2%), 61 cases with normal papilla (7 Fr–12 cms straight stents), migration 4 (5.8%), 8 leaks with papilla associated with peri Ampullary diverticulum (7 Fr–10 cms double pigtail stent),

proximal migration 0 and distal migration 1 (6%) and 114 cases of cholangitis (10 Fr–12 cms straight stent), migration 1 (1%). The techniques of stent removal were – Total 104 cases. Removal with balloon extractor (34 cases), rat tooth foreign body forceps (47 cases), dormia basket (16 cases) and with Soehendra retriever (7 RAD001 in vitro cases). Successful removal in all cases. Complications were 2 cases of mild pancreatitis with the rat tooth removal group. Conclusion: 1) Highest stent migration rate was in cases where 7 r–10 cms stents were placed in papilla associated with peri Ampullary diverticulum. 2) Double pigtail stents prevent proximal migration. But the distal migration prevents them from being put for long term intention. 3) 10 Fr stents exhibit the least proximal migration rates. 4) The rat tooth foreign body forceps is the best modality of retrieval of proxiamally migrated Biliary stents followed by balloon extraction. Key Word(s): 1. proximal biliary stent migration; 2. type of stents; 3. method of retrieval Presenting Author:

this website PANKAJ DESAI Additional Authors: MAYANK KABRAWALA Corresponding Author: PANKAJ DESAI Affiliations: Gastro Care Objective: A study 18 cases of draining pseudocysts complicated by portal hypertension and gastric varices with EUS guided locating the site of puncture distally on the bulge. Methods: 18 cases from all that were referred to us from 1st January 2011 to May 30, 2014 with pseudocysts Amino acid were found to be complicated with fundic and esophageal

varcies secondary to splenic vein. UES revealed big varices around the GE junction and the proximal body and no window was found for EUS guided cyst drainage in the conventional manner. The bulge of the cyst was followed distally with an EUS scope and an area devoid of varices was found distally. Here the tip of the EUS scope was fully up and it was impossible to get a 19G needle out for puncture and further steps of conventional cyst drainage. Therefore we marked the area with biopsy forceps taking a pinch of tissue for identification on passage of the side viewing scope subsequently. A conventional ERCP 4.2 mm channel scope from Olympus was then passed, positioned in front of the marked area and the cyst punctured around the mark with a needle knife papillotome from Boston and guide wire placed under fluoroscopic control. The tract was then dilated with a 6.5 Fr cystotome from Endoflex and dilated with a CRE balloon up to 12 mm only to avoid bleeding. Two 10 Fr Double pig tail stents were kept. In cases with necrosis and additional naso cystic catheter was placed for lavage which was removed after 48 to 72 hours exchanging it for an additional 10 Fr DPT stent.