Abstracts of Papers Submitted to the 52nd Meeting of the American Pancreatic Association, November 3–6, 2021, Miami Beach, Florida

Heme Oxygenase-1 Inhibition in Combination With Arsenic Trioxide as a Novel Combination for Pancreatic Cancer Treatment M. Abdalla, A. Dafferner, I. Ahmad. University of Nebraska Medical Center, Omaha, NE. Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies and has one of the worst prognoses. The anti-cancer drug; Arsenic Trioxide (ATO) is used in the treatment of patients with acute promyelocytic leukemia (APL). ATO and hypoxic tumor microenvironment (TME) reprogram the expression profile of multiple proteins and upregulate Heme Oxygenase-1 (HO-1), which provides a survival advantage for tumors. HO-1 is a stress enzyme that catalyzes the degradation of heme to biliverdin, carbon monoxide (CO), and free iron (Fe). Increased HO-1 levels play a role in carcinogenesis and increase cellular growth, angiogenesis, and metastasis in several malignancies, including PDAC. However, any relationships between HO-1 inhibition, the TME, and tumor response to ATO and their mechanisms of action remain unclear. Methods: We used different HO-1 inhibitors, different concentrations of ATO in multiple PDAC cell lines to study survival, ROS production by oxidant sensitive probes (DCH, and DHE), Glutathione oxidation, and Apoptosis by Annexin V/PI. Results: Our studies show that ATO induces HO-1 in PDAC cells, and inhibiting HO-1 increases reactive oxygen species (ROS) and sensitizes PDAC cells to ATO therapy in vitro. A dose dependent increase in apoptosis was seen in multiple PDAC cell lines treated with ATO, with enhanced effects when combined with HO-1 inhibitors. Conclusions: Our results show the potential action of HO-1 inhibition in combined therapy as a novel targeted therapeutic strategies against PDAC. Visceral Artery Pseudoaneurysms in Necrotizing Pancreatitis: Risk of Early Bleeding With Lumen Apposing Metal Stents M. Abdallah, K. Vantanasiri, S. Young, N. Azeem, S. Amateau, S. Mallery, M.L. Freeman, G. Trikudanathan. University of Minnesota, Minneapolis, MN. Background: Visceral artery pseudoaneurysm (PSA) in necrotizing pancreatitis (NP) is associated with significant morbidity and mortality. In this study, we aimed to evaluate the incidence, clinical presentation, management, and outcomes of PSA in NP. Methods: All NP patients managed at our institution between 2010–2020 were reviewed from a prospectively maintained database for the diagnosis of PSA. Results: Thirty-nine (6.4%) of 608 patients with NP had a confirmed diagnosis of PSA. Demographics, and surgical necrosectomy for walled off necrosis (WON) were similar between PSA vs no-PSA. Endoscopic and percutaneous and endoscopic drainages for WON were more common in PSA (74.4 vs 56%, P = 0.03) and (38.5 vs 23.5%, P = 0.04)), respectively. Seven (18%) patients developed PSA without requiring any type of intervention for WON. In patients with endoscopic transluminal drainage, the duration from lumen apposing metal stent (LAMS) insertion for WON to PSA diagnosis was shorter in patients with indwelling LAMS vs patients with no indwelling LAMS [11.5 vs 69 d] (P < 0.001). 77% of patients presented with anemia, 74.3% with GI bleeding, and 30% with hemorrhagic shock. Computerized tomography was diagnostic for PSA in 83.9% with false negative rate of 16.1%. PSA was commonly diagnosed in splenic (50%) and gastroduodenal (28%) arteries. Angiography and embolization for PSA was successful in 32 out of 35. In-hospital mortality was observed in 9 (23.1%) patients. Conclusions: Although visceral artery PSA affects a small percentage of NP patients, it is associated with significant morbidity and mortality. Bleeding from PSA occurred within 11 days in patients with indwelling LAMS which may warrant early evaluation of WON after LAMS insertion. CT abdomen with IV contrast is an effective modality for PSA diagnosis. Angiography should be used when clinical suspicion is high for PSA and CT imaging is negative. Angiography with embolization has a high success and low complication rates in treating PSA. Endoscopic Ultrasound Guided Fine-Needle Aspiration for Solid Lesions in Chronic Pancreatitis: A Systematic Review and Meta-Analysis M. Abdallah,1 K. Ahmed,2 W. Taha,3 A. Musa,4 A. Abdalla,5 E. Reardon,1 G. Trikudanathan.11University of Minnesota, Minneapolis, MN; 2The Wright Center for Community Health, Scranton, PA; 3NewYork-Presbyterian Queens, Flushing, NY; 4Howard University, Washington, DC; 5Mayo Clinic, Rochester, MN. Background: Patients with chronic pancreatitis (CP) are at a higher risk of developing pancreatic adenocarcinoma compared the general population. Endoscopic ultrasound fine needle aspiration (EUS-FNA) of solid pancreatic lesions (SPL) has an excellent sensitivity (85–90%) and specificity (98–100%) for diagnosing pancreatic malignancy. However, data