S150 Poster presentations

in DG and SG were 257 and 207 IU/l, respectively (p = 0.044).Median TRACP-5b in DG and SG were 484 and 372 mU/dl,respectively (p = 0.064). 1,25(OH)2D in DG and SG were 70.8and 59.1 pg/ml, respectively (p = 0.044).Conclusion: Bone density of the patients receiving TG showedthe lowest level of all. Bone disorder in PG and SG were mildcompared with TG and DG, respectively. PG for the upper-third and SG for the middle-third gastric cancer would befavorable procedures for bone metabolism.

Disclosure of Interest: None Declared.

PP054-MONVITAMIN D AND VITAMIN B12 DEFICIENCIES ARE COMMON INPATIENTS WITH MIDGUT CARCINOID, BUT CAN BE IMPROVEDBY SUPPLEMENTATIONA. Lind1, B. Wangberg2, L. Ellegard1. 1ClinicalNutrition,2Surgery, Sahlgrenska University Hospital, Gothenburg,Sweden

Rationale: Patients with disseminated midgut carcinoidmight face malnutrition by diarrhoea, surgical and medicaltreatment; leading to malabsorption of bile salts, fats,vitamin B12 and fat-soluble vitamins. We assessed nutritionalstatus in 25 patients and subsequently tested supplementationof vitamin D, calcium and vitamin B12 in another 25 patientswith midgut carcinoid.Methods: 50 consecutive outpatients, 25 patients in eachpart, (23 men and 27 women) were assessed by clinicalchemistry and by DXA. Medium age was 68 years (50 83) andmedium BMI: 24.5 (16.5 36.5). Vitamin D status <25nnmol/Lwas defined as severe deficiency, <50 as moderate, <75 asinsufficient. INR �1.2 was classified as vitamin K deficiency,B12 <140pmol/L and calcium <2.15mmol/L. Differencesbetween groups were analysed by t-test and results presentedas mean (SD).Results: Supplementation with vitamin D and B12 increasedserum levels of 25-hydroxy vitamin D and B12. Meanserum vitamin D level was 50±28nmol/L in part 1, and70±29 in part 2 (p = 0.019). Mean serum vitamin B12 was402±396pmol/L in part 1, and 734±333 in part 2 (p = 0.002by).

Table: Vitamin D, K, B12 and bone density (% prevalence) in out-patients withmidgut carcinoid

Part 1 (n = 25)Withoutsupplements

Part 2 (n = 25)With recommendedsupplements

Severe vitamin D deficiency (<25) 29 a 0INR (�1.2) 22 b 9 b

B12 (<140pmol/L) 32 c 0Calcium (<2.15mmol/L) 20 0Low bone density (< 1.0 SDS) 76 60

a Patient on vitamin D supplement excluded, n = 24.b Patients on ant-vitamin K excluded, n = 23/22. c Patients on vitamin B12excluded, n = 19.

Conclusion: Low serum levels of vitamin D and B12, and lowbone density are common in patients with midgut carcinoid.Supplementation of vitamin D, B12 and calcium improve serumlevels and is thus recommended as a standard procedure.

Disclosure of Interest: None Declared.

PP055-MONRECOVERY OF NON-PROTEIN RESPIRATORY QUOTIENT ANDHEALTH RELATED QUALITY OF LIFE AFTER LIVING-DONORLIVER TRANSPLANTATIONH. Yamanaka-Okumura1, K. Sugihara1, M. Yamamoto1,Y. Taketani1, T. Ikemoto2, Y. Morine2, S. Imura2, M. Shimada2,E. Takeda1. 1Department of Clinical Nutrition and FoodManagement, 2Department of Digestive and PediatricSurgery, Institute of Health Bioscience, Tokushima, Japan

