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Background Choledocholithiasis is the most common benign biliary disease. Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) has been the first-line therapy in recent years, although laparoscopic common bile duct exploration has promising results. This retrospective study aimed to define the factors associated with biliary clearance by standard ERCP technique and conversion rate of LC. Materials and Methods We retrospectively evaluated the records of 217 choledocholithiasis patients who had undergone ERCP with stone removal by the standard technique from 2010 to 2018. A failed ERCP was defined when the first ERCP session could not remove the stones . The number of patients who later underwent open cholecystectomy or LC was also recorded. Conversion was defined when LC had to be converted OC. Statistical Analysis Student’s t-test was used for the comparison of continuous variables. Nominal variables were analyzed using Pearson’s chi-square test or Fisher’s exact test. Binary logistic regression was performed for multivariate analysis. Results The rate of successful biliary clearance was 81.1%. Of the patients, 109 (50.2%) had difficult stones. Increasing age (p = 0.004), increasing number (p = 0.001), and increasing size of stone (p < 0.001) were the three significant factors that were associated with the failure of biliary clearance. The difficult stone group had a higher failure rate of ERCP and a higher conversion rate of LC compared with the easy stone group (p = 0.001 and p = 0.027, respectively). Conclusions ERCP with the standard technique is a highly effective and safe management option for patients with common bile duct (CBD) stones. The difficult stone group was found to be an independent risk factor that affected the success rate of both ERCP and the following LC. Difficult stone criteria should be assessed to identify a patient who might benefit from laparoscopic CBD exploration.

Corrosive proctocolitis has occurred after accidental contamination of endoscopes in most patients. But accidental administration of corrosive agents for bowel cleansing can occur. The agents implicated for chemical colitis is 15% hydrochloric acid and 2% ethoxylated alcohol. We present a case of corrosive proctocolitis, present with anal pain and bloody diarrhea. Endoscopy revealed edema, erythema, and friability of the colonic mucosa. An experience of successful nonoperative treatments has been demonstrated.

Nontraumatic intramural duodenal hematoma can cause upper gastrointestinal tract obstruction, upper gastrointestinal hemorrhage, jaundice, and pancreatitis and may be present in patients with normal coagulation. However the pathogenesis of the condition and its relationship with acute pancreatitis remain unknown. We present a case of spontaneous intramural duodenal hematoma and a case of successful nonoperative treatments.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is often used to provide internal biliary drainage in patients with unresectable perihilar cholangiocarcinoma; however, clinical success is not achieved in some patients. The aim of this study was to evaluate the factors associated with clinical success of ERCP with biliary drainage in unresectable perihilar cholangiocarcinoma. Methods: We retrospectively evaluated 68 patients with unresectable perihilar cholangiocarcinoma who underwent ERCP with biliary drainage from 2010 to 2018. Patients received either unilateral or bilateral metallic stents. Unsuccessful biliary drainage was defined as a reduction in serum bilirubin of less than 50% from baseline levels within 2 weeks. Student’s t-test and Pearson’s Chi-square test were utilized for analyses. Results: The rate of successful biliary drainage was 60.3%. Elective biliary drainage exhibited a significantly higher success rate compared to emergency biliary drainage [odds ratio (OR)=3.903, 95% CI, 1.212-12.566, P=.032]. High serum total bilirubin was associated with a significantly higher success rate compared to low serum total bilirubin (OR=1.069, 95% CI, 1.008-1.134, P=.025). Conclusion: Higher serum total bilirubin levels and elective intervention were identified as factors affecting the success rate of ERCP with biliary drainage. These factors should be assessed to identify patients who might benefit from this procedure. [ABSTRACT FROM AUTHOR]