on the performance characteristics of EUS-FNA in CP are mixed. In this systematic review and meta-analysis, we aim to examine data from published studies on the diagnostic performance of EUS-FNA in detecting pancreas malignancy in CP. Methods: We conducted a comprehensive search of MEDLINE, Cochrane, Embase, Scopus databases for studies published in English language that reported performance characteristics of EUS-FNA for SPL up to November 2020. Results: A total of 6753 studies were identified on initial search. Studies that reported EUS-FNA of cystic pancreas lesions were excluded. Eight studies met the inclusion criteria. Seven studies were retrospective, and one was prospective. A total of 593 patients with CP underwent EUS-FNA for SPL. The pooled sensitivity of EUS-FNA was 65% (95% CI, 52.6–75.6%, I2 = 44%), specificity was 96.8% (95% CI, 75–99.7%, I2 = 89%), negative likelihood ratio (NLR) 41.4 (95% CI, 11.1–149.6, I2 = 70%), positive likelihood ratio (PLR) 24.1 (95% CI, 2.8–208, I2 = 90%). The pooled data from seven studies that compared 901 non-CP vs 127 CP showed that the sensitivity of EUS-FNA in diagnosing pancreatic malignancy was 91.5 vs 65.3% [OR, 5.5; 95% CI, 2.9–10.2); I2 = 31.8%]. The specificity pooled from six studies [333 non-CP vs 357 CP] was 95.9% vs 82.4%, [OR, 1.3; 95% CI, 0.2–9.8; I2 = 73%]. The risk of bias was serious in one study, low in four studies and moderate in three studies. Conclusions: This pooled meta-analysis shows a low sensitivity of EUS-FNA in diagnosing malignancy in CP patients with SPL in comparison to patients without CP. Circulating Tumor DNA for Early Relapse Detection and Monitoring Disease Status in Patients With Early-Stage Pancreatic Adenocarcinoma M. Abdelrahim,1 S. Chandana,2 A. Esmail,1 T.A. Katz,3 B. Drummond,3 S. Sharma,3 E. Kalashnikova,3 P. Olshan,3 P.R. Billings,3 A. Aleshin.31Houston Methodist Cancer Center, Houston, TX; 2CHCWM, Grand Rapids, MI; 3Natera, Inc., San Carlos, CA. Background: Pancreatic adenocarcinoma (PDAC), one of the most aggressive malignancies, is associated with very poor outcome and prognosis. Biomarkers that have been evaluated for and showed poor sensitivity and A and for in PDAC and Methods: In this patients with pancreatic and one with adenocarcinoma were prospectively for and for a of for in were from from tumor from patients were and Results: the patients, three patients with negative had of clinical and were from Eight patients had at the the patients, were and clinical the patients, had and In the was observed in patients with sensitivity and The of was associated with survival 95% CI, P = However, a similar of levels an with outcome 95% CI, P = In we observed levels were by as Conclusions: Our that of after in PDAC is associated with was to be a compared to and be used to on to as a of in Patients With S. of of of Background: pancreatitis is the most common serious complication of endoscopic We aimed to the between and outcomes in patients with pancreatitis Methods: We a study data from the and of and diagnostic were to patients with a on as the Risk we patients as Our outcome was including mortality. outcomes were of and total We for to the between and Results: total patients, were as and as of patients to compared to of patients (P < 0.001). patients had more and and patients. patients had higher mortality rates vs P < of days vs P < and total vs P < 0.001). positive was associated with of Conclusions: In patients with is associated with including mortality patients with have of and total be to outcomes and clinical when in patients may be at risk for of on Patients A Pancreatic A. I. I. A. E. University of University, Background: and clinical The aim of this study was to the associated with outcome after pancreatic patients Methods: Patients a pancreatic between and were from the Risk and risk for were outcome was evaluated by the of and by the rate of Results: A total of patients were and a of the patients. The risk for was higher of the patients. The showed high risk of the patients. patients underwent a The mortality was and the mortality (P = and (P = were associated with the of the patients had in after associated with (P = Conclusions: The outcome of patients with performance is similar to The used were associated with the of The of and PDAC Patients E. B. B. A. G. G. University University, University of University San University, of Background: The aim of a pancreatic for pancreatic ductal adenocarcinoma (PDAC) is The of is on the The aim of this study was to the of on survival and PDAC patients were to a Methods: databases were for pancreatic for PDAC between and Patients with therapy were excluded. The was to the and and were on and treatment was The survival, to and metastasis was to the reported and Results: The study and patients. patients had an of and of showed that therapy and were associated