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To describe the indications, endoscopic findings and complications of Endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary care hospital. Study Design: Retrospective analysis of data collected from all patients underwent ERCP in the year 2015. Setting: Gastroenterology department, Military Hospital Rawalpindi. Period: From 1st January 2015 to 31ST December 2015. Materials and Methods: The main outcomes were technical success, safety and complications. Results: Total 469 patients underwent ERCP inmilitary hospital Rawalpindi in year 2015. Common bile duct (CBD) cannulation was achieved in 437 (93.1%) patients. CBD stones were found in 182 (38%) and CBD stricture in 79 (16.8%). Sphincteroplasty was needed for extraction of large stones in 13 (2.7%) cases. CBD stricture with co-existing stones above was seen in 25 cases (5.3%). Large stones not amenable to endoscopic extraction were seen in 24 cases (5.1%). Total 25 cases of ampullary growth (5.3%) and 15 cases (3.1%) of CBD leak post cholecystectomy were noted. 6 cases (1.27%) were identified as choledochal cyst with CBD Stones. PD stones with dilated PD identified in 5 cases (1.06%) and post-cholecystectomy CBD clipped in 3 cases (0.63%). 3 cases of displaced PD stent ended up in successful retrieval. 21 cases developed acute pancreatitis (4.4%) out of which 3 were found to have severe pancreatitis having fluid collections. 3 cases (0.6%)had retroperitoneal perforation (2 were managed conservatively and 1 through surgery). 4 cases (0.8%)had significant post procedure bleed requiring re-scope with adrenal injection at bleeding site, and hemostasis achieved. Conclusions: ERCP in Combined Military Hospital Rawalpindi hospital was associated with a high degree of technical success and a low risk of complications.

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Objectives: To compare Rifaxamin and Lactulose in improving the gradesof hepatic encephalopathy in patients with decompensated liver disease. Study design:Randomized controlled trial comparing the use of rifaxamin and Lactulose. Place and durationof study: 1st July 2014 to 30th June 2015 in Department of Medicine, Aziz Bhatti ShaheedTeaching Hospital Gujarat. Results: 1st July 2014 to 30th June 2015 in medical departmentof Aziz Bhatti Shaheed Teaching Hospital Gujarat. Results: 400 cases were divided in twoequal groups: Group A took Rifaximin & Group B Lactulose. Improvement in grades of hepaticencephalopathy were calculated on weekly bases. Monitoring was done by checking bloodammonia levels, number connection tests, flapping tremors and mental status. 40 patients(10%) did not stay in ward for one week. In ninety percent etiology of decompensated liverdisease was hepatitis C virus. Improvement was noted in 76.96% (n=137) in Group-A and72.52% (n=132) in Group-B, p value was found insignificant (>0.05). Conclusions: Rifaximinand lactulose had similar efficacy in the treatment of mild to moderate hepatic encephalopathy.

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