An 83-year-old woman was admitted because of colicky pain in the abdominal right upper quadrant and a cholestatic pattern in liver chemistry. Transcutaneous abdominal ultrasound showed a huge dilation of the extrahepatic bile duct. A distal common bile duct stone was also observed. An endoscopic retrograde cholangio-pancreatography (ERCP) was performed. Vater’s papilla was located in the right ...

The key therapeutic intervention during endoscopic retrograde cholangiopancreatography (ERCP) is sphincterotomy, but lack of training and experience leads to a higher risk of complications [1,2]. Herein, we present a simple, reproducible, easyto-build, ex vivo, ERCP model for the training of sphincterotomy using standard sphincterotomes and a needle knife. The model is based on incorporating on...

BACKGROUND Chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure ...

Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46). Of the 38 cases with s...

AIM Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anu...

A 71-year-old man presented to secondary care with a 2-week history of right upper quadrant pain associated with rigors. Obstructive jaundice was demonstrated on blood sampling, and subsequent magnetic resonance cholangiopancreatography imaging revealed an 8-mm obstructing calculus within the common bile duct. An endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and ball...

BACKGROUND The paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this observational study we aimed to assess the outcome of patients with biliary SOD managed without sphincter of ...

BACKGROUND Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. ...

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main ...

BACKGROUND Endoscopic sphincterotomy has been shown to inhibit stone formation in the gall bladder of experimental animals. AIMS To investigate the alterations in bile composition and gall bladder motility after endoscopic sphincterotomy. PATIENTS A study was performed of gall bladder bile composition and gall bladder motility in patients with gallstone disease ((n = 20; age 40-60 years, me...