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Although interobserver agreement is low, observer experience increases agreement.

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severe post-ERCP pancreatitis (PEP), one of which had fatal outcome In the next 88 SOCs rate of adverse events was 8% (PEP 3%, cholangitis 3%, bleeding 1%, mortality 0%, none severe). The sensitivity and specificity of SOC biopsies were 75% and 87% for detecting cancer, respectively. Conclusion: The risk of pancreatitis after SOC decreases to the level seen in standard ERCP as experience accumulates. SOC may be considered a safe diagnostic aid in unclear biliary strictures even in outpatient setting.

pancreaticoduodenectomy (PD). Nowadays there exist modern intraabdominal vacuum techniques as an option of therapy besides the pancreatectomy of the rest. Methods: In our hospital we have treated two patients with type C POPF with intraabdominal vacuum bandages. For this we intraabdominally placed a silicone-coated (Mepi-thel®) polyurethane sponge (V.A.C.® GranuFoam™) under a continuous suction of between 75 and 125 mmHg at the target place. One of the applications was carried out via open surgery while the other one was done laparoscopically. In both cases the vacuum bandages have been repeatedly changed and finally an open wound management via wound tamponade was applied until the wounds healed definitely. Results: From January 2013 to December 2016 161 pancreatic surgeries have been carried out in our hospital. 100 cases thereof were PD with a total fistula rate of 16% (16/100). Among these there have been two cases of type A POPF (2%), 11 cases of type B POPF (11%) and three cases of type C POPF (3%). Two cases of type C POPF could be treated successfully by the use of intraabdominal vacuum bandages. No rest pancreatectomies have been necessary. Conclusion: The experiences in our hospital have shown that the above intraabdominal vacuum technique represents a sensible therapy option in the treatment of type C POPF and that by the use of a rest pancreatectomy can be avoided.

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