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Case seriesPatient: Female, 71 • Male, 48 • Female, 44 • Female, 62Final Diagnosis: Esophageal motility disorderSymptoms: DysphagiaMedication: —Clinical Procedure: ManometrySpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:The esophagus can be affected by a variety of disorders that may be primary or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis and further management somewhat challenging. High resolution impedance manometry (HRiM) has established itself as a valuable tool in evaluating esophageal motility disorder. HRiM is superior in comparison with conventional water perfused manometric recordings in delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and in distinguishing the luminal pressurization of spastic esophageal contraction from a trapped bolus. Making these distinctions can help to identify achalasia, distal esophageal spasm, functional obstruction, and subtypes according to the latest Chicago Classification of Esophageal Motility Disorders version 3.0.Case Report:We report a case series of 4 patients that presented with dysphagia; and with the ancillary help of the HRiM, we are able to diagnose esophageal motility disorder and evaluate its pathogenetic mechanism. This approach aids in tailoring each management individually and avoiding disastrous mismanagement.Conclusions:From the series of case reports, we believe that HRiM has an important role to play in deciding appropriate management for patients presenting with esophageal motility disorders, and HRiM should be performed before deciding on management.

Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients’ demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142)Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant.

S4). ERCP demonstrated no excretion of mucin from the papilla of Vater. Cholangiography revealed a filling defect in the upper bile duct, and the lower tip of the defect area was oval-shaped. The patient was therefore diagnosed with non-malignant MCN-L and an extended left hepatectomy with right hepaticojejunostomy were performed. Patient tolerated the surgery well.Results: Examination of the resected specimen confirmed that the tumor originating from S4 of the liver with polypoidal extension into the left hepatic duct and common bile duct. Microscopic findings indicated a diagnosis of Mucinous cystic neoplasm with low grade dysplasia. Conclusion:The diagnosis of MCN-L requires a high degree of suspicion. Histopatho-logical examination establishes definitive diagnosis. Intrahepatic MCN-L can present with episodic jaundice due to its characteristic intraductal growth pattern and intraluminal mass formation. They are best treated radically as they have a definite potential to transform into malignant tumors in nearly 10%.

Background: Our goal is to isolate and expand tumor cells in culture and identify the spectrum of malignant attributes. Methods: Fresh tumor tissue from Grade 3, Stage IA, intrahepatic CCA was minced and subjected to enzymatic digestion for 75 minutes at 37 C. Digested contents were