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Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5 %) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75 %). Among these responders, 10 patients (83.3 %) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7 %) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail. [ABSTRACT FROM AUTHOR]

Background and study aim: Endoscopic ultrasound- guided fine needle aspiration (EUS-FNA) is frequently performed for suspected biliary tumors for diagnosis and staging but carries a theoretical risk of needle-track seeding. We aimed to evaluate the impact of preoperative EUS-FNA on long-term outcomes for patients with cholangiocarcinoma (CCA). Patients and methods: In a retrospective singlecenter study of consecutive patients with CCA with preoperative EUS-FNA,main outcomemeasures were overall survival and progression-free survival. Results: In 150 patients with confirmed CCA, 61 underwent preoperative FNA. Median overall survival was 18.5 months (95% confidence limits [CL] 15.4, 25.7): 111 patients died and 39 survived. Of the 150 patients, 119 underwent curative- intent surgical resection, with median progression- free survival of 17.8 months (95%CL 14.5, 22.8); 89/119 patients had tumor recurrence or died, and 30/119 remained alive and disease- free. On multivariable analysis, overall survival was associated with: undergoing curativeintent surgery (hazard ratio [HR] 5.79, P=0.001), lack of lymph node involvement (HR 1.89, P= 0.011), younger age (HR 1.51 for every 10 years, P<0.0015), and small tumor size (HR 1.11 for every 1cm, P=0.029). For patients undergoing curative- intent surgery, on multivariable analysis, improved progression-free survival was associated with: lack of lymph node involvement (HR 1.88, P=0.010), smaller tumor size (HR 1.16 for every 1cm smaller, P=0.003), and younger age (HR 1.53 for every 10 years, P<0.001). Number of needle passes showed no statistically significant impact on overall survival. Conclusion: Preoperative EUS-FNA in patients with CCA does not appear to adversely affect overall or progression-free survival. [ABSTRACT FROM AUTHOR]