Rationale: The nutritional state of living donor liver transplan-tation (LDLT) recipients is one of the most important factorsaffecting post-operative outcome. The assessment of health-related quality of life (HRQOL) is of increasing importance,few studies have examined this in conjunction with LDLTrecipient nutritional state.Methods: Ten LDLT recipients with end-stage liver diseasewere recruited for this study. Measurements of resting energyexpenditure (REE), non-protein respiratory quotient (npRQ),anthropometrics, and laboratory data were performed beforeand 1, 6, and 12 24 months after LDLT. HRQOL was measuredby using Short-Form (SF-36) before and 1, 3, 6, and12 24 months after LDLT.Results: The preoperational value of npRQ was 0.796±0.026and it increased significantly after the operation. Serumnon-esterified fatty acid (NEFA) levels were high in thepreoperative state, but had significantly decreased one monthafter the operation. A negative correlation between npRQand NEFA was observed throughout the study period. ChEand Alb levels improved to normal levels within 6 and12 24 months, respectively. The recovery of the physicalcomponent summary (PCS) of the SF-36 was observed afterthe improvement of all domains of laboratory data and energymetabolism based on the nutritional state.Conclusion: The findings revealed that improvement ofnutritional metabolism after LDLT may require 4 weeks. Thisstudy demonstrated that the recovery of metabolic function,laboratory data, and HRQOL in LDLT recipients are variable,and it took more than 6 months to normalize the liverprotein synthetic capacity and physical HRQOL score periods.Therefore, long-term nutritional support is required in LDLTrecipients.

Disclosure of Interest: None Declared.

PP056-MONNUTRITIONAL STATUS AND ITS IMPACT ON OUTCOMES OFPATIENTS WITH CIRRHOSIS ADMITTED TO HOSPITALC. Bunchorntavakul1, R. Supanun2. 1Gastroenterology andHepatology, 2Internal Medicine, Rajavithi Hospital, Bangkok,Thailand

Rationale: Nutritional status is an important predictor ofclinical outcomes in cirrhotic patients. However, few studiesregarding this issue have been conducted in Asia.Methods: This prospective non-interventional study wasconducted at a tertiary center, Rajavithi Hospital, Bangkok,between Aug 2013 and Feb 2014. Nutritional status wasassessed by subjective global assessment (SGA) and midarm circumference (MAC). Malnutrition was defined as SGAclass B/C and MAC <5 percentile of matched population.Results: A total of 60 patients were included; 70% weremale and the most common cause of cirrhosis were alcohol

Liver and gastrointestinal tract S151

(50%) and hepatitis C (35%). Most patients were classifiedas Child-Pugh class B (41.7%) and C (36.7%). The hospitalmortality was 26.7% and the most common complicationswere infections (60%) and renal failure (43.3%). The medianhospital length of stay was 8.5 (1 51) days with the mediancost of 1,164 (183 9,969) US$. The prevalence of malnutritionvaries between 18 92% according to the assessment methods;18% by BMI, 63% by MAC, 78% by serum albumin, and92% by SGA. There was a significant correlation betweennutritional assessments by MAC, SGA, BMI, and albumin(p < 0.05). Cirrhotic patients with malnutrition had trendtoward increased mortality, complications, hospital stayand cost, however, there was no statistical significance.The significant predictors of hospital mortality were Child-Pugh class B (16% mortality) and C (50% mortality), severemalnutrition defined as SGA class C (35% mortality), presenceof ascites (2.3 folds), hepatic encephalopathy (2.5 folds), andrenal failure (3.3 folds).Conclusion: Malnutrition is common in cirrhotic patientsadmitted to hospital and is associated with a trend towardincreased complications and mortality. Severe malnutritionidentified by SGA and advanced stage of cirrhosis werepredictors of hospital death.

Disclosure of Interest: None Declared.

