Conclusion: Endoscopists should consider hepatic penetration of a duodenal ulcer, particularly in cases with ill-defined regional findings on an abdominal CT. MP SWAN,1 S ALEXANDER,2 M BARNES,1 E PREWETT,2 D CROAGH1 AND DA DEVONSHIRE1 1Gastroenterology Unit, Monash Health, Clayton, Victoria, 2Department of Gastroenterology,

Barwon Health, Geelong, Victoria Introduction: Choledocholithiasis is a common indication for ERCP. Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy is increasingly being used as a standard endoscopic technique in the management of larger (>10 mm diameter) common bile stones. All the studies advocating its Sirolimus cost use have arisen from overseas units, typically from tertiary referral centres. Methods: Analysis of prospectively collected data on EPLBD performed in three Victorian centres. The three centres differ in the case volume and workload with

click here approximately 200, 300 and 600 ERCP procedures performed annually in each of the units. A sphincterotomy was performed prior to the EPLBD in all patients. The size of the maximal inflation of the balloon was decided based upon the estimated diameter of the mid-distal common bile duct (CBD). Patients were followed clinically after the procedure. Indications, complications, and need for repeat ERCP procedure were collected. The proceduralist was asked to offer Galeterone an opinion regarding the alternative endoscopic techniques that would have been needed in the absence of EPLBD. Results: Over a 30-month period, prospective data collected from three Victorian hospitals were analysed. In total, 98 patients underwent EPLBD ranging in size from 10 mm to 20 mm. 58% of patients were female with a mean age 64 [range27–91]. 68 patients had an endoscopic sphincterotomy and EPLBD performed at the same procedure, the remaining 30 patients had EPLBD performed after an ES at a previous ERCP. 87 patients had a successful complete clearance of the duct after the initial EPLBD. Stones were removed in over 80% cases with an extraction

balloon; the remainder were cleared with a basket (17) and mechanical lithotripsy (2). 14 patients (14%) required a repeat ERCP; 11 for refractory stones, 3 for recurrent choledocholithiasis. Complications included two post ERCP bleeds requiring transfusion and 3 post ERCP pancreatitis (all mild). Proceduralist opinion was that the use of EPLBD in the individual cases reduced the likely need for a repeat ERCP by 54% overall. Conclusions: This local study illustrates that the use of endoscopic papillary large balloon dilation is an increasing utilized technique that is efficacious in the management of large CBD stones. The performance of EPLBD did not lead to an increase in complications and was associated with a decreased need for repeat ERCP procedures.