Abstract: Plastic biliary stents are commonly used during Endoscopic Retrograde Cholangio-Pancreatography (ERCP). The main indication for biliary stenting is benign or malignant obstruction. Plastic stents, among others, can be used as an escape route in patients with large common bile duct stones, or in cases of acute cholangitis with or without sphincterotomy to provide drainage until definitive treatment. Stent occlusion is the main disadvantage, limiting their patency to around 3 months, after which replacement is recommended. We present a case of a large, close to 2cm, stone developing around and encasing the proximal end of a plastic biliary stent. The stent/stone complex was successfully removed en bloc. The stent was placed in the common bile duct without sphincterotomy, and remained in situ for 2 years. The presented case highlights the importance of definitive treatment for common bile duct stones, the need to respect the ductal axis especially when dealing with large stones and the significance of biliary sphincterotomy during endoscopic interventions in the bile duct.

Abstract: BACKGROUND AND AIMS: Symptoms of gastroesophageal reflux disease (GERD) are common in the general population. Although the results of laparoscopic fundoplication are well documented, there have been no reports on the operative outcome in patients refractory to or with only partial response to medical therapy for GERD. PATIENTS-METHODS: Thirty-two patients with GERD, whose continuous high doses of medical treatment with proton-pump inhibitors produced no or only partial symptom relief, underwent laparoscopic Nissen fundoplication. Symptoms were evaluated with a standardized questionnaire preoperatively and 12 months after surgery. RESULTS: The complete follow-up evaluation was obtained in 30 out of the 32 patients. The main symptoms before surgery were regurgitation (93%), heartburn (60%), epigastric pain (47%), and globus sensation (47%). All patients were relieved from heartburn, vomiting, and globus sensation. Dysphagia was relieved in 75% of the patients and regurgitation in 86%. Dysphagia as a new symptom occurred in 9%. The overall morbidity rate was 16%. Patient satisfaction rate was 87%. CONCLUSION: Laparoscopic fundoplication seems to be an effective treatment for severe, drug-resistant GERD. The high patient satisfaction rate and the positive therapeutic response in 95% of patients justify this procedure in this strictly selected group of patients.

Abstract: The current paper describes a wavelet-based method for long-term processing and analysis of gastrointestinal sounds (GIS). Windowing techniques are used to select sequential blocks of the prolonged multi-channel recordings and proceed to various wavelet-domain processing stages. De-noising, significant-activity detection, automated segmentation and extraction of summary curves are applied in an integrated mode, allowing for enhanced content manipulation and analysis. The proposed analysis scheme combines flexible long-term graphical representation tools, while maintaining the ability of quick browsing via visualization and auralization of the detected short-term events. This work is part of a project aiming to implement non-invasive diagnosis over gastrointestinal-motility (GIM) physiology. However, the proposed techniques might be applied to any study of long-term bioacoustics time series.

Abstract: OBJECTIVE: This retrospective study evaluates the relationship between periampullary duodenal diverticula and the common bile duct (CBD). MATERIALS AND METHODS: The patients were examined with HASTE breath hold MR cholangiography (MRC) using a 1 T Siemens Expert Plus Scanner. Axial T2-weighted images were also obtained in all patients. RESULTS: From the 66 patients, only 23 clearly depicted to have deverticula, while 31 patients were suspected to have diverticula and for the rest 12 patients, the MRC results were negative. From these 66 patients, the 18 patients proved to have stones in the CBD. CONCLUSION: MRC has very low sensitivity in the detection of duodenum diverticula, but is the method of choice to evaluate their relationship with the distal part of the CBD.

Abstract: BACKGROUND: A microwave generator and delivery system for endoscopic use was built. Using a 650-W, 2450-MHz magnetron, 0-160 W were generated from the tip of a 180-cm flexible coaxial cable (2.1 mm diameter). METHODS: Three methods of achieving hemostasis with microwaves were identified studying standard bleeding canine ulcers: (1) interstitial method: inserting the coaxial tip into the tissue and heating slowly until bleeding stopped; (2) contact method: tip held in contact, light pressure applied; (3) noncontact method: microwave-induced sparking (dielectric breakdown) with tip held 1 mm from tissue. RESULTS: Studies of optimal energy levels for hemostasis showed that high power (70 W) noncontact methods required significantly less energy to stop bleeding than contact or interstitial methods. The noncontact method was more effective than the contact method, stopping 20 of 20 bleeding ulcers vs. 10 of 20 (P < 0.001) and was more rapidly effective causing less tissue damage (P < 0.05) than the interstitial method. CONCLUSIONS: In a randomized comparison using a non-contact method, microwave coagulation was superior (P < 0.001) to a polidocanol 1% + adrenaline 1:10,000 injection and control treatment stopping 40 of 40 vs. 0 of 20 and 0 of 20 standard bleeding ulcers. Microwaves stopped bleeding from 10 of 10 severed mesenteric vessels, whereas injection was ineffective (0 of 10, P < 0.001). Microwaves look promising for hemostasis at flexible endoscopy.