chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. reduction of hypertonocity is a special treatment for fissure healing. for this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. however, both of these methods may cause a degree of incontinence in some patients. the uptake of m...

to determine whether the medical treatment of anal fissure can be an effective alternative for surgery methods: retrospectively, we randomly selected 190 patients being treated for anal fissure between the years 2005-2010 in 3 equal groups: group a: patients who received medical treatment with topical nitroglycerin, group b: patient treated with topical diltiazem, and group c: patients underwen...

Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided and extracorporeal shock wave lithotripsy. We he...

INTRODUCTION Only limited data are available regarding the safety of therapeutic ERCP in pregnancy. We report our experience with therapeutic ERCP in pregnant women. METHODS Medical records of 18 pregnant women (first trimester 4, second 6, third 8) who underwent ERCP between July 1994 and December 2004 were reviewed. Patients and their families were contacted to assess the well being of moth...

It is well known both by clinical examination and by objective measurement that a high pressure zone is to be found in the anal canal, due to the action of the anal sphincteric muscles. Division of part of the internal anal sphincter in the operation of internal sphincterotomy resulted in a diminution in this pressure zone (Bennett and Duthie, 1964). The pressure remaining after internal sphinc...

Deep cannulation of the desired channel (biliary or pancreatic) is the basic requirement to successfully perform a therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In biliary cannulation, we have a broad armamentarium of standard and specialized techniques. However, failure rates can range from 1-10%. The consequences of failure in cannulation are serious: repetition of the ER...

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation...

An 88-year-old female with a previous history of retinopathy requiring treatment with Adiro® (acetylsalicylic acid) presented with jaundice, pruritus and right upper quadrant pain. An abdominal ultrasound revealed multiple stones in the common bile duct (CBD). Adiro® was stopped five days before ERCP. ERCP confirmed the presence of multiple stones in the CBD, which were extracted after performi...

During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one ofthese patients. Stones were cleared endoscopically in 73.3% and surg...