare the IPMN group to non-IPMN group.

RESULTS:
A total of 400 patients were reviewed. The total prevalence of IPMN in CKD patients was 13.7% (55/400). In 68% of the study patients, the MRI was done for a kidney transplant evaluation. The average age of patients in the study was 58 ± 14 years, 59% were male and 52% patients were on dialysis. Diabetes and Hypertension accounted for 26% and 45% of CKD respectively. In patients with IPMNs, the average size was 10 ± 5.7 mm; 45% were located in the head, 33% in the body and 22% in the tail. Notably, 16% were main duct IPMNs, 80% were side branch IPMNs and 4% patients had mixed (MD + SB) IPMNs. Amongst the patients with IPMNs, 7.5% of patients had associated high-risk features and were referred for endoscopic ultrasound. Comparison of the IPMN group to non-IPMN group is shown in Table 1. IPMNs were most commonly observed in elderly patients. Gender, dialysis status, etiology of CKD, smoking and alcohol intake did not seem to impact the prevalence of IPMN in CKD patients.

CONCLUSION:
Patients with CKD have a higher prevalence of IPMNs than the general population. We further aim to confirm this interval data with our age and gender matched control group without CKD.
99 Cholangitis in Patients With Pancreatic Adenocarcinoma Does Not Impact Resection Rates in Patients Who Are Undergoing Neoadjuvant Chemotherapy
Authors: Darnell Eli P. , Wang Thomas J. , Lumish Melissa A. , Hernandez-Barco Yasmin G. , Weniger Maximillian , Fernandez-Del Castillo C. , Casey Brenna W. , Krishnan Kumar 
Published: October 2019

INTRODUCTION:
Pancreatic adenocarcinoma continues to have a high mortality rate. Successful surgical resection (Whipple procedure) of cancer remains the only potential durable cure. In order to improve survival, many patients receive neoadjuvant chemotherapy prior to surgery, which requires biliary stenting in those patients with jaundice. Some patients will develop cholangitis from transient stent obstruction. The impact of preoperative cholangitis on the ability to get surgery is not clear. We investigate the role of cholangitis in patients with pancreatic adenocarcinoma undergoing neoadjuvant chemotherapy.

METHODS:
We identified all patients of Massachusetts General Hospital (MGH) from 2013 to 2018 who underwent neoadjuvant chemotherapy and received ERCP with metal biliary stenting for jaundice. Chart review was performed to identify patients who had cholangitis. We further determined the rate of successful surgery, time to surgery, and mortality rates. Statistics were performed using the student t-test or Fisher's exact test to establish significance.

RESULTS:
In total, we identified 97 patients who establish care at MGH to pursue neoadjuvant chemotherapy in preparation for curative surgery. Of these 25 had developed at least one episode of cholangitis within one year of diagnosis, 6 had more than one episode, while 72 did not have any episodes of cholangitis. Whipple surgery was attempted in 76% of the cholangitis-1 group compared to 78% of the non-cholangitis group (P = 1.0). The average time to surgery was 194 days in the cholangitis group and 176 days in the non-cholangitis group (P = 0.40). There was no difference in surgical resection rate or time to surgery between patients with more than one episode of cholangitis compared to the non-cholangitis group. There was no difference between groups in six (P = 0.57) or twelve month (P = 0.56) mortality.

CONCLUSION:
Our data reveal that cholangitis within a year of diagnosis does not impact the ability of a patient to undergo successful Whipple operation. We propose that aggressive endoscopic biliary endotherapy should be considered, even in patients with recurrent preoperative cholangitis, to assist with completing neoadjuvant protocols in hopes of a curative surgery.
102 Application of Liquid-Impregnated Surfaces on Gastrointestinal Devices to Reduce Device-Associated Complications
Authors: Zhang Zheng , Seekell Raymond , Jaffe Sarah , Smith J. David , Varanasi Kripa , Hernandez Lyndon 
Published: October 2019

INTRODUCTION:
Plastic stents can occlude and require reintervention in up to 75% of cases and this has contributed to more frequent use of much more expensive metal stents. Efforts to increase the duration of plastic stent patency, such as antibacterial stent and hydrophilic coating or design modifications, have met limited success. We hypothesize that a biocompatible liquid-impregnated surface (LIS) coating combining a textured substrate with a liquid lubricant creates a lubricious surface that reduces cell attachment and biofilm formation. Our aim is to determine the ability of LIS coating in an in vitro model to reduce thrombus formation and lumen occlusion.

METHODS:
A polyethylene (PE) tube, made with the same material and size as a 10 Fr biliary stent, is coated with a LIS coating. A Chandler loop assay with freshly harvested bovine blood is used to analyze cell attachment and thrombus formation. Pressure buildup within either PE tubes or 5 Fr polyurethane tubes in presence of whole blood is tested with an occlusion assay. The coated devices are challenged with bile extract solution at 38 °C up to 35 days. The surface composition is analyzed by Attenuated Total Reflection-Fourier Transform Infrared Spectroscopy (ATR-FTIR).

