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Background The 2018 Tokyo Guidelines (TG18) recommend urgent endoscopic biliary drainage based on acute cholangitis (AC) severity. Therefore, we evaluated the safety and mortality benefits of urgent endoscopic retrograde cholangiopancreatography (ERCP) in different age groups. Methods Using International Classification of Diseases‐10 (ICD‐10) codes, we sampled adult AC patients from National Inpatient Sample. TG18 definition of cholangitis severity was used to identify patients with severe and nonsevere (mild or moderate) AC. Age categories were 18–64, 65–79, and 80 and above. Multivariate linear or logistic regression was used as appropriate. We used Stata, version 14.2, to perform analyses considering two‐sided p < .05 as statistically significant. Results Among 137 100 patients, there were 93 365 (68.09%) patients with nonsevere cholangitis and 43 735 (31.91%) patients with severe cholangitis. Urgent ERCP (within 24 h) resulted in decreased mortality in all age groups for both severe and nonsevere AC. Post‐sphincterotomy bleeding was more common in patients ≥80 years of age, whereas post‐ERCP acute cholecystitis was more common in patients 65–79 years. The rates of post‐ERCP pancreatitis, bile duct perforation, and duodenal perforation did not differ among the age groups. In addition, there were no differences in the rate of sedation‐related complications between different age groups who underwent urgent ERCP. Conclusion This study demonstrates the mortality benefit from urgent ERCP for AC in different age groups and describes the safety of performing urgent ERCP in patients of various ages. Therefore, we recommend that urgent ERCP be performed according to the TG18 guidelines regardless of age.

Multiple myeloma (MM) is characterized by malignant proliferation of malignant plasma cells; it is the second most common hematological malignancy associated with significant morbidity. Genetic intricacy, instability, and diverse clinical presentations remain a barrier to cure. The treatment of MM is modernized with the introduction of newer therapeutics agents, i.e., target-specific monoclonal antibodies. The currently available literature lacks the benefits of newer targeted therapy being developed with an aim to reduce side effects and increase effectiveness, compared to conventional chemotherapy regimens. This article aims to review literature about the current available monoclonal antibodies, antibody-drug conjugates, and bispecific antibodies for the treatment of MM.

e16283 Background: The prevalence of depression ranges from 33% to 45% in pancreatic cancer, the highest among gastrointestinal malignancies. Psychiatric illnesses impact the quality of life and compliance with treatment and regular physician visits. Therefore, we sought to examine ethnic differences in the prevalence of depression and anxiety in pancreatic cancer. Methods: We investigated the National Inpatient Sample 2019 employing International Classification of Diseases-10 (ICD-10) codes to include adult patients with pancreatic cancer. Multivariate linear or logistic regression was used (for continuous and categorical variables, respectively). The confounders adjusted for in the regression models were: history of MI and stroke, coronary artery disease, sleep disorders, chronic pain disorders, smoking, alcohol, obesity, PTSD, sexual abuse, arthritis, and physical disability, in addition to patient and hospital-level variables. We used Stata, version 14.2, to perform analyses considering 2 sided P < 0.05 as statistically significant. Results: A total of 116,055 patients with pancreatic cancer were included. 13,825 (11.91%) had depression and 16,845 (14.51%) had anxiety. The prevalence of depression in various ethnic categories was: 13.63% in Whites, 7.59% in Blacks, 8.47% in Hispanics, and 5.63% in Asians ( P< 0.001). Anxiety prevalence was: 16.25% in Whites, 9.92% in Blacks, 11.65% in Hispanics, and 7.29% in Asians ( P< 0.001). On multivariate analysis, compared to Whites, all ethnic groups had lower odds of depression (Blacks; adjusted odds ratio (aOR): 0.45, 95% confidence interval (CI): 0.38–0.52, P< 0.001, Hispanics; aOR: 0.60, 95% CI: 0.49–0.73, P< 0.001, Asians; aOR: 0.43, 95% CI: 0.31–0.59, P< 0.001). Similar results were seen for anxiety when ethnic groups were compared to Whites (Blacks; aOR: 0.49, 95% CI: 0.43–0.56, P< 0.001, Hispanics; aOR: 0.67, 95% CI: 0.55–0.82, P< 0.001, Asians; aOR: 0.44, 95% CI: 0.33–0.59, P< 0.001). Conclusions: Whites had the highest burden of depression and anxiety in pancreatic cancer. However, Hispanics represented the ethnic minority with a greater prevalence of psychiatric disorders. Further research needs to establish the factors responsible for these ethnic differences.[Table: see text]

