Management and outcome of residual bile duct stones following cholecystectomy at a tertiary referral centre in Sri Lanka.

BACKGROUND: In spite of the advent of pre- and per-operative imaging techniques, the problem of residual bile duct stones following laparoscopic or open cholecystectomy still exists with a reported frequency of 2-10%. Endoscopic stone extraction is a minimally invasive technique which is fast becoming popular in the management of residual ductal stones. OBJECTIVE: To review the experience in our unit with regard to clinical presentation and the outcome following endoscopic management of residual bile duct stones. DESIGN: Retrospective descriptive study. SETTING: Patients referred to a tertiary referral centre with suspected residual bile duct stones following open or laparoscopic cholecystectomy from 5 March 2002 to 31 December 2006. PATIENTS AND METHOD: 56 patients with suspected residual bile duct stones were reviewed with regard to clinical presentation, stone profile, success rate and outcome. RESULTS: Mean age of the sample was 43.2 years. Female to male ratio was 34/22. 4 (73.3%). Main presenting symptom was epigastric or right hypochondrial pain (39.2%). Presence of residual stones or gravel noted in 91% (51) during ERCP. Complete stone extraction was achieved in 83.9% (47). All these patients became completely asymptomatic. Four patients had ERCP related morbidity. There were no deaths. Longest follow up was 38 months and the shortest 1.5 months. CONCLUSIONS: Endoscopic approach is a safe and effective method in the diagnosis and treatment of residual bile duct stones.

Developing a molecular marker for metachronous colorectal cancer.

OBJECTIVE: To determine the prevalence of microsatellite instability in patients with metachronous colorectal cancer as a potential marker for identification of high risk individuals. SETTING: Surgical research laboratory, Whittington Hospital, Highgate Hill, London. SUBJECTS AND METHODS: 37 colorectal tumours from 18 individuals with metachronous colorectal cancers were investigated at five microsatellite loci by single stranded conformational polymorphism (SSCP) analysis. A control group of 11 individuals who had developed one sporadic colorectal cancer each were also similarly analysed. MEASUREMENTS: Tumour microsatellite instability was defined as the appearance of new polymarase chain reaction (PCR) bands, either larger or smaller than those produced from the normal mucosa. RESULTS: 27 of the total of 37 metachronous cancer specimens PCR amplified successfully. Microsatellite instability was demonstrated in 59.3% (16/27) of individuals with metachronous tumours. None of the tumours in the control group showed microsatellite instability. CONCLUSIONS: These results suggest that individuals with colorectal cancer with replication errors are at a greater risk of developing metachronous colorectal cancer than those without replication errors.