RESULTS:
LIS-coated tubes demonstrated a 100% thrombus reduction using the Chandler loop assay (Figure 1a). The coating remained stable on the surface up to 35 days both in air and in the bile acid solution (Figure 1b,c). LIS-coated tubes were observed to remain patent after 12 hours of swine bile infusion, compared to controls that were completely obstructed. The coated surfaces also reduced occlusion rates in bovine blood (Figure 2).

CONCLUSION:
With a formulation developed through thermodynamic and hydrodynamic validation, a biocompatible LIS coating was applied on a model GI device both internally and externally. In addition to the anti-thrombogenic and antimicrobial performance, the slippery characteristics of the coating can reduce friction, facilitate device deployment during implantation. The coating has the potential to be applied on a GI device such as a biliary stent for a further product development.
103 Pancreatic Adenocarcinoma Following Liver Transplantation: UNOS Data Analysis
Authors: Corral Juan E. , Patel Sheetal , Kröner Paul T. , Wijarnpreecha Karn , Patel Arpan , Al Nimri Sarah M. , Bi Yan , Mousa Omar Y. 
Published: October 2019

INTRODUCTION:
Solid organ transplant recipients are at increased risk of de novomalignancies, in some cases up to 15.6%. Data regarding pancreatic cancer following liver transplantation is limited. We aim to evaluate the incidence of pancreatic adenocarcinoma among liver transplant recipients in the United States. Describe survival in those patients and identify subgroup of patients at increased risk.

METHODS:
We examined the United Network of Organ Sharing (UNOS) database and identified patients with pancreatic adenocarcinoma who underwent liver transplant between 1988 and 2016. Patients 18 years of age and older were included. Demographics, primary diagnosis and survival data were recorded. Kaplan-Meier survival analyses and log-rank tests were performed.

RESULTS:
In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 liver transplant recipients. A total of 140 patients developed pancreatic adenocarcinoma after liver transplantation. Most common indications for transplantations were Hepatitis C, alcohol cirrhosis and hepatocellular carcinoma (25 [17.9%], 24 [17.1%] and 9 [6.4%] respectively). Annual incidence was 16 pancreatic cancer cases per 100,000 transplant recipients. Compared to national annual incidence of 12.9 cancer cases per 100,000 patients, the relative risk was 1.23 (95% CI 0.59–2.56). Compared to other liver transplant recipients, those who developed pancreatic cancer were older and transplanted earlier in the time period evaluated (P < 0.001 and P = 0.002 respectively). Gender, ethnicity, BMI, and primary diagnosis (i.e., transplant indication) were not significantly different among groups. Patient survival was significantly lower in patients who developed pancreatic adenocarcinoma (Log-rank test P < 0.001) (Figure 1).

CONCLUSION:
Analysis of the UNOS database showed that pancreatic adenocarcinoma is increased among liver transplant recipients without reaching statistical significance. Primary indications for transplantation and demographics were similar among both groups. Our findings suggest that pancreatic adenocarcinoma is more likely associated to long-standing immunosuppression and non-traditional risk factors rather than alcohol consumption or obesity. Further studies describing the natural history of pancreatic cancer after solid organ transplantation are suggested.
106 Trends, Predictors, and Outcomes of Septic Shock in Patients With Pancreatitis
Authors: Albeiruti Ridwaan , Chaudhary Fahad , Hutson William 
Published: October 2019

INTRODUCTION:
Patients with pancreatitis are at an increased risk of developing infections. The goal of our study was to determine the association of septic shock on in-hospital outcomes among patients with pancreatitis as well as the risk factors.

METHODS:
A retrospective study using the National Inpatient Sample database (2003–2016) was used to identify acute pancreatitis patients with and without septic shock. A linear regression analysis was used to assess the impact of septic shock on patients hospitalized with acute pancreatitis. A univariate logistic regression was used to determine comorbid conditions and predictors for septic shock in this cohort.

RESULTS:
We identified 7158894 pancreatitis patients between 2003–2016. Patients hospitalized for pancreatitis with and without septic shock had similar baseline characteristics. The incidence of septic shock was highest among patients aged >65 (P < 0.001). Septic shock was associated with significantly higher mortality among those with pancreatitis (34.4% vs 1.5%, P < 0.001). Septic shock was associated with 3 times longer hospitalization (12 days versus 4 days, P < 0.001), higher median hospital cost ($117907 vs $21563, P < 0.001), respiratory failure (60.7% vs 3.6%, P < 0.001), and renal failure (61.6% vs 9.2%, P < 0.001). Septic shock was more likely in patients with comorbidities including diabetes, COPD, and CAD.

CONCLUSION:
Our study found that septic shock in acute pancreatitis patients is associated with increase in mortality, length of stay, and health care utilization. More investigation is needed to further understand how to best mitigate some of these predictors for mortality.