PP057-MONRESULTS OF ERAS PROTOCOLS IN COLORECTAL SURGERYR. Haldun Gundogdu1, P. Eren Ersoy1, S. Akbaba1,O. Yazicioglu1, T. Sayin1, O. Nasrullayev1. 1General Surgery,Ataturk Egitim Arastirma Hastanesi, Ankara, Turkey

Rationale: Since the protocols of enhanced recovery aftersurgery (ERAS) have been used, particularly the results ofcolorectal surgery improved significantly. The ERAS protocolssuggest evidence based current variations instead of conven-tional practice. We have been carrying out the protocols inmost of the colorectal surgery cases since 2006 in our clinic.In this study, we aimed to investigate the effect of ERAS on;the length of stay, oral intake and, gastrointestinal tolerance.Methods: We included 115 colon and 39 rectum operations,which were performed consecutively according to ERASprotocols. For all patients, the length of stay, the timingof oral intake, gastrointestinal tolerance, morbidity and,mortality were recorded.Results: All components of ERAS were applied fort the pa-tients. Patient concordance was 83.1%. All patients’ receivedwater orally in 16 hours after the operation. The meantime for food intake orally was 34 hours for colonic surgeryand 30 hours for rectal surgery. Only in 5 patients, oralintake was halted because of gastrointestinal intolerance. Themean time for length of stay for the uncomplicated patients(n = 121) was 7.1 days. However 98% of those patients had nocontraindications for discharge on the postoperative 5th day.Conclusion: The ERAS protocols provided early oral intake incolorectal surgery. The rates of gastrointestinal tolerance aremuch better than the ones in the literature. The reason forthe insignificant decrease in length of stay may be explainedby some social reasons; most patients were from other cities,and they showed resistance for discharge. In consequenceof this study, we concluded that ERAS protocols for electivecolorectal surgery is applicable on trust and decided tomaintain the procedure.

References[1] Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for

Perioperative Care in Elective Colonic Surgery: Enhanced RecoveryAfter Surgery (ERAS®) Society Recommendations. World J Surg.2012 Feb; 37(2): 259 84.

Disclosure of Interest: None Declared.

PP058-MONNUTRITIONAL ASSESSMENT IN PATIENTS WITH CIRRHOSIS:COMPARISON BETWEEN VARIOUS METHODSK. Chanpiwat1, C. Bunchorntavakul1. 1Gastroenterology andHepatology, Rajavithi Hospital, Bangkok, Thailand

Rationale: Malnutrition is an important prognostic factoramong patients with cirrhosis. However, there are severallimitations of conventional assessment methods in this pop-ulation. This study was aimed to determine the performanceof various nutritional assessment methods in patients withcirrhosis.Methods: This cross-sectional study was conducted at Ra-javithi Hospital, Bangkok, Thailand, between Oct 2013 andJan 2014. Patients with cirrhosis at outpatient clinic wereassessed for their nutritional status several methods includingsubjective global assessment (SGA), anthropometry (bodymass index, triceps skinfold thickness and mid-arm musclecircumference; MAMC), hand grip strength dynamometry(HGS), and bioelectrical impedance analysis (BIA). Malnutri-tion was defined by standard cut-point for general populationof each method. Patients with hepatocellular carcinoma,overt encephalopathy, and severe other comorbidities wereexcluded.Results: Eighty-five patients were evaluated, 54% were maleand the mean age was 54.4±11.6 years. Most patientswere Child-Pugh class A (80%) and the common etiologiesof cirrhosis were hepatitis B (35%), hepatitis C (27%), andalcohol (21%). The prevalence of malnutrition was variedaccording to the assessment methods used; 44.7% by SGA,51.8% by MAMC, 36.5% by HGS, and 15.3% by BIA. Therewas a strong correlation between skeletal muscle massmeasured by BIA and MAMC (k = 0.4036, p < 0.0001); and HGS(k = 0.736, p < 0.0001). SGA showed slightly agreement withHGS (k = 0.298, p < 0.05); and BIA (k = 0.291, p < 0.05).Conclusion: Although the prevalence is varied accordingto the assessment methods used, malnutrition is relativelycommon (15 52%) in patients with cirrhosis even in those withChild-Pugh class A. Among various methods, MAMC appearsto be simple, highly sensitive and correlated with skeletalmuscle mass. Therefore, it can be used as a screening toolfor malnutrition in cirrhosis.

Disclosure of Interest: None Declared.