with survival, with to and and with to of the patients had an of and of the showed that therapy and was associated with was associated with to and therapy and with to In was associated with survival was Conclusions: to play a role in the survival of PDAC patients with and of Patients With Adenocarcinoma In in of the K. S. G. E. A. M. B. Health, Background: The of and the of an in is Methods: We an institution study from to of patients with a of that had surgical We and data and clinical and to any with Results: patients with for an The was and the was were 9 patients had were and had a of A total of patients presented with imaging 11 and type were in the of the A was in patients, pancreatitis on imaging in and the pancreatic was The was was and 9 total was no significant in of cystic levels (P Patients with had of pancreatitis on imaging (P = and a pancreatic (P = in survival was patients vs P = Conclusions: patients with of pancreatitis and an pancreatic should for the of in Pancreatic A. A. A. University Background: are several in as pancreatic and have in after pancreatic is a novel associated with different of is in pancreatic and in acute has been to the of The aim of this study was to levels and after pancreatic Methods: patients to pancreatic for were and were were on one and and one Results: patients underwent a pancreatic The was in in and total in patients. patients pancreatic to a The rate of was and and was This was on and on and one However, between patients with and with comprehensive complication Conclusions: levels after pancreatic are one after pancreatic This may the and response of patients. of A Pancreatic Cancer P. G. P. S. P. S. K. A. S. S. of Nebraska Medical Center, Omaha, of Nebraska Omaha, Omaha, NE. Background: Pancreatic Cancer has maintained high to therapeutic identified have to a for this the The study the from to for with in and in to this Methods: to a were identified and the was for The of was in a was out The identified were a and were for tumor and studies. Results: for to showed a high of with an of up to in and a high apoptosis the of high and identified a significant in cell and a and of the of on a of was observed in at of a (P = in tumor at of and in with (P = was the be of the and tumor Conclusions: Our data that is a potential therapeutic for A and the of Pancreatic Adenocarcinoma M. K. A. Background: studies have pancreatic ductal adenocarcinoma (PDAC) on are the and by which and of respectively. However, cell lines commonly to study this are the of the PDAC in cell In this study, we to the of PDAC cell Methods: was on and cell The PDAC was on expression was Results: to the observed in the most of our were as In of the cell lines were as P < 0.001). comparison of and their cell lines out of of expression < and < in cell with a of In expression between and cell lines the of the cell lines is to the of the of a cell that was from a tumor when as a tumor in Conclusions: The of cell lines is to the of the in PDAC the the which are in may therapeutic to the of With Pancreatic in the Treatment of Pancreatic of of Inc., of M. of Background: is the of treatment for data on with are The aim of this was to and of Methods: of of Pancreatic Cancer and to chronic pancreatitis pancreatic pancreatic acute pancreatitis and were and in a was by and Results: no on and for on for chronic reported in of on = and of no on = no on to were to with no for and reported with any were to after and were it as reported be no reported reported of by their on were of Conclusions: to of reported in and when to after of patients were on for the are to to and of Chronic in by for M. P. S. of at of Health, of of of Background: Chronic pancreatitis (CP) is an of pancreas with no therapeutic is for We have that it of CP including in by in However, of action is The aim of this study was to evaluate of in of and to on in vitro. Methods: CP was by of of a and treatment was after of was with the treatment in were after Pancreatic and were In studies were on to evaluate on in with and for Results: treated without had significant in and were with the of action was with no increase in In of on in showed significant in levels of Conclusions: CP in by in as as in for by M. P. S. of at of Health, of of of Background: is no targeted for We have that in In the study we show that therapeutic action is from Methods: The of on of was in therapeutic in at in with after of were at the profile at a when the we at after for and and were used to evaluate the study was on on Results: Treatment with of in an dependent as it in with levels in the pancreas at a when the show a after on confirmed that treated In studies on with showed a significant increase in including on and a in at levels in Conclusions: treatment the of in by and in an and dependent of Chronic Pancreatitis: A Systematic Review and Meta-Analysis M. G. K. E. M.L. B. Medical