The success of the procedure and the complete removal of lithiasis in this first study were: in group A 97.1% and 70% , in group B 100% and 86.4%, respectively, without significant differences. Seven or ten Fr plastic stent was placed in group A 30.4% and group B 18.2%, without ABT-888 in vivo significant differences. Comparing only the giants stones was noted that the successful stones extraction in the first ERCP was in group A 58.6% and group B 89.3% (p = 0.019). The use of mechanical lithotripsy in group A was 44.8% and in

group B 21.4%, without significant difference. With respect to complications in group A was 5.8% (1 perforation, 2 cholangitis and 1 binding of basket) and in group B was 6.8% (2 mild pancreatitis, 1 cholangitis). There was no death in both groups following the ERCP. Conclusion: The combination of sphincterotomy and large volumes balloon dilation in the treatment of difficult stones is equally effective and safe as in sphincterotomy alone. The combination therapy was

more effective in the management of giant stone. Key Word(s): 1. choledocholithiasis; Presenting Author: HUIJER HWANG Additional Authors: RAUL MATANO, MARTIN GUIDI, JULIO DE MARIA, ESTEBAN PROMENZIO, FERNANDO Bortezomib RAGONE, JUAN VISCARDI Corresponding Author: HUIJER HWANG Affiliations: El Cruce Hospital Objective: Hiliar tumors (HT) are neoplasms with a poor prognosis and most patients die within a year of diagnosis. While surgery is the standard for curative treatment, in most cases the

Phosphoprotein phosphatase goal is palliative treatment. Endoscopic biliary drainage (EBD) and percutaneous biliary drainage (PBD) are two minimally effective invasive techniques. It is not known with certainty what is the approach of choice. Several studies have shown that EBD can be difficult in Bismuth III and IV tumors because of the high risk of post-procedure cholangitis. Aim: To report the effectiveness and complications of EBD and PBD in the palliative management of HT. Methods: Descriptive observational retrospective analysis of the management of HT in a Trainning Center of ERCP, from October 2008 to March 2012. We analyzed the following variables in the groups treated with EBD and PBD: rate of effective drain, reintervention rate, survival, complications and death associated with the procedure. Results: We included in EBD group: 40 patients and 52 procedures and in PBD group: 22 patients and 28 interventions. The final success in the first group was 85% and the second 90.9% (p = 0.788). Five patients (4 HT Bismuth IV) required combined approach. The global rate of success was 95.16%. Twelve patients of EBD group were Bismuth IV, whose effectiveness was 58.3%. Meanwhile, 11 patients of PBD group were Bismuth IV, whose effectiveness was 81.8% (p = 0.442). Overall survival in EBD group was 7.9 months, while in PBD group was 4.8 months. With respect to complications in the EBD group was 11.