7% (18/19). The mean time required to reach CHIR-99021 supplier the blind end was 34.0 min. The diagnostic success rate was 89.5% (17/19). The mean procedure time was 72.6 min. The success rate of overall modified SBE-assisted ERC was 78.9% (15/19). The complication rate was 26% (hyperamylasemia in four patients). Conclusion: Diagnostic and therapeutic ERC using our novel approach of modifying SBE without the use of special or prototype instrumentation or enteroscope replacement is safe and effective. Key Word(s): 1. single-balloon enteroscopy; 2. endoscopic retrograde cholangiography (ERC); 3. roux-en-y reconstruction; 4. billroth-II gastrectomy Presenting Author: AKIRA TERAMOTO Additional Authors:

KASEN KOBASHIKAWA, KOTA TOMISATO, AKIYUKI KONDO, ATSUSHI IRAHA, SHOKO NAKAMURA, SHINOBU MATSUKAWA, AKIRA YABUTANI, MASAMOTO NAKAMURA, TOMOKUNI NAKAYOSHI, NOBUFUMI UCHIMA, FUKUNORI KINJYO, SHINICHIRO KAMEYAMA, TOMONARI ISHIMINE, TSUTOMU ISA, AKIO YANAGISAWA Corresponding Author: AKIRA TERAMOTO Affiliations: Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Urasoe General Hospital, Kyoto Prefectural

Hospital of Medicine Objective: Introduction: Inflammatory pseudo-tumor (IPT) is an uncommon cause of cholangitis, composed of inflammatory cell infiltration and proliferating

fibrous tissues. Even with imaging devices, click here ERCP and cytodiagnosis that we have today, it is difficult to deny malignant neoplasm and the final diagnosis is relied on pathological outcome of surgically dissected specimen in many cases. Methods: Presentation of case: A 35year-old-man has been followed at our hospital since 2009 for chronic liver dysfunction. The cause of liver dysfunction was not identified from his hepatic biopsy and serum tests. In 2013, he has presented to our hospital with complaint of epigastric pain and ultrasonography showed upper bile duct dilation up to 8 mm. Stenosis with thickened biliary wall was located at lower bile duct using enhanced CT and MRCP, 4-Aminobutyrate aminotransferase and this was seen as a hypo-echoic tumor-like lesion in EUS. ERCP was performed and there was no malformation of Vater’s papilla or malfusion of pancreaticobiliary ducts. Main findings of cholangiography were (A) biliary stenosis at mid ∼ lower part of common bile duct, (B) caliber variations at the base of right hepatic ducts. Biopsy forceps and cytodiagnosis brush were used for biopsy at (A), and eight bile specimen were collected from ENBD but malignancy was not proven pathologically. Pancreaticoduodenectomy was conducted as the patient gave his consent to the proposal of surgery. The pathological outcome was consistent with chronic cholangitis with small duct hyperplasia, showing the nature of IPT.