These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP. ClinicalTrials.gov: NCT02509416.

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Pure specimens of conjugated bilirubin are not available so that information regarding its metabolism can be obtained only by indirect means. In normal animals a tracer dose of unconjugated C14 bilirubin will be cleared quickly from the plasma and eliminated in the bile as conjugated C14 bilirubin( 1). If, however, the bile duct is ligated the conjugated C1* bilirubin will appear in the plasma and then be excreted in the urine. Using the Weber and Schalm technique(2) it has been possible to separate conjugated from unconjugated bilirubin quantitively and thus to determine their individual rates of disappearance from the plasma.

Through-the-scope (TTS) endoscopic Doppler ultrasound probe technology is a tool that has garnered interest for the evaluation of variceal and non-variceal bleeding. In previous studies, this technology has been proposed as a more objective method of identifying the bleeding subsurface blood vessel in peptic ulcer hemorrhage. We describe 3 cases where the use of an endoscopic Doppler probe guided the diagnosis and management of upper gastrointestinal (GI) hemorrhage due to causes other than peptic ulcer disease. The first case describes a patient with a duodenal Dieulafoy lesion, while the other 2 cases outline patients with a gastroesophageal varix as the etiology of the bleed.