Visceral artery pseudoaneurysms are often treated surgically or by transcatheter embolisation. We report a case of a pseudoaneurysm in a patient with chronic pancreatitis, which was successfully occluded by percutaneous injection of thrombin into the pseudoaneurysmal sac as a first-line management.

Aim: The aim of this study is to determine the success rate of biliary cannulation in cases where endoscopic retrograde cholangiopancreatography (ERCP) is repeated after failed precut sphincterotomy. Materials and Methods: In this retrospective study, consecutive ERCPs performed between August 2013 and June 2017 were included. Data was analyzed for indication of ERCP, success rate at initial cannulation attempt, use of precut sphincterotomy, biliary access rate after precut, repeat ERCP rate, and associated complications. Results: A total of 1872 ERCPs were included in the study. Of these, 55% were done for common bile duct stones, 37% for malignant biliary obstruction, and 8% for biliary leak. During the initial ERCP, 84.9% cases had successful biliary cannulation. Nearly 86.8% cases undergoing precut sphincterotomy achieved biliary access. Repeat ERCP was done in 28 cases after a median interval of 3 days and biliary cannulation was achieved in 78.5% cases. Conclusion: Repeat ERCP after 3 days in cases of failed initial precut sphincterotomy should be practiced and recommended as this allows definitive biliary therapy in majority of such patients and prevents morbidity and mortality from other invasive alternative therapies.

Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298-12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pylori-negative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188-17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56). Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

Nasogastric (NG) tube insertion is a common clinical procedure used for both diagnostic and therapeutic purposes. As the importance of enteral nutrition is being increasingly recognized; the use of NG tube insertion has steadily increased. Here, we present an interesting case in which a kinked NG tube was removed in a unique manner with “push and pull” technique without untoward trauma.

No abstract