Su1491 THE EFFECT OF STATINS ON RATE OF GROWTH, MALIGNANT TRANSFORMATION AND SURGICAL INTERVENTION OF PANCREATIC CYSTS: A 10-YEAR FOLLOW-UP STUDY Motasem Alkhayyat, Mohannad Abou Saleh, Ashraf AlMomani, Alaa Habash, C. Roberto Simons-Linares, Achintya D. Singh, Charles Martin, Toms Augustin, Robert Simon, R Matthew Walsh, Prabhleen Chahal Background and Aims: The anti-inflammatory effects of statins are increasingly being recognized with few studies demonstrating a possible chemo preventative role of statins. There is scarcity of data on the effect of statin on pancreatic cysts (PC). In this study we aim to examine the effects of statins on the rate of growth, high-risk transformation, and surgical intervention of PC over a 10-year period. Methods: A cohort study of a prospectively maintained database of patients with abdominal imaging (MRI, CT) findings of PC from 2008-2018 was conducted. Patients older than 18 without a history of pancreatic surgery or cancer, with a 10-year follow up and data on initial diagnosis were included. Patients with statin use were identified and compared to non-statin users. Outcomes were measured at 1,3,5, and 10 years. These included increased growth (size), surgical intervention and high-risk transformation (dysplasia or malignant cells on cytology or pathology, new commu- nication with pancreatic duct (PD), new dilation of main PD, change in size of previous dilation, extension of cyst location, cyst>=3 cm, new thickened enhanced cyst wall, new non-enhanced mural nodule, new distal pancreatic atrophy, new abrupt change in main PD size, new lymphadenopathy). Kaplan-Meier estimates and Cox proportional hazards models were used for time to high-risk transformation and surgery. Mixed effect logistic regression models were used to evaluate rate of growth overtime. Univariable and multivariable analyses were used to evaluate significance of selected predictors of measured outcomes after adjusting for age, gender, race, alcohol, smoking, charlson comorbidity score, BMI and NSAID/aspirin use. Results: Of the 1,000 patients evaluated, 686 met the inclusion criteria. There were 80% IPMNs (97.2% side branch) and 2.2% mucinous cystic neoplasms. There were 316 patients on statin (46.06%). Baseline characteristics are presented in Table 1. In univariable analysis, statin use was associated with reduced rate of high-risk transformation [HR: 0.84; 95% CI: 0.43-1.65; p=0.61], minimal effect on risk of surgery [HR: 0.97; 95% CI: 0.56- 1.68; p=0.92] and minimal risk of increased growth [HR: 1.03; 15% CI: 0.88-1.50; p=0.32] compared to non-statin users. In multivariable analysis, statin was associated with increased rate of high-risk transformation [HR: 1.12; 95% CI: 0.50-2.49; p=0.78], higher risk of increased growth [HR: 1.16; 95% CI: 0.82-1.66; p=0.40] and increased risk of surgery [HR: 1.22; 95% CI: 0.63-2.35; p=0.55]. All reported results were statistically insignificant (Table 2). Conclusions: This is one of the few studies that have examined the effect of statins on PC. We found no significant association between statin use and rate of growth, high-risk transformation or risk for surgery. S-601 AGA Abstracts Table 2. Multivariable Predictors of Any Change in Growth (Size or Number), High- Risk Transformation and Surgery–in statin users Su1492 EUS-GUIDED PANCREATIC CYST CHEMOABLATION AS A MINIMALLY- INVASIVE ALTERNATIVE TO PANCREATICODUODENECTOMY AND DISTAL PANCREATECTOMY FOR THE MANAGEMENT OF APPROPRIATELY SELECTED MUCINOUS PANCREATIC CYSTS: A SINGLE- CENTER EXPERIENCE Leonard Walsh, Kayla M. Hartz, Courtney Lester, Andrew Groff, Abraham Mathew, James H. Birkholz, Charles Dye, Matthew Dixon, Max Hart, John M. Levenick, Jennifer Maranki, Hadie Razjouyan, Matthew Moyer Background and Aims: Endoscopic ultrasound (EUS)-guided chemoablation offers effective treatment for mucinous pancreatic cysts and carries a complete ablation rate of 50-79% and a serious adverse event rate of 0% to 10%. [1] Surgical resection offers a definitive treatment approach however presents its own set of difficulties, including substantial risk for serious adverse events and high cost. We aimed to demonstrate that EUS-guided chemoablation offers an efficacious yet safe and cost-effective alternative to surgery in appropriately selected patients. Methods: We conducted a retrospective review of all patients undergoing either EUS-guided pancreatic cyst chemoablation or surgery (Whipple procedure or distal pan- createctomy) for mucinous pancreatic cysts between 2012-2018. Cyst size, volume (pre- and post-ablation), number of worrisome features, and other characteristics including patient age, sex, smoking status, ASA (American Society of Anesthesiologists) score were recorded. Procedure details including cost, minor and serious adverse events, length of stay (LOS) and outcome at 12 months were recorded. Costs were defined by Medicare reimbursement. The study was approved by the institutional review board. Results: 51 patients underwent EUS-guided chemoablation and 14 underwent surgery by either Whipple or distal pancreatec- tomy between 2012-2018. The median age of patients in the chemoablation group (CG) was 70 and in the surgery group (SG) was 65. Median ASA score in both CG and SG was 3. Average initial cyst volume in CG was 11.3 mm 3 compared to 60.7 mm 3 in SG. Average number of worrisome cyst features based on the Fukuoka guidelines [2] in CG was 0.7 and 2.9 in SG. Average LOS after the procedure was 0.1 days in CG compared with 7 days in SG. At 12 months, 57% of patients in CG had complete ablation ( ≥95% volume reduction), 24% had partial ablation (75-94% reduction) and average percent reduction in cyst volume was 84%. Serious adverse event rate was 2% in CG (acute pancreatitis) compared with 57% in SG (sepsis, pulmonary embolism, abscess, splenic artery and vein branch hemorrhage, pancreatic leak requiring drain). Minor adverse events occurred in 12% of patients in CG (pain, minor bleeding) compared with 100% in SG (pain, minor bleeding, pancreatic leak not requiring intervention). The Medicare reimbursement fee schedule for EUS-fine needle infusion (FNI) was $5,140 compared with the Whipple average covered charges of $106,085 or $188,562 depending on complications or comorbidities. [3,4] Conclusions: Our single- center data suggests that EUS-guided chemoablation offers an efficacious and more cost- effective treatment alternative with a significantly lower rate of adverse events compared to surgery for the treatment of mucinous pancreatic cysts that are 2-5 cm in size, technically amendable to chemoablation, and without signs of malignancy. Table 1: Patient demographics, pancreatic cyst features, and outcomes AGA Abstracts