Introduction

PNET is an important determinant of survival in MEN1 patients and the most important cause of MEN1-related death. Early identification of pNETs in MEN1 is important since these represent a common cause of morbidity and mortality of the syndrome. Prognosis is associated with tumour size. Many pNETs are small subcentimetre lesions and only become symptomatic when the tumour is large. Conventional radiology is usually suboptimal in detecting small tumours (< 2cm), thus missing the window to remove them at an earlier stage. We aim to compare EUS detection of pNETs in patients with confirmed MEN1 compared to cross-sectional imaging including CT and/or MRI pancreas and assess the incremental benefit of EUS.

Aims & Methods

Over a span of 7 years, a total of 20 patients with clinically confirmed MEN1 had surveillance of pNET performed with EUS, CT/MRI and biochemical screening. Data were retrospectively retrieved from the hospital electronic records database. EUS and CT/MRI done within 3-6 months of each other were compared to minimize discrepancy in findings due to pNET size progression and new lesions over time. Statistical analysis was performed using SPSS v20 on the size and number of pNET detection by EUS and CT/MRI using the Wilcoxon Signed Rank Test and McNemar Chi-square.

Results

A total of 28 EUS procedures and an equal number of cross sectional imaging (CT/MRI) were performed. pNETs were identified in 95% of all 20 MEN1 cases. Overall median pNET size was 7.1mm on EUS and 14.5mm on CT/MRI (p=0.007). Mean value for smallest PNETs detected by EUS was 4.6mm and 12.7mm on CT/MRI (p=0.001). EUS detected more pancreatic lesions/pNETs compared to CT/MRI (p<0.001) in 25 of the 28 procedures (89.3% more). The remaining 3 procedures showed equal numbers of pNETs detection by both modalities. The interquartile range (IQR) for smallest pNET detected by EUS was 3.0-5.0mm while IQR for CT/MRI lies between 8.3mm-14.8mm. EUS detected all 100% cases of pNETs in our series of MEN1 compared to CT/MRI imaging alone which detected 57.9% cases (p=0.008). 14 of 20 patients had FNA performed with a positive yield of 85.7%. In 50% of patients, pNET measured ≤10 mm. 45% of patients underwent surgery for pNETs while the rest had surveillance.

Conclusion

In MEN1 patients, CT/MRI underestimated the presence of pancreatic lesions/pNETs in 42.1% compared to EUS (p=0.008) and was not able to identify pNETs < 8mm in all but one case.
EUS offers higher sensitivity than cross sectional imaging (CT/MRI) in terms of detecting the number of positive pNET cases as well as a greater number of pancreatic lesions especially subcentimetre lesions in MEN1. EUS should be considered a standard tool in the algorithm for MEN1 workup, instead of an adjunct reserved for diagnostic dilemmas.

References

NCCN Guidelines 2015 version 1.2015 Neuroendocrine Tumours.

Introduction

Acute pancreatitis (AP) is an inflammatory disorder that causes a considerable economic health burden. While the majority of AP shows a mild clinical course, about 10% of patients have moderate or severe disease with major local and systemic complications and a prolonged hospital stay. Still there is a lack of early biomarkers of severity while multiple complicated scoring systems fail to predict the course of disease. Here, we aim to investigate the role of the microbiome to predict the course of AP at admission.

Aims & Methods

In 16 European centers buccal and rectal swabs were collected from 450 AP patients within the first 72h of hospital admission. All samples were sequenced with Oxford Nanopore Technologies. Primary endpoints are the association of orointestinal microbiome with revised Atlanta classification and severity. Secondary endpoints are the association with mortality and length of hospital stay.

Results

In total, 832 samples from 424 patients were sequenced, 26 patients met exclusion criteria. After normalization of microbial data 409 buccal samples and 391 rectal samples remained for subsequent analysis. Significant differences were observed in beta diversities for rev. Atlanta classification (Bray Curtis, p-value 0.009**), severity (Bray Curtis, p-value 0.008**), mortality (Bray Curtis, p-value 0.006**) and length of hospital stay (Bray Curtis, p-value 0.043*) in rectal but not buccal swabs. Notably, these results remain significant after factoring in 74 potential confounding variables such as alcohol consumption, smoking status, and antibiotics. No differences were observed in alpha-diversity. Classifier for severity was built with different abundant taxa achieving an AUROC of 80%.

Conclusion

The rectal but not oral microbiome has the ability to predict the course of acute pancreatitis at admission of the patient.

Introduction

Work-life integration is a critical issue many individuals face in the workforce, particularly in professions with high demands, such as healthcare. Physicians, in particular, experience significant challenges in managing their professional and personal lives due to long work hours, unpredictable schedules, and the emotional toll of caring for patients. The resulting work-life conflicts can negatively impact their well-being, job satisfaction, and patient care. Despite recognizing this issue, there is still a lack of research on the extent of work-life conflicts and their effects on physicians.

Aims & Methods

We distributed a voluntary and anonymous survey via e-mail to all members of the German Society for Digestive and Metabolic Diseases (DGVS - Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen). Sociodemographics and data on parental status, number of children, and used support structures were gathered. The Work-Family Conflict Scale (ISSP) was used to measure the compatibility of family and job. Query logic branched depending on responses, and single and multiple-choice questions were used, as well as Likert scales.

Results

At the point of this interim analysis, 586 respondents finished the survey and were included for statistical analysis. Of the respondents, 45% were women, 71% were parents, and 60.3% had children living in the household. The mean age was 47 years (SD 11,0). In most cases, respondents lived with a working partner (93%), with male respondents more likely to have a stay-at-home partner (8,9% versus 2,9%). A corresponding trend was observed in partners working part-time (Overall: 41.5%. Partners of male physicians 58,9%, partners of female physicians 17,2%). In the ISSP, there were high levels of work-life conflict (scale 1-4, average work/life 3,06 life/work 1,79). Female respondents reported statistically significantly higher work/life, but only numerically higher life/work conflicts than male respondents. (work/life 3,18 versus 2,94, p ˂ 0.001; life/work 1,88 versus 1,77 p = 0.080; two tailed Chi Square). Parents were affected significantly more often by work-life and life-work conflicts.

Conclusion

This study provides valuable insights into the challenges faced by physicians in balancing their professional and personal lives. Finding ways to manage work-life conflicts and maintain a healthy balance is critical for the well-being and longevity of physicians, as well as the quality of care they provide to their patients. Healthcare employers should support their employees in achieving a satisfactory work-life balance.