We describe the case of a 75-year-old female who underwent ERCP for choledocholithiasis. The extraction balloon catheter got impacted at the distal end of a common bile duct (CBD) during attempted stone extraction. Multiple attempts by 2 different ERCP experts to remove the balloon catheter proved unsuccessful. At the time the procedure was carried out, Spyglass Cholangioscopy was not available in the hospital. The balloon catheter was cut outside the channel of scope and used as a nasobiliary drain after an oro-nasal conversion. On repeat ERCP, a few days later, the extraction balloon catheter had fallen out spontaneously into the duodenum. The common bile duct was re-cannulated and stone was successfully removed. This is only the second case report of an impacted extraction balloon catheter in CBD.

pathology reporting system. Statistical analysis was performed using multinomial logistic regression. Results A total of 15906 polyps were removed at colonoscopy over the specified period. Mean size was 7.3 mm (range: 1 to 120 mm). 86.6% of all polyps were non pedunculated and 56.3% polyps were located in the left colon. The size, site, morphology and histology of these polyps is shown in table 1.A histopathological diagnosis of polyp cancer was made in 104/15906 polyps (0.65%). 94/104 polyp cancers (90.25%) were associated with non pedunculated morphology [OR 1.45, 95%CI 0.75-2.78 p=0.005].Risk of developing in cancer in polyps !20 mm was significantly higher than in smaller polyps [ OR 6.57 95% CI 5.7-13.1 p< 0.001 ].89 cancers were found in the left colon and rectum compared with 15 cancers in the right colon ( 85.5% vs 14.5%) [OR 1.98, 95%CI 0.9-3.1 p=0.007]. Conclusion This is the largest report of the prevalence of cancer in colorectal lesions 6-10 mm in size. We have demonstrated that the prevalence of covert cancer in colorectal lesions <5 mm is negligible and that of polyps 6-10 mm is very low (0.17%). All these cancers were in non-pedunculated adenomas in left colon. Based on the data, we have demonstrated in the 6-10 mm polyp subgroup, we suggest a modified ' resect and discard' concept ( based on OD AND location based strategy) extending to 6-10 mm polyps in the right colon. Given the fact, that most non experts fail to reach PIVI criteria based on OD alone, this modified strategy would reduce the need for optical assessment and increase the scope of 'resect and discard' to a larger number of polyps.