Abstracts Accessory Papilla Therapy Post-ERCP Pancreatitis (%) Secretin Used (%) Standard Technique (n⫽86) 11 (12.8) 15 (17.4) Precut Technique (n⫽21) 1 (4.8)* 16 (76.2)* Total (n⫽107) 12 (11.2) 31 (29.0) *Differences were not statistically significant when compared to standard technique (p⬎0.05) Mo1430 Santorinicele: a Morphological Alteration for Different Diseases Armando Gabbrielli*, Valentina Allegrini, Laura Bernardoni, Luigi Benini, Luca Frulloni, Antonio Amodio, Riccardo Manfredi, Italo Vantini Institute of Pancreas, Azienda Ospedaliera Integrata, Verona, Italy Background: Santorinicele is a cystic focal dilatation of the terminal portion of the dorsal pancreatic duct, diagnosed in patients with pancreas divisum (PD), which can cause acute recurrent pancreatitis (ARP). In literature few papers with small number of patients and short follow up were published. Endoscopic pancreatic sphincterotomy of minor papilla (EPSm) appeared to be effective in reducing ARP attacks. Magnetic resonance cholangio-pancreatography with secretin stimulation (s-CPRM) is useful to detect Santorinicele and to select symptomatic patients suitable for endoscopic therapy. Aim: To report 25 consecutive subjects with PD and Santorinicele (PD-S) diagnosed in our Institute and to evaluate the efficacy of EPSm in symptomatic patients. Patients and Methods: 25 consecutive subjects (8 M, 17 F, mean age 56.9 years, range 29-78) with PD-S were enrolled between January 2005 and October 2012.All underwent s-CPRM. 5/25 (20%) subjects had benign pancreatic hyperenzymemia (BPH). 20/ 25 (80%) were symptomatic for ARP (6 M, 14F, mean age 57.6 years, range 2978) (at least 2 episodes of ARP in the last year). Results: 5 asymptomatic patients with BPH weren’t treated. 20 patients with ARP were eligible for ERCP: 19 underwent EPSm, 1, recently diagnosed, is waiting for treatment. In 16/19 patients (84.2%) EPSm was successfully performed. In 3/19 (15.8%) minor papilla was not visualized despite secretin injection. Prophylactic 7 Fr. pancreatic stent was inserted in 11 patient and removed after 2 days. Mortality was absent. Morbility occurred in 9/19 (47.3%): mild acute pancreatitis:6; bleeding:1; retroperitoneal perforation:1; bleeding plus mild acute pancreatitis:1. All but one patients were treated conservatively. Patient with perforation was operated on. 12/16 treated patients (75%) didn’t have relapse in a mean follow up of 23.2 months (range 7-41). 4/16 (25%) had relapse in a mean period of 9.8 months (range 1-24) from EPSm. They all underwent s-CPRM. In 2 patients stenosis of the sphincterotomy was found. Both underwent EPSm again: no relapse after 9 and 18 months. 1 had a strong improvement at the s-MRCP test comparing with the previous exam and has been asymptomatic for further 9 months after relapse. The only one who had heterozygous mutation in CFTR gene (⌬F508) and 3 consecutive relapses developed a calcific chronic pancreatitis. Conclusions: Santorinicele can be exist both in symptomatic and asymptomatic subjects. EPSm is useful to reduce the ARP rate. In patients affected by PD-S relapsing after EPSm additional risk factors should be investigated. Mo1431 Endotherapy for Pancreas Divisum: a Systematic Review Rajan Kanth*1, Naga Swetha Samji1, Anupama Inaganti1, Sarah D. Komanapalli1, Ramon E. Rivera2, Mainor R. Antillon2, Praveen K. Roy1 1 Internal Medicine, Marshfield Clinic, Marshfield, WI; 2Ochsner Clinic Foundation, New Orleans, LA Purpose: Pancreas divisum (PD) is most common congenital pancreatic anomaly resulting from failure of embryological ventral and dorsal duct fusion. It has been associated with recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and chronic abdominal pain (CAP). Several studies have reported the effectiveness of endotherapy in symptomatic PD. We performed a systematic review to evaluate the effectiveness and safety of endotherapy in pancreas divisum. Method: Pubmed, Embase, Web of knowledge and abstracts from major conference were searched for relevant articles (search date Oct-2012). Data on indication, success, failure and complication of endotherapy for pancreas divisum were extracted. Data on RAP, CP & CAP were included as a part of endotherapy indication. Endotherapy was defined as endoscopic minor papilla sphincterotomy, stenting or dilation. Result: Twenty two studies (867 patients) were included. Studies were reported from USA (17), the Netherlands (1), France (1) and Italy (1), Australia (1), Japan (1). 