University, of of PA; University Medical Center, University Medical Center, University Background: is the most common of chronic pancreatitis (CP) the of of patients are This systematic review aimed to the of CP. Methods: Embase, and of databases were for published studies that at patients with CP and which reported the of and CP. The of a of acute pancreatitis pancreatic and in the CP patients was A effects was used to pooled with 95% (95% Results: the studies identified and were in the were a total of patients with CP had CP. The pooled of CP was (95% CI, a of studies that reported = = = and = pooled were (95% CI, (95% CI, (95% CI, and (95% CI, respectively. Patients with CP underwent surgical = endoscopic = intervention in (95% CI, and (95% CI, respectively. Conclusions: 9 out of patients at the of CP. in studies is to treatment in the Pancreatic Cancer Tumor A. I. N. S. A. S. N. University of Background: A of therapeutic in pancreatic ductal adenocarcinoma (PDAC) is the of a and tumor microenvironment Our data the cell as a of and We to that in PDAC. Methods: tumor cells, with without were and were in in of evaluated effects on tumor cells inhibition of of the PDAC in Results: PDAC in PDAC in and in vs which was by higher of of and in vs confirmed of production in from tumors. on in was confirmed by of inhibition of the in and an in of and Inhibition of in and treatment in and as as vs and Conclusions: production in and a novel to therapeutic Risk to and of on Pancreatic Cancer in the A. of Medical Center, CA. Background: is an pancreatic risk are data on the of and on risk by the risk of pancreatic a is by of and Methods: We the of with pancreatic by and risk an risk in in the were between and at and duration were a We of pancreatic as a of and and We for effects of and on risk by and of pancreatic a different Results: an of of were pancreatic We no in the effects of (P = (P = by was associated with risk 95% CI, to to a (95% CI, risk in the between and pancreatic The risk a show the of when Conclusions: is associated with pancreatic and the by The risk to is by for The risk of pancreatic total and that is the most that a of Pancreatic Cancer Patients With and N. M. M. K. Medical Background: therapy with and to of and pancreatic (PDAC) the likelihood of of after remain unclear. Methods: Patients surgical with of after for PDAC were the CT from the of of of tumor and of the of the artery were Results: patients surgical with for after for PDAC were patients were with had positive CT at of diagnosis were evaluated for patients, and and were associated with a and risk of patients surgical patients were to = = and in CT at diagnosis were associated with a and risk of after of patients had were patients had and the risk of was Patients underwent had survival rates when compared to patients vs P < 0.001). However, patients with showed survival rates when compared to patients vs P = Conclusions: Novel of and at the of diagnosis after in PDAC patients. Patients with and with positive a poor prognosis. in of Pancreatic Cancer N. P. A. Medical Background: A in pancreatic ductal adenocarcinoma (PDAC) tumor and cell have been used to PDAC tumor a systematic of has been Methods: of in was expression of in the and expression was of was used to in the of and was to Results: identified in the of the four The = associated with The = is for of The = was and production and of cell were The = is in of cell and has been the were associated with a of with the were for the = of with in treatment response with tumor (P < in the inhibition of tumor (P = in the inhibition (P = in a of the and no on tumor (P = in a of the Conclusions: were identified in PDAC The of provides an to response to of Necrotizing A S. M. S. P. P. M. M. N. M. M. K. E. S. I. A. M. M. M. N. W. B. M. University Medical Medical Center Medical Center, University Medical Center, Medical Center University Medical Center, Medical Center Medical Center, Medical Center, Background: necrotizing pancreatitis is a treated by a with as outcome may be by early Methods: We conducted a in to is to in patients with necrotizing treatment with and within after patients were diagnosed with treatment with and aimed to the necrosis The was the of Results: In patients were to The was in the and in the (P = significant between the and was observed in the rate of and 95% CI, P = and and 95% CI, P = The of for necrosis was and (P < 0.001). The of was in days vs days P = and total days vs days P = In the patients were treated with with patients. Conclusions: in patients with necrotizing pancreatitis is to in With a including more of patients may be treated Monitoring of Pancreatic Cancer Patients by of A. M. P. A. University of Cancer Center, Houston, TX; Houston, Background: Circulating tumor DNA in is a diagnostic in In pancreatic (PDAC), is an for for of therapeutic response