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Background and Study Aims: Endoscopic management using standard accessories is the preferred modality for treatment of benign biliary strictures. However, with difficult strictures, there is frequently failure of endoscopic therapy. We are reporting our experience regarding use of a standard diathermic dilator (cystotome) to aid in stricture dilatation and stent placement in patients with difficult strictures., Patients and Methods: Data were analyzed from January 2014 to January 2017 at a single tertiary care center in North India. Total 25 patients were included., Results: The mean age was 45 years (varying from 38 - 55 years). Of the 25 patients with difficult strictures, 14 (56 %) were male and 11 (44 %) were female. Further, of these, 19 had biliary and 6 had pancreatic strictures. The average time of diathermic current application was 3.5 seconds (ranging 3 - 5 seconds). Technical and clinical success were achieved in 100 % of cases. None of the patients had any procedure-related (early or delayed) major complications., Conclusion: The cystotome is an extremely safe and useful accessory in benign biliary and pancreatic strictures, whereas conventional methods to negotiate stricture have failed.

Background and Study Aims: The role of endoscopic-ultrasound (EUS) guided fine-needle aspiration (FNA) in patients with lymphadenopathy in terms of diagnostic adequacy and safety in large population is not well defined. The aim of this study was to evaluate diagnostic adequacy and safety of EUS-FNA in patients with lymphadenopathy., Patients and Methods:  Retrospective study from October 2010 to September 2015 at tertiary care center in Delhi-NCR. We analyzed data from 1005 EUS- FNAs of lymph nodes., Results:  The study cohort comprised 1005 lymph nodes in 865 patients; 68 % were males, mean age was 50 ± 14 years. Indications of FNA were to look for etiology of pyrexia of unknown origin or staging of malignancy mainly. FNA was taken from mediastinal nodes (n = 528, 52.5 %) and intra-abdominal nodes (n = 477, 47.5 %). Median size of nodes at long axis and short axis was 17 (12 - 25.7) and 10 (8 - 15) mm respectively. Adequate material by FNA was obtained in 92.8 % cases. The cytopathologic diagnosis were malignancy in 153 (15.2 %), granulomatous change in 452 (42 %), and reactive lymphadenopathy in 328 (35.6 %). There was statistically significant difference seen between groups with pathological and reactive lymph nodes regarding size at long and short axis, hypoechoic nature, well defined borders and presence of necrosis and calcification. Procedure-related adverse effects were encountered in 6 patients (0.8 %). Four patients had mild mucosal bleeding in chronic liver disease patients and two had mild hepatic encephalopathy related to sedation., Conclusion:  EUS-FNA of lymph nodes has good diagnostic adequacy and safety.

Background and Study Aim: Different types of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) techniques are used in clinical practice; the best method in terms of outcome has not been determined. The aim of the study was to compare the diagnostic adequacy of aspirated material, and the cytopathological and EUS morphological features between capillary action, suction, and no-suction FNA methods., Patients and Methods:  This was a prospective, single-blinded, randomized study conducted at a tertiary care hospital. Patients were randomized to the three groups: capillary action, suction, and no suction. A total of 300 patients were included, with 100 patients in each arm., Results:  A total of 300 patients (195 males) underwent EUS-FNA of 235 lymph nodes and 65 pancreatic masses (distribution not statistically different between the groups). The mean age was 52 ± 14 years. A 22 gauge needle was used in the majority (93 %) of procedures. There was no statistical difference between the three groups regarding lymph node size at the largest axis and ratio, type of needle, echo features, echogenicity, calcification, necrosis, shape, borders (lymph nodes), number of passes, and cellularity. Diagnostic adequacy of the specimen was 91 %, 91 %, and 94 % in the capillary, suction, and no suction groups, respectively ( P  = 0.67). Significantly more slides and blood clots were generated by the suction method compared with the other methods., Conclusion:  The capillary action, suction, and no suction methods of EUS-FNA are similar in terms of diagnostic adequacy of the specimen. The suction method has the disadvantages of causing more bleeding and generating more slides.

Systemic lupus erythematosus (SLE) is a multi-organ disorder, which can involve any system of the body, single, or in combination. In the gastrointestinal tract, it can present as nausea, vomiting, abdominal pain, gastroesophageal reflux, dysphagia, constipation, diarrhea, fecal incontinence, intestinal pseudo-obstruction, perforation, and hemorrhage. Abdominal cocoon or sclerosing-encapsulated peritonitis is a rare cause of intestinal obstruction, resulting from the encasement of variable lengths of bowel by a dense fibrocollagenous membrane that gives the appearance of a cocoon. It is often seen in adolescent girls. We hereby present a case of abdominal cocoon with repeated vomiting and subacute intestinal obstruction as presenting features of SLE in a young girl. The abdominal features responded well to steroids and immunosuppressive therapy.