The routine use of peroperative (pre-exploration) cholangiography was prospectively studied in 433 consecutive patients undergoing elective cholecystectomy. Satisfactory peroperative cholangiography was achieved in 396 patients using a C-arm image intensifier with image retention facility. Clinical indications for exploration of the common bile duct were noted for each patient but the decision for choledochotomy was determined by the cholangiographic results. Two hundred and forty-nine (63 per cent) patients had no clinical indications for duct exploration and cholangiographic findings were all normal. Of the 147 patients with positive clinical criteria, 39 (9.8%) had abnormal cholangiograms and required exploration of the common bile duct. In three patients duct exploration was negative giving a false positive rate of 0.73 per cent. The use of the image intensifier allowed dynamic study during cholangiography and optimum evaluation of the duct system. The results support the view that peroperative cholangiography could be restricted to patients with clinical indications for exploration of the common bile duct.

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The carcinoid syndrome generally occurs due to metastasis of a carcinoid tumour in the liver. A patient is presented who had carcinoid syndrome due to abdominal disease without hepatic metastasis.

Endoscopic polypectomy has become a standard procedure for treating colorectal polyps. This has markedly reduced the morbidity and mortality by avoiding the major surgical procedures to remove these polyps. Over a period of two years (July 1984 through June 1986), endoscopic polypectomy was performed on 35 patients at Riyadh Central Hospital. Sixteen of them had bilharzial polyps. One patient showed carcinomatous change as well in the bilharzial polyp, and he was referred for surgery. Subsequent follow-up of the remaining patients revealed a marked symptomatic improvement in all. Their response to the procedure was excellent. Only one patient developed rectal bleeding following polypectomy and required blood transfusion.