17 studies were retrospective and 5 were prospective. Mean age of patients ranged from 33-52yrs. In 595 cases (20 studies) stents (size range: 5-11 Fr) were used and 667 cases (16 studies) underwent minor papilla sphincterotomy. Stricture dilation was performed in 78 cases (8 studies). Stent exchange (in 3-12 months) and repeat sphincterotomy was performed in several studies. Follow up after endotherapy ranged between 15-64 months. Endotherapy was successful in 43-100% of ARP, 27-80% of CP, 11-55% of CAP group. Procedure related common complications were pancreatitis (0-33%), hemorrhage (0-4%), and perforation (0-3%). Papillary restenosis and stent restenosis was found in 0-25% and 0-45% of cases respectively. Stent migration occurred in 0-20% of cases. Conclusion: For symptomatic pancreas divisum, minor papilla endotherapy is effective. Effectiveness of endoptherapy was higher in patients with recurrent acute pancreatitis compared to patients with chronic pancreatitis or chronic abdominal pain. Mo1432 Prophylactic Pancreatic Stents: Factors Influencing Migration, and Utility of Aggressive Patient Follow-up David K. Swartz*, Tyler P. Black, Jorge V. Obando, Mahfuzul Haque, Malcolm S. Branch, Paul S. Jowell, Rebecca Burbridge Division of Gastroenterology, Duke University Medical Center, Durham, NC Background: Placement of a prophylactic pancreatic duct stent reduces the rate of post-ERCP pancreatitis. Prophylactic pancreatic stents are intended to spontaneously migrate out of the pancreatic duct. Failure to migrate can result in complications (e.g. iatrogenic stricture of the pancreatic duct, acute pancreatitis). Because of this, many institutions universally obtain radiological imaging to confirm stent passage, and endoscopically remove stents that have not migrated. Aims: (1) To examine the compliance rate with a standard institutional follow-up program to confirm pancreatic stent migration. (2) To examine the stent and patient factors influencing the migration rate of prophylactic pancreatic stents. Patients/Methods: All ERCP’s performed at Duke University Medical Center between January 1, 2008 and October 1, 2011 involving placement of prophylactic pancreatic stents were identified from a prospectively maintained database. The institutional follow-up program for stent passage recommends KUB confirmation at 10-14 days, verbal and written instructions provided at the time of the procedure, and registered letters and attempts at direct contact for non-compliant patients. Case records were retrospectively reviewed to ascertain patient demographic factors, patient-related data (placement of dorsal duct stent, prior pancreatico-biliary surgery, pancreatic or biliary sphincterotomy, pancreatic duct stricture, concomittant biliary stent placement), stent-related data (french size, length) and details of stent passage (means of confirmation, time to confirmation, need for endoscopic removal). Results: A total of 458 patients had prophylactic pancreatic duct stents placed during the study period (70% female, average age ⫽ 52 years). Of these, 362 patients had stent follow-up information available. Less than 1/3 of patients were compliant with the institutional stent follow-up program recommendations, with only 31% having confirmation of stent passage or non-passage by KUB within 30 days. The overall spontaneous stent passage rate was 69% (249/362). In multi-variate analysis on patients with follow-up data, only the stent diameter and presence of a biliary stent had a significant effect on stent migration rate. Smaller stent diameter (3Fr 100%, 4Fr 88%, 5Fr 83%, 7Fr 22%; p⬍0.0001) and absence of a concomitant biliary stent (88% vs 64%; p ⫽ 0.0003) resulted in higher chance of stent migration. Conclusion: Very few patients are compliant with follow-up prophylactic pancreatic duct stent recommendations, despite a robust institutional follow-up program. Given this information, routine institutional follow-up may not be of great utility. The high rate of stent migration with small caliber stents, and the identification of specific factors for non-migration (such as presence of a biliary stent) may allow follow-up to be targeted to certain groups. Mo1433 Endoscopic Resection of Ampullary Lesions With and Without Extra Papillary Extension: Safety and Outcomes in a Tertiary Care Hospital Vanoo Jayasekeran*, Bronte A. Holt, Andrew D. Hopper, Stephen J. Williams, Rebecca Sonson, Milan S. Bassan, Michael J. Bourke Gastroenterology, Westmead Hospital, Sydney, NSW, Australia Introduction: Ampullary adenomas have the potential for malignant transformation and should be considered for resection. Larger lesions (⬎30mm) and those with extra papillary extension (giant laterally spreading tumours of the papilla) are often recommended for surgical resection. However, more recent literature suggests that endoscopic resection of giant LST-P lesions is safe and is a viable alternative to surgery.1 Methods: Data on consecutive patients undergoing endoscopic resection of ampullary lesions were prospectively collected between August 2006 to November 2012. Pre resection staging was undertaken with a combination of either CT scan, EUS, multiple biopsies from suspicious areas and with ERCP to exclude intraductal extension of lesions. In all cases, en bloc excision of the papilla was a key aspect. In papillary adenomas ⬍30mm, complete en bloc resection was performed without submucosal injection. Giant ampullary adenomas with significant extrapapillary extension (GAEPE) with predominantly vertical extra papillary extension were treated with initial papillectomy in the vertical plane and beyond the inferior aspect of the true papilla. Adenomas that were predominantly laterally spreading underwent chromogelofusine assisted EMR on one or both sides of the papilla followed by en bloc papillectomy. Stiff spiral snares were used for AB380 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013 www.giejournal.org