*4678MANAGEMENT OF GALLSTONE PANCREATITIS: CHOLE-CYSTECTOMY OR ERCP AND ENDOSCOPIC SPHINC-TEROTOMY.Madhukar Kaw, Praveena Kaw, Med Coll of Ohio, Toledo, OH; Brooks &Kushman, Southfield, MI.Background: Currently, laparoscopic (lap.) CCX is the recommended treat-ment of gallstone pancreatitis. ERCP and ES within 24-48 hours is sug-gested in the treatment of acute biliary pancreatitis. Aim: To assess role oflap. CCX after ERCP and ES in patients with gallstone pancreatitis.Methods: 118 patients with gallstone pancreatitis (mean age: 44, range:18-68 yrs.), 102-F, 16-M were identified. Inclusion criteria were typicalabdominal pain, serum amylase ≥ twice normal (normal ≤ 128), and gall-bladder (GB) stones, dilated common bile duct (CBD) ±CBD stone by ultra-sound (US), CT scan or ERCP. Results: 81 patients underwent CCX afterinitial evaluation including ERCP in 43 (53%) and ERCP + ES in 38 (47%).Of the 34 patients with no CCX, 33 underwent successful ERCP + ES only.Mean follow-up was 22 months (range 8-49). Recurrent pancreatitis wasseen in 3 (3.7%) in CCX group (CBD stone in 2, papillary stenosis in 1), andin 2 (5.8%) in ERCP + ES only group (CBD stone and papillary restenosisin one, alcohol induced in other - this patient also had cholecystitis). 10patients in ERCP + ES only group had follow-up US and showed persis-tent GB stones in 8 and disappearance of GB stones in 2. Procedure relat-ed complications included one patient with cystic duct leak in CCX groupand one with mild ERCP induced pancreatitis in ERCP + ES only group.Conclusions: Recurrent pancreatitis after ERCP + ES only for gallstonepancreatitis is rare. In patients who have undergone ERCP + ES only forgallstone pancreatitis, CCX should be considered only in presence of symp-tomatic GB disease such as cholecystitis, cystic duct obstruction, etc. andnot just to prevent recurrent gallstone pancreatitis.

*4679MOTHER AND BABY CHOLANGIOSCOPY. A SINGLE CENTREEXPERIENCE, INDICATIONS AND LIMITATIONS.Andrew P. Chilton, Ian A. Fraser, Chukka U. Nwokolo, Duncan E. Loft,Walsgrave Hosp, Coventry, United Kingdom.Peroral Mother and Baby cholangioscopy (MBC) allows direct visualizationof the biliary tree. The proceedure requires a dedicated duodenoscope(Mother scope) with a 5.5mm therapeutic channel through which a 4.5mmcholedochoscope (baby scope) can instrument the biliary tract. The babyscope has bi-directional tip control and a therapeutic channel allowingbrushings, biopsies, electrohydraulic lithotripsy (EHL) and laser lithotrip-sy to be undertaken. Methods: MBC has been undertaken at our institu-tion from November 1992 in the treatment of selected patients and lesionswhich have resisted conventional endoscopic treatments or provided diag-nostic diffeculties. All EHL was carried out with a Piezo electriclithotripter. Results: From November 1992 to March 1999, cholangioscopywas performed on 18 occasions in 16 patients (44% female and 56% male)with a median age of 64 (range 42-82 years). Choledocholithiasis was theindication in 14 patients (10 single stones, 4 multiple stones). In twopatients the stones spontaneously cleared and no further action wasrequired. EHL was performed in 12 patients, facilitating complete ductclearance in seven. Clearance was not possible in five patients, two werestented and remain well, three underwent surgical exploration of the com-mon bile duct. In two of the 16 patients diagnostic MBC was performed,one for a problematic right hepatic ductal stricture which MBC revealed tobe an unusual case of pan-sclerosing cholangitis. The 2nd patient had aright hepatic duct mass thought to be an impacted stone, MBC diagnosedan unusual case of biliary papillomatosis. A 100% success rate in intuba-tion of the common bile duct was achieved and no proceedure related com-plications were encountered. Conclusion: Most stones can be delt with viaconventional therapeutic ERCP, however experience has formulated thefollowing indications for MBC. Lithotripsy of a single large ductal stoneand impacted stones. Diagnosis of unusual strictures and filling defects.Limitations to MBC are multiple stones and CBD diameter (preferably ≥8mm). All patients undergo prior ERCP and sphincterotomy and at MBCballoon dilation of the ampulla is performed prior to insertion of the chole-dochoscope.

