Purpose The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary and pancreatic diseases in the pediatric population was not well defined until recently. Our aim was to determine the feasibility, outcomes, and safety of ERCP in a local pediatric population, particularly using standard adult endoscopes and accessories. Methods This retrospective study was conducted at the National Hospital of Sri Lanka. Pediatric patients (aged <16 years) who underwent ERCP from January 2015 to December 2020 were included in the study. Data, including patient demographics, indications for the procedure, technical details, and associated complications, were collected from the internal database and patient records maintained at the hospital. Results The study included 62 patients who underwent a total of 98 ERCP procedures. All the procedures were performed by adult gastroenterologists using standard adult endoscopes and accessories. The mean age was 11.01±3.47 years. Pancreatic diseases were the major indications for most of the procedures (n=81, 82.7%), with chronic pancreatitis being the most common. Seventeen procedures (17.3%) were carried out for biliary diseases. Overall cannulation and technical success rates were 87.8% and 85.7%, respectively. Stent placement was the most common therapeutic intervention (n=66; 67.4%). Post-ERCP pancreatitis was the most common complication, occurring in eight patients (8.2%). Conclusion ERCP can be successfully and safely performed in pediatric populations using standard adult endoscopes and accessories with complications similar to those of adults. Adult ERCP services can be offered to most pediatric patients without additional costs of pediatric endoscopes and accessories.

Background Guillain–Barré Syndrome is an immune mediated polyneuropathy. Ulcerative Colitis is an immune mediated chronic inflammatory condition mainly of the large intestine. Guillain–Barré Syndrome can present as a rare extraintestinal manifestation of Ulcerative Colitis when in remission or in a relapse. However, the concomitant presentation of Guillain–Barré Syndrome during a relapse of Ulcerative Colitis is very rare and only a few cases are reported to date. Case presentation A 24 year old young male diagnosed of Ulcerative Colitis presented with bloody diarrhea of frequency more than six times a day. He had been in clinical remission even after defaulting treatment for more than a year. He had also noted difficulty in walking prior to admission to the hospital. He was managed as for a severe relapse of Ulcerative Colitis and Guillain–Barré Syndrome. Appropriate management of both the illnesses helped him to recover. Conclusion Immune mediated diseases can have rare coexisting presentations. We report a case of Ulcerative Colitis with concomitant Guillain–Barré Syndrome. It is essential to be open minded and timely, appropriate treatment led to successful management of both the illnesses.

Management of liver abscesses in patients with thalassaemia is a challenge due to difficult venous access, other organ dysfunction, diabetes mellitus and etc. Here we report four thalassaemia patients with liver abscess where three of them had presented repeatedly with liver abscesses and three of them developed Covid-19 infection as well followed by a mini review of previously reported cases.

Introduction and objective We used AST to ALT ratio (AAR) and, liver stiffness measurement (LSM), splenic stiffness measurement (SSM) by transient elastography to develop a statistical model and present it as a user-friendly smartphone application to exclude the presence of oesophageal and cardio-fundal varices to avoid upper gastrointestinal endoscopy in selected patients. Methods A prospective study was carried out among patients with Child-Pugh Class A cirrhosis (non-viral and non-obese - BMI<30kg/m2). LSM and SSM were obtained using Fibroscan (EchoSens) by a single operator, blinded to the presence or absence of varices. The predictors used to develop the formula were AAR, LSM and SSM. Multiple logistic regression was used to create the algorithms in 70% of the sample and validated using 30% of the sample with Bootstrapping of 1000. Best algorithms with the highest area under the curve (AUC) were selected and identified as different cut-off levels to exclude or predict the presence of varices. Those values were included in a smartphone application on android and iOS web-based platforms. Results One hundred nine out of 211 had varices. After modelling different combinations, logistic regression formula (LRF)=5.577+(LSM*0.035)+(SSM*0.08)+(AAR*1.48) resulted AUCs 0.93. Cut-off value <-1.26 of LRF predicted the exclusion of varices with a negative predictive value of 90%. Cut-off value >0.829 of LRF predicted the presence of varices with a positive predictive value of 91%. Multiple values were used to develop a smartphone app on the Angular 2+ platform. (It can be downloaded for use @https://mediformula-65ef0.web.app/).