Endoscopic Interventions for the Patients with Symptomatic Choledochal Varices Do Hyun Park, Myung-Hwan Kim, Sang Soo Lee, Jung Sik Choi, Sung Koo Lee, Dong Wan Seo Background: Choledochal varices describe extrahepatic bile duct abnormalities such as stricture or indentation of bile duct by compression of collateral vessels in patients with extrahepatic portal venous obstruction (EHPVO). Cholestasis, biliary pain, fever, and cholangitis may be present in these patietns. This study was designed to evaluate the role of endoscopic interventions including long-term follow-up and procedure-related complications in patients with symptomatic choledochal varices. Methods: Record for 14 patients with extrahepatic portal vein obstruction and cavernous transformation on US, CT and MRCP with MR angiography who underwent ERCP for various biliary symptoms were retrospectively reviewed. Results: Median age of enrolled patients was 48 year (range 27-73). Male to female ratio was 1.5:1. Median follow-up period was 38.5 months. Endoscopic sphincterotomy was performed all enrolled patients, balloon dilation for stricture due to bile duct varices was performed at 2 of 14 patients, stenting for bile duct stricture due to bile duct varices was performed at 4 of 14 patients. After endoscopic intervention, recurrence of cholangitis and biliary pain occurred in one of 14 patients. Remaining patients were asymptomatic during follow-up periods. Procedure-related complication was unexpected torrential bleeding associated balloon dilation for stricture (nZ1), and balloon sweeping for stone removal (nZ1). However, successful hemostasis was achieved by prompt transpapillary endoscopic balloon compression and use of terlipressin in these patients. Conclusion: Endoscopic interventions may be useful in patients with choledochal varices for symptomatic improvement. However, endoscopic interventions for symptomatic choledochal varices should be cautiously performed because of unexpected massive bleeding during ERCP. In this situation, transpapillary endoscopic balloon compression with intravenously infusion of terlipressin may be useful for hemostasis of bleeding choledochal varices. T1300 Interpretation of Post Procedural ERCP Spot Films by Radiologists Is Prone to Significant Error Chirag Patel, Jacques Van Dam, Robert Mindelzun, Subhas Banerjee Background: ERCP has evolved from a diagnostic to a predominantly therapeutic procedure, where decisions regarding interventions need to be made immediately. Over time, radiology support during ERCP has declined due to time and other constraints. Radiologists are now rarely present during the procedure and typically ‘post read’ saved spot films. Post reading cannot guide decision making during this dynamic test and it is unclear whether it is as accurate as a dynamic read. This study was undertaken to evaluate discrepancies between endoscopists’ dynamic reading of fluoroscopic images and spot films and radiologists’ post reading of spot films alone. Methods: We reviewed the charts of 108 consecutive patients who underwent ERCP at a major US university hospital, performed by two experienced therapeutic endoscopists. Radiologists were not present during ERCP. 100 patients for whom both endoscopy and radiology reports were available (endoscopy nZ108; radiology nZ100) were analyzed for clinically relevant discrepancies. All 100 cases were also subsequently ‘post read’ in a blinded fashion by two endoscopists and an experienced GI radiologist to arrive at a consensus interpretation, against which the discrepancies were compared. Results: The radiology post read (RPR) missed 65 significant findings in 43 patients, while the endoscopy dynamic read missed 2 significant findings in 2 patients. RPR correctly identified only 20 of 34 patients with CBD stones (SensitivityZ59%; 95% CI Z 4175%), 18 of 24 biliary strictures (75%; 53-89%), 46 of 65 cases of biliary dilation (71%; 58-81%), 41 of 56 biliary stents (73%; 59-84%), 5 of 10 pancreatic ductal (PD) strictures (50%; 20-80%), 6 of 15 PD stents (40%; 17-67%) and 14 of 15 cases of PD dilation (93%; 66-100%). RPR identified 100% of bile leaks (3 of 3), PD stones/ calcifications (13 of 13) and pancreatic cysts (2 of 2). RPR identified only 61 of 143 intraductal endoscopic interventions. Conclusions: 1. Radiology interpretation of post ERCP spot films does not guide decision making during this dynamic test and adds little to the endoscopist’s read of the study. 2. The significant error rate in radiology reports is likely due to an interpretation based solely on spot films, whereas endoscopists have access to dynamic intraprocedural fluoroscopic and endoscopic images. 3. Cost analysis of endoscopist interpretation alone versus the current practice of dual interpretation will be presented.