and Methods: in were by a targeted of This and and The for was was the and were in from 69 patients with PDAC had in were and 9 from patients were in the tumor was were with survival survival and response to therapy Results: A total of were at in patients and in patients after In patients without was higher after therapy compared to vs P < was an increase in after was P < were of patients at at in patients patients after The most were in and Patients with any had a shorter P < Conclusions: Our results the potential of a targeted in treatment and for PDAC patients. A of Artery in Pancreatic Cancer B. M. K. of Medical University, Background: study the of artery in patients with pancreatic ductal adenocarcinoma by Methods: patients with pancreatic ductal adenocarcinoma with on CT and were were evaluated with and were with on common artery were and reviewed and by tumor was on within which were and were Tumor to was Results: and patients were with of The tumor free to of and were and were were and respectively. The tumor free to was in that of vs = vs P = All were with was were (P = and (50%) were and and no was with the artery was and were and (P = Conclusions: as for The may the for a to for pancreatic of for in Pancreatitis: Systematic Review and W. W. University, of Medical Medical of of Medical and University of Background: is an in the treatment of acute pancreatitis and are as the most effective This systematic review and meta-analysis of aimed to the and of for in Methods: Embase, and were for in patients. The outcome was of for was ratio were a Results: studies patients were The the for 95% CI, and the at 95% CI, and at days 95% CI, treatment P < were associated with a significant in the for 95% CI, P = 0.03) without in and show significant in In were similar to 95% CI, P = were no significant in clinical outcomes and and to study Conclusions: and are effective in the for in patients. The of and data in this is is an Early in Pancreatic N. M. K. University, San Health, University Medical Center, Background: We have that results in cell has been in pancreatic from expression of by and expression of the The a by multiple by the of examine the and of in we conducted in multiple of PDAC. Methods: from and cell were at and of were from with without PDAC. was for general as as for cells cells cells and cells and lesions were was to examine expression was in and PDAC. Results: of with in and lesions the percentage of lesions more lesions from for in expression were identified in and PDAC. Conclusions: In and are most in and with as an early in in with and With in Patients to the B. S. S. Clinic, Rochester, MN. Background: of have pancreatitis and and multiple studies have identified levels in patients without clinical of has been in pancreatitis and provides of the potential of and outcomes in We aim to the profile and their in of patients with different as compared to patients. Methods: study in a 2020. patients to the were the were in the after Results: The study patients, of developed of IV was similar between the and and levels were higher in the and levels were to be in the were in the patients, including a higher percentage of higher of and higher of as therapy and were more in the Conclusions: We that patients had and in patients had and and more as compared to patients. In we that the of by and is associated with and which are characteristics of to Pancreatic Cancer University of Nebraska Medical Center, Omaha, NE. Background: The survival rate of pancreatic low at are the most commonly used to study The rate for anti-cancer is and a for that more have and to compared to This study on developing an to study Methods: surgical of the cells were and with of and = underwent = with and without = and = = of cells cells in the were after Results: of pancreatic cells in no tumor on review at had of with was of an response at the and more in The showed no of Conclusions: of pancreatic cells in no tumor at studies cell lines for and response of and on of in Patients With in a Center S. Background: The diagnosis of out of three the of and imaging with We aimed to study the of and in the diagnosis of Methods: All patients to the of with a of between and were in the The of patients were reviewed and initial imaging and diagnosis were The diagnosis of was as the Results: patients with were diagnosed with had and imaging of = = met met for diagnosis. were diagnosed with vs without imaging (P < Patients with had similar diagnosis vs with P = of was diagnosed in patients without on vs of patients with of type (P < 0.001). Conclusions: the patients with a diagnosis of have diagnostic criteria. is in patients with without in of imaging may be for diagnosis in patients with of has no on the diagnostic rate of patients with should have imaging may be when is associated of in Pancreatic Adenocarcinoma S.

Hali tarjima qilinmagan