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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.

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.