e19530 Background: Immunotherapy with chimeric antigen receptor T (CAR-T) cells has proven effective in recent trials for patients with B cell malignancies, who relapsed after stem cell transplantation. Genetically modified allogeneic CAR T-cells used in advanced B cell malignancy engage with multiple target allo-antigens along with CD19 and/or CD20, leading to elimination of malignant B cells resulting in a potent graft versus malignancy effect with avoidance of tumor escape. Some concerns regarding their use exist like life-threatening graft-versus-host disease (GVHD) and rapid clearance by the host immune system. This study summarises the efficacy and safety of allogeneic CAR-T therapy in B cell malignancies. Methods: A systematic literature search was conducted on PubMed, Embase, Cochrane and Clinicaltrials.gov from inception to Jan 26, 2022, using MeSH terms and keywords for B cell malignancies and CAR-T therapy. We also screened the data presented in various conferences and handpicked references from previous systematic reviews. Outcomes of interest were complete remission (CR), 1-year overall survival (OS), GVHD, cytokine release syndrome (CRS), and immune effector cell associated neurotoxicity (ICANS). Proportional outcomes were pooled using a random effects model (Freeman-Tukey double arcsine transformation) in OpenMetaAnalyst software. Results: The initial search retrieved 1247 articles. After excluding reviews, duplicates and non-relevant articles, we included data from 9 clinical trials (n = 146 patients). The most common malignancy was acute lymphoblastic leukemia (125 patients, 86%). The median age of patients ranged from 19 to 49 years. All patients received CD19 targeting therapy and the cell dose administered ranged from 0.4×10^6 to 5×10^8 cells/kg. CR was reported in 93 of 146 patients, with a pooled rate of 63% (95% CI 47.4 - 78.6%; I2 78.5%). The pooled 1-year OS was 57.3% (95% CI 30.8 - 82%; I2 79.2%). The pooled proportion of GVHD was 9.4% (95% CI 3.1- 15.6%; I2 47.6%). The pooled CRS and ICANS rates were 59.3% (95% CI 30.5 - 88.1%; I2 95.2%) and 15.4% (95% CI 4.6 - 26.3%; I2 72.7%), respectively. Conclusions: Allogeneic CAR-T therapy has demonstrated acceptable efficacy and safety in B cell malignancies, with CR being reported in about 60% of patients and GVHD in < 10% of patients. Although allogeneic CAR-T cells are showing promise, several trials are ongoing and we need longer follow up.[Table: see text]

Background The data on racial epidemiologic trends for acute cholangitis (AC) are scarce. Therefore, we conducted a longitudinal assessment of the racial breakdown of AC-related hospitalizations in the United States (US) over 11 years (2008-2018). Methods Using the National Inpatient Sample, we retrieved adult (>18 years) patients with AC. The adjusted yearly hospitalization rate per 100,000 for each race category was calculated based on the US population estimate for July 1 of the corresponding year obtained from the US Census Bureau. We followed Healthcare Cost and Utilization Project recommendations to: (1) derive a time-interrupted trend (before and after 2015), after determining that the International Classification of Diseases coding change affected AC hospitalizations because of more specific coding in the tenth revision; and (2) generate proportionate estimates using revised trend weights. Results A total of 321,849 patients with AC were included in the analysis. Before 2015, the overall hospitalizations (per 100,000 persons) increased from 16.03 in 2008 to 20.76 in 2014 (P<0.001). Following 2015, the overall hospitalizations increased from 14.34 in 2016 to 14.70 in 2018 (P=0.04). After Whites, Asians represented the ethnic group with the highest race-specific AC hospitalizations per 100,000 persons. Conclusions This cohort study demonstrated an overall rising and disproportionate rate among different races for AC-related hospitalizations. Even though Asians constitute only 6.5% of the US population, they represent the ethnic minority with most hospitalizations for AC.

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e16138 Background: Cholangiocarcinoma is a malignancy associated with poor survival and outcomes. Structural abnormalities causing bile duct obstruction frequently lead to superimposed acute cholangitis (AC). We evaluated the impact of AC on hospitalized patients with cholangiocarcinoma. Methods: We investigated National Inpatient Sample 2019, employing International Classification of Diseases-10 (ICD-10) codes to include adult patients with cholangiocarcinoma. Analyses were performed using STATA (v 14.2), considering 2 sided P< 0.05 as statistically significant. Proportions were compared using Fisher exact test and continuous variables using Student’s t-test. Confounding variables were adjusted using multivariate logistic and linear regression analyses and included: gender, race, Charlson Comorbidity Index (CCI) score, median household income for patients’ zip codes, hospital location/region/ bedside, and insurance status. Results: A total of 36,900 patients were included in the analysis. Of those 15.26% (5,630) had AC on presentation (Table). Concomitant AC was associated with a higher adjusted length of stay (LOS) by 1.78 days and hospitalization cost by 3,028 USD in cholangiocarcinoma patients ( P< 0.01). There were higher adjusted odds of acute renal failure (Adjusted odds ratio (aOR) 1.31, P< 0.01) and lower odds of aspiration pneumonia while hospitalized in AC patients (aOR 0.37, P< 0.01). ERCP represented the primary technique of biliary drainage. No disparities were seen between the two groups undergoing ERCP or cholecystostomy tube, which resulted in comparable mortality trends ( P> 0.05). Rates of acute respiratory failure, mechanical ventilation, ICU admission, cardiac arrest, and sepsis were not different between the two groups ( P> 0.05). Conclusions: Unbiased and comparable biliary drainage via either ERCP or cholecystostomy resulted in observing no mortality differences between the two groups. However, superimposed AC in cholangiocarcinoma patients results in higher LOS driven by acute renal failure.[Table: see text]