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Immunotactoid deposits are defined by their ultrastructural appearance and are characterized by microtubular or cylindrical structures typically measuring greater than 30 nm in diameter. Although a rare entity, immunotactoid deposition most often manifests as immunotactoid glomerulopathy and is associated with underlying lymphoplasmacytic disorders. Corneal immunotactoid deposition known as immunotactoid keratopathy has also been reported in patients with paraproteinemia. Here, we describe the first reported case of immunotactoid deposition in the stomach. The deposits were composed solely of kappa immunoglobulin light chains without significant lambda light chain or immunoglobulin heavy chain components. The patient displayed no renal signs or symptoms, and additional thorough clinical examination failed to detect any evidence of a paraproteinemia or plasma cell dyscrasia. Thus, the gastric immunotactoid deposits in this case appear to be an isolated finding of light chain deposition, of which the significance and etiology are unclear.

Background Strictures are a common complication of inflammatory bowel disease (IBD) and are usually treated by surgical resection or strictureplasty. As an alternative to surgery, endoscopic balloon dilation and steroid injection have been used to relieve symptoms. Goals To assess patient or stricture characteristics that may predict a better outcome and duration of response as endoscopic therapy is not without its risks. Study A retrospective review of patients with IBD strictures who underwent dilations between 1996 and 2005 was performed. The patients were followed in the adult and pediatric IBD clinics at a single center. Information was collected from medical records. Results Strictures were identified in the small and large bowel of 24 patients (22 adult and 2 pediatric). The majority had Crohn's disease (22/24). In total, 71 dilations were performed on 29 strictures; 46 dilations for 17 strictures were augmented with triamcinolone. Mean duration of follow-up was 32 months. This study included 1 stomal, 12 anastomotic, and 16 de novo strictures. Of 12 anastomotic strictures, 6 were complex. Endoscopic dilation was uneventful in 22/24 patients. Bleeding and perforation occurred on separate occasions in 1/6 complex stricture patients and rupture of a paracolonic abscess in another patient with a de novo sigmoid stricture. Surgery was performed on 2 patients, 1 for refractory disease and 1 for noncompliance with therapy. Conclusions Endoscopic dilation can provide long-term effective palliation of symptoms with minimal risk in patients with simple strictures. Complex anastomotic strictures are technically more challenging compared with de novo strictures.

Post-ERCP pancreatitis (PEP) is a potential complication of ERCP. Pharmacotherapy for prevention of PEP aims at reducing basal sphincter pressure and contractility or a decrease in pancreatic secretion to reduce intraductal pressure. Timing and route of administration of drugs are critical to ensure maximum benefits from medications. Pancreatic stenting offers an alternative to decompress the pancreas and is effective in reducing PEP in high-risk patients.

The association of Crohn's disease (CD) and Sweet's syndrome is rare and the presence of Sjögren's syndrome in Crohn's disease is even rarer, with only three reports found in the literature. We describe two cases of Crohn's disease associated with Sweet's syndrome, one of which is the first case of CD and Sweet's concomitantly associated with Sjögren's syndrome. Both cases responded rapidly to Infliximab therapy with complete resolution of the skin lesions.

Sphincterotomy is a high-risk procedure with considerable complications. Trainees should learn and understand the basics of endoscopic retrograde cholangiopancreatography and sphincterotomy to ensure good clinical outcomes. Teaching of sphincterotomy usually involves supervised hands-on clinical practice with patients. Proper positioning of the endoscope allows for correct orientation with the papilla, and performing the cut along the “ideal” biliary axis optimizes results and reduces complications. Learning and practicing sphincterotomy can be supplemented by simulator models. The Neo-Papilla model uses a modified chicken heart attached to the porcine ex vivo model and allows for cutting of actual tissue. The mechanical simulator allows trainees to practice cutting an artificial papilla marked with the “perfect” axis to understand the proper sphincterotomy technique. Understanding the indications and contraindications helps with appropriate application of sphincterotomy. Objective criteria should be available for assessing performance. Improved technique and avoiding a deviated cut may improve overall results and prevent complications.

Echinococcosis or hydatid disease is endemic to many countries around the world where livestock, mainly sheep and cattle, are raised with dogs who act as the definitive hosts for the adult phase of the echinococcal tapeworm. We report a case of a man, age 22 years, who emigrated from Kyrgyzstan as a teenager, presenting with abdominal fullness and nausea and found to have a 9 cm echinococcal cyst of the liver which was successfully treated with laparoscopic hepatectomy because of a very favorable location.

responded to medical therapy. The localization and extent of the IENDO matched with the preoperatively performed MRI in all cases. In none of the cases mucosal involvement was found confirming the endoscopic impression. Conclusion: As earlier reported IENDO was only found in the bowel serosa and muscularis. MRI was found to be much more reliable in detecting IENDO compared to RSS, even combined with biopsy. Discussion: Although unproven, the cause of HECH in IENDO may be more mechanical (due to menstrual swelling of the ENDO deposits in the bowel wall causing tears in the overlying, but uninvolved, mucosa) than menstrual from mucosal deposits. Abstracts