*4680REVERSIBILITY OF KUPFFER CELLS DYSFUNCTION IN RATSWITH OBSTRUCTIVE JAUNDIC: PHAGOCYTIC FUNCTION ANDPRODUCTION OF REACTIVE OXYGEN SPECIES EVALUATED BYFLOW CYTOMETRY.Wen Li, Billy Cs Leung, James Yw Lau, Enders Kw Ng, Angus Cw Chan,Sydney Sc Chung, The Chinese Univ of Hong Kong, Hong Kong, P. R.China.Background: The function of the reticuloendothelial system is impaired inobstructive jaundice. The effects of obstructive jaundice on Kupffer cellsand the influence of internal and external drainage are unclear. Aims: Tostudy the effect of internal and external drainage on Kupffer cell phagocy-tosis and production of reactive oxygen species in rats with obstructivejaundice. Materials and Methods: Fifty male Sprague-Dawley rats weigh-ing 300-350 g were randomly assigned to 4 groups: sham operation (SH, n= 11), obstructive jaundice by bile duct ligation and division (OJ, n = 12),internal drainage by choledochoduodenostomy (ID, n = 13) and externaldrainage by exteriorizing a biliary drainage tube at the nape (ED, n = 14)on day 7 after bile duct ligation. Kupffer cells were isolated by flow cyto-metric sorting 7 days later. The phagocytic function of the Kupffer cells wasmeasured by flow cytometry using fluorescent microspheres (1.72 µm). Theproduction of reactive oxygen species (ROS) was assayed by flow cytome-try using dihydrorhodamine 123 (DHR) with phorbol myristate acetate(PMA) as an activator. Results: The phagocytic function was suppressed inOJ rats (20.8±7.4%) compared with SH rats (41.3±23.2%) (P=0.007). Afterdrainage procedures, the depressed Kupffer cell function was reversed byID (37.0±15.2%) (P=0.036), but not by ED (21.6±7.0%) (P=1.000). Therelease of ROS was higher in the OJ rats (1.35±0.36) than in the SH rats(0.98±0.09) (P=0.042). After drainage, the ROS production returned to nor-mal levels in the ID rats (0.97±0.11) (P=0.032), but remained high in theED rats (1.35±0.46) (P=1.000). Conclusion: Kupffer cell functions, includ-ing phagocytosis and release of reactive oxygen species, are impaired inobstructive jaundice. Internal biliary drainage, but not external drainage,causes recovery of Kupffer cell functions.

*4681ENDOSCOPIC MANAGEMENT OF PSC PATIENTS SUFFERINGFROM DOMINANT BILE DUCT STRICTURES.Hassan Abou-Rebyeh, Tarek Sabha, Wilfried Veltzke-Schlieker, AndreasAdler, Bertram Wiedenmann, Rainer Eckhard Hintze, Gastroenterology,Charite-Virchow, Humboldt-University, Berlin, Germany; Gastro-enterology, Charite-Virchow-Klinikum, Berlin, Germany.Introduction: In general, PSC patients are in good condition for manyyears until progressive bile duct stenoses lead to cholestasis deterioratingphysical condition. Extrahepatic bile duct stenoses contributing to symp-tomatic cholestasis in PSC patients are referred to as dominant stenoses.So far, reported techniques and outcome of endoscopic dilation therapy ofdominant stenoses are contradictory. Aim: We estimated the benefit ofendoscopic dilation of dominant stenoses in patients with PSC. Methods:Our PSC patient pool of the last 9 years (Nov. 90 - Oct. /99) was studied ret-rospectively. Dominant stenoses were treated by balloon dilation and boug-inage. Stenting of dominant stenoses was only carried out in case of unsuc-cessfull dilation therapy. Results: 72 patients suffering from symptomaticPSC were investigated by ERC. 40% (29/72) of all PSC patients presenteddominant stenoses. The mean age was 40.9±14.2 years, 65% (19/72) weremale and 35% (10/72) female. Patients suffering from dominant stenoseswere treated by repeated dilation procedures (98 interventions in 29patients, mean: 3.4 interventions per patient). Endoscopic therapyimproved physical condition as well as decreased cholestatic parameters.AST, ALT, AP, gGT and bilirubin (78% from 6.1±6.4 down to 1.4±0.6 mg/dl).98 interventions were accompanied by 8.2% of complications in terms ofpost-ERC pancreatitis (2.0%), CBD perforation (3.1%) and post-ERCcholangitis (3.1%). All complications were considered as mild to moderatesince all disappeared within a few days following conservative therapy.Discussion: Many PSC patients suffer from extrahepatic dominant bileduct stenoses. Dilation therapy was able to widen dominant stenoses aswell as to relieve cholestasis thus improving the general state of health.Conclusively, we recommend to screen symptomatic PSC patients for dom-inant bile duct stenoses. Dominant bile duct stenoses should be repeated-ly treated by endoscopic dilation therapy since most afflicted PSC patientsbenefit significantly.

VOLUME 51, NO. 4, PART 2, 2000 GASTROINTESTINAL ENDOSCOPY AB201