EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

A patient with pancreatic arteriovenous malformation who presented diagnostic and therapeutic difficulties is presented. The initial tests appeared to suggest inflammatory bowel disease, but the diagnosis was clinched by the finding of blood issuing from the ampulla of Vater. Repeated angiographic embolization did not obliterate the vascular malformation, and the symptoms eventually resolved after Whipple's pancreaticoduodenectomy.

No abstract

No abstract

Inflammatory bowel disease is common in Kerala, India. The disease characteristics of patients with IBD are almost similar to those from other parts of the country. Both UC and CD were seen in equal proportion in Kerala.

A 2(1/2)-year-old boy presented with pruritus and jaundice of 2 weeks duration. On investigation, serum total bilirubin was 23.4 mg/dL and gamma glutamyl transpeptidase was normal. Liver biopsy was consistent with progressive familial intrahepatic cholestasis (PFIC). A partial external biliary diversion (PEBD) was done. Pruritus disappeared, growth improved and serum total bilirubin became normal, 2 months after surgery. This is the first report from India, of PFIC treated with PEBD and suggests that PEBD should be considered in patients with PFIC even if bridging fibrosis is present.

No abstract

resection. Torqueing of the enteroscope deep in the small bowel may create resistance to instrument passage and removal with increased risk for perforation. Iatrogenic perforations deep in the small bowel can be successfully managed endoscopically using endoclips.65 year old male, a chronic smoker and alcoholic and a diagnosed case of chronic calcific pancreatitis since 2014, presented with recurrent abdominal pain, loss of weight and loss of appetite. CT SCAN of abdomen showed 3.4 x 3.6 cm mass in the head of pancreaas with biliary and pancreatic ductal dilation. It also showed calcification of pancreatic parenchyma. EUS guided FNA was suggestive of neuroendocrine tumor of pancreas. Prominant collaterals were seen adjacent to the mass. He presented a week later with massive upper GI bleed from the 2nd part of duodenum. Initial endoscopic hemostasis was achieved with hemoclips. However, as he rebled within 48hrs, EUS was done which showed active bleeding from the collateral seen near the mass. EUS guided coil (4 mm size, Three in number) were placed into the collateral. Complete thrombosis of the collateral was noted. Hemostasis was achieved. Patient remained stable and was discharged after 3 days.