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AIM:To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS:Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome. RESULTS:Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION:Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

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Background: Kidney chronic failure and its replaced remedies make the patient exposed to a wide range of physical, mental, economic, and social problems and as the life quality is affected by them, the life quality would be changed. Therefore, evaluation of the life quality by specific evaluation tools and based on demographic information help the patients' problems to be dealt with principally. In this study, we examine the life quality of hemodialysis patients and kidney transplant recipients in Ahvaz. Methods: This study is a cross sectional study to compare the life quality of patients who had kidney transplantation or underwent hemodialysis treatment. Sampling was conducted based on purposeful method and the life quality of 70 patients and 70 kidney transplant recipients referring to medical center and the people who had the criterion for entering the study were examined by a questionnaire of kidney diseases' life quality (KDQOL-SF36); then, after collecting data, they were compared by applying statistical tests including T-test and Chi-square test. Results: The mean total scores of the life quality did not show a statistically significant difference in two groups (P = 0.344), but the kidney transplantation group with a significant mean difference obtained better scores in the dimensions of general health (P = 0.002), physical health (P = 0.000), sleep (P = 0.028), limitation in playing a role (P = 0.000), and physical limitation (0.002) in comparison with hemodialysis group. The two groups did not show any significant difference in dimensions of disorder in social natural function and social relations, physical pain, limitation because of pain, vivacity, coping with disease, inner emotion related to disease, self-knowledge, emotional issues, and sexual activities. Conclusions: Although kidney transplantation could increase the patients' life quality in some dimensions, in the kidney transplantation group the people still encounter their previous problems and are in need of receiving more care to keep their transplant kidney. Based on results, therefore, educational -medical centers must predict and implement necessary arrangements to increase the life quality in both groups.

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