Background Endoscopic papillary large balloon dilation (EPLBD) after sphincterotomy (EST) was introduced for the removal of large (≥ 10 mm) or multiple bile duct stones. This method combines the advantages of EST and EPLBD by increasing the efficacy of stone extraction while minimizing complications of EST and EPLBD when used alone. This prospective study aimed to compare between EPLBD with prior limited EST and sole sphnicterotomy for extraction of multiple and/or large common bile duct stones. Results Statistical analysis revealed insignificant difference between the studied groups as regards the presence of periamullary diverticulum (23% vs. 19%, P > 0.05) and the use of mechanical lithotripsy (4% vs. 9%, P > 0.05). The rates of overall and initial stone clearance were not significantly different between both groups [94% vs. 90%), P > 0.05; and 84% vs. 78%, P > 0.05, respectively]. The procedure-related pancreatitis and bleeding in EST/EPLBD group were lower compared to EST group (3% vs. 5%, P > 0.05; and 2% vs. 6%, P > 0.05, respectively). None of the studied groups’ patients died or developed procedure-related perforation or cholangitis. Conclusion Endoscopic large balloon dilation with prior limited sphincterotomy is an effective and safe endoscopic technique for removing multiple and/or large CBDSs.

Background and study aim: The progress of hepatorenal syndrome (HRS) in hepatic patients is not yet understood. Nitric oxide level, through its impact on haemodynamic circulation, may be engaged in the progress of the disease. Our study expected to clarify the possible role of eNOS G894T in decompensated liver cirrhosis and HRS and its relationship with nitrite level.Methods: Study included 80 cirrhotic patients (40 decompensated cirrhotic and 40 HRS) and 40 healthy participants as controls. Renal and liver function tests, CBC, serum electrolytes, plasma nitrite and eNOS G894T by real-time PCR were surveyed.Results: There were higher frequencies of TT and GT genotypes of eNOS G894T versus GG in both cirrhotic (22.5% and 50% respectively) and HRS (30% and 45% respectively) than in controls (10% and 30%) (P=0.007). T allele was more prevalent than G allele in cirrhotic (47.5%) and HRS (52.5%) patients compared to controls (25.0%) (P=0.001). TT and GT genotypes increase risk of cirrhosis by OR 4.909 [95% CI: 1.24 -19.46] and OR 3.636 [95% CI: 1.32 -9.99] and HRS OR7.200 [95% CI: 1.86 -27.77] and 3.600[95% CI: 1.27 -10.7] respectively. T allele can increase risk of cirrhosis by OR 2.714 [95% CI: 1.39 -5.30] and HRS OR 3.316 [95% CI: 1.70 -6.48]. Clear connections were observed between TT genotype and lower plasma nitrite level (P<0.001). Conclusion: Mutant variants of eNOS G894T gene in cirrhotic and HRS patients from controls could partially explain the progress to decompensation and HRS in liver cirrhosis. https://aeji.journals.ekb.eg/