were similar to the SUR-N and EUS-N groups (p> 0.05). Cause of AP (p¼0.06), infected necrosis (p¼0.13) and median time from onset of symptoms to treatment (p¼0.34) were similar for both groups. The Mar- shal (p<0.01) and CT Balthazar scores (p<0.01) were significantly higher for SUR-N. Acute adverse events were statistically significant for the EUS-N vs SUR-N (71% vs 37%, p<0.01). Despite the occurrence only in SUR-N group of sepsis, post-operative hernia, bowell obstruction, pneumonia, fistula (pancreatic and biliary) and chylous ascites there was no statistical dif- ference compared to EUS-N group. The late adverse events were statisti- cally significant for patients undergoing SUR-N vs EUS-N in relation to bowell and biliary obstruction (21% vs 0%, p¼0.04 and 27% vs 0%, p ¼ 0.01, respectively) and required surgery (36% vs. 8%, p¼0.02, respectively). The average follow-up was 493 days, there was no difference between patients who underwent SUR-N and EUS-N in relation to pancreatic sequelae, including pseudocyst (p ¼ 0.62), cases of onset diabetes (p¼0.31) or need for pancreatic enzymes (p¼0.29). Conclusion: Compared to SUR-N, the EUS-N showed a lower rate of adverse events. EUS-N appears to be a safe and effective procedure must be included in the therapeutic algorithm patients with WOPN. 0184. Validation of modified determinant-based classification of severity for acute pancreatitis in a tertiary teaching hospital Dong Wu 1 , Bo Lu 1 , Hua-dan Xue 2 , Hong Yang 1 , Jia-ming Qian 1 , Peter Lee 3 , John Windsor 4 1 Department of Gastroenterology, Peking Union Medical College Hospital, China 2 Department of Radiology, Peking Union Medical College Hospital, China 3 Department of Gastroenterology & Hepatology, Digestive Disease Institute, Cleveland Clinic, United States 4 Department of Surgery, The University of Auckland, New Zealand Introduction: The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC ‘severe’ category into two groups, the MDBC classified non-mild acute pancreatitis into 4 groups rather than 2 in RAC and 3 in DBC. Aim: In this study we aim to validate MDBC in both ICU and non-ICU patients and evaluate infected necrosis as a determinant of severity. Method: An exploratory analysis of an existing database was per- formed including consecutive patients admitted to a tertiary teaching hospital. Patients were assigned to the categories of severity defined by the DBC, RAC and MDBC. Clinical interventions and outcomes were compared between categories. Results: A total of 1120 patients were enrolled and the overall mortality was 5.6%. When MDBC was applied, the four Groups were significantly different in regards ICU admission rates (32%, 37%, 69% and 84%) and mortality (2%, 12%, 39% and 61%). Groups 2 and 3 were different in regards intervention rates and morbidity, providing evidence that IN as an important determinant of severity. Conclusion: This study validates the MDBC proposal to subdivide the DBC ‘severe’ category into two groups for ICU and non-ICU patients in a tertiary hospital. 0185. Open necrosectomy in acute necrotizing pancreatitis: Experience in a fourth level hospital Leidy Juliana Puerto, Rolando Medina Rojas, Juan Felipe Sanjuan Marin Universidad Surcolombiana de Neiva, Colombia Introduction: Pancreatic necrosis as a complication of acute pancrea- titis is associated to a high mortality rates, and its actual treatment is focused in the pancreatic necrosectomy through minimun invasive pro- cedure due to its minor incidence rates of mayor complications and mortality. Aim: Identify the morbimortality of treatment in necrotizing pancre- atitis through open surgery in a fourth level hospital. Background: In 2012, B. BELLO y J. MATTHEWS publish in the World Journal of Gastroenterology, a literature review including two retrospec- tive studies with a total of 29 patients, in which mínimum invasive man- agement for necrosectomy showed a 79% successful rate with a 10.3% mortality. Method: A descriptive retrospective analysis of patients with severe acute pancreatitis related to pancreatic and peripancreatic necrosis that had open pancreatic necrosectomy surgery from 2008 to 2016. Results: 26 patients were admitted with a diagnosis of a pancreatic and peripancreatic necrosis, 6 patients were excluded from the study for not having access to their clinical history. The study included 20 patients out of which 13 (65%) died and 7 (35%) survived with sec- ondary severe comorbilities including intrabdominal collection, pancreatic fistula, enterocutaneous fistula, open abdomen, pancreatic pseudocyst. Discussion: in our study we found a 65% mortality rate which compared to 3-10% rates reported in the literatura is very high. This in- dicates the importance and need of implementing other surgery ap- proaches to treat this type of pathology. Conclusion: Pancreatic necrosectomy by laparotomy in our hospital has highest morbimortality rates compared with the described in world wide literature, for this reason the implementation of mimimum invasive protocoles are recomended. 0186. Chronic pancreatitis. A propose of a case with low clinical expression Patricia Alejandra Lopez Penza, Ruso Luis Hospital Maciel, Clinica Quirúrgica “3”, Uruguay Introduction: Chronic inflammatory disease of the pancreas, slow and irreversible that determines fibrosis of the parenchyma, with consequent loss of functional tissue and in advanced phases exocrine and endocrine insufficiency of the gland. Aim: A clinical case of chronic pancreatitis of alcoholic etiology is analyzed. Outstanding pathology in our country (Uruguay) with low clinical expression. Method: Case report: Man 52 years old, smoker and heavy alcoholic (3 liters wine / day). Consultation for abdominal colic pain in the right hypochondrium with irradiation to the back, after ingestion of fatty foods .It denies pigmentary syndrome. No fever. To the examination: no jaunice. Right abdominal upper pain. Abdom- inal ultrasound: 36 mm cephalic portion of the pancreas, a lot of calcifi- cations. 9.7 mm Wirsung duct with intraluminal lithiasis. No gallblader lithiasis. Choledoco with standard caliber. Amylasemia: 711 (U/L). Liver function tests and calcemia: normal. Abdominal CT: peri-inflammatory pancreatic fat with no collections. Good evolution based on medical treatment. In the absence of pancreatic dysfunction. Discussion: Exceptional pathology in our environment and closely related to alcoholism, of initial imaging diagnosis (calcifications of the pancreatic parenchyma) without significant clinical expression. In its evolution it is manifested by repeated episodes of acute pancreatitis. This patient has two major complications: stenosis of the Wirsung's duct with formation of intraluminal lithiasis. of interest is the absence of association between severe structural alterations of the pancreas and the endocrine and exocrine functionality that is conserved. Abstracts / Pancreatology 17 (2017) S1eS68 S37