S52 Abstracts old) who presented to the clinic with abdominal pain, weight loss and generalized weakness; she had no fever. On physical examination she appeared pale, with no sign of jaundice; an abdominal examination revealed pain in the upper abdomen. Blood count revealed anaemia (the level of haemoglobin was 10.3 g per deciliter). No signs of cholangitis were present. Tumoral markers were normal. A transabdominal ultra- sonography showed a mass in the area of the head of the pancreas, apparently out of the pancreas, with defined margins, 58 mm of size. The patient underwent a CT that showed an irregular, inhomogeneous pancreatic head, with suspected infiltration of the peri-pancreatic tissue. The patient came to our observation to perform an EUS with a biopsy of the lesion. We used a Pentax linear echoendoscope (EG3830UT). In the duodenal bulb we observed a fistula orifice, about 10 millimeter diameter, with a stone inside and bile coming from around the stone. The endosonographic view confirmed the communication between the common bile duct and the duodenal bulb. Stones were present in the bile duct between the fistula and the papilla of Vater; sludge and micro- stones were inside the proximal choledochus. There was a mild dilation of the intra-hepatic biliary tree. The pancreatic head was inhomoge- neous, hypoechoic, as in case of surrounding inflammatory reaction, with no clear focal lesions. The fistula was cannulated with a 18 F balloon under optical view and endosonography confirmation, without Rx-assistance, and stones were removed from the proximal biliary tract; after the procedure dark bile and debris came into the bulb lumen. The examination was completed with an ERCP in the radiological room: a sphincterotomy was performed and multiple stones were extracted with a Dormia basket. Then a pediatric endoscope (5 mm diameter) was passed through the fistula and explored the distal biliary tract till the papilla and the proximal tract till its division in secondary branches. At this examination the biliary lumen was clean, without material inside. The patient was discharged after few days in a good healthy state and she is now without symptoms. Chronic inflammation around stones in the common bile duct, edema and scarring can lead to fistula formation, sometimes mimicking a tumor in the elderly. V3.4 LAPAROSCOPIC NISSEN FUNDOPLICATIO WITH DIVISION OF SHORT GASTRIC VESSELS (VIDEO) M. Ciannel1a*, V. Borrelli, G. Capece, F. Persico, M. Giuffre, C.P. De Angelis, C. Fonderico, L. Angrisani u.O.Complessa Chirorgia lilparoscopica Mininvasiva PO. "s. Giovanni Bosco" ASLNa1, Napoli Background and aim: Laparoscopic fundoplicatio has been shown to be a very effective operation in the treatment of patients with gastro- oesophageal reflux disease with or without hiatal hernia. Dividing the short gastric vessels during surgery for gastro-oesophageal reflux is controversial. This video depicts the salient operative features for performing a orig- inallaparoscopic Nissen fundoplicatio technique with division of the short gastric vessel. Material and methods: The pneumoperitoneum was established by using a Veress needle placed at the midclavicular costal margin. The procedure was performed trough 4 trocars (three 5 mm, one 10 mm) and one 10 mm for the 30° camera digital Olympus (Visera). The gastrohepatic ligament and the gastrophrenic ligament are divided ex- posing the anterior wall of the oesophagus. The oesophagus is than safely mobilized. The next step in the procedure is to legate the short gastric vessels (three or four). The Harmonic scalpel or clips are used for the division of the short gastric vessel beginning at a point high on the greater curvature. If necessary, on the presence of a hiatal hernia, a posterior cruroplasty is carried out. A 360-degree fundoplication is cre- ated loosely around the 33F bougie, with 2 interrupted nonabsorbable sutures (one of them including the oesophageal wall). Important tech- nical elements included crural and hiatal dissection, crural closure, and fundic mobilization by dividing the short gastric vessels in all patiens Results: 33 patients, 15 women and 18 men (age: 21 to 73; mean age: 42) BM!: 31 (range 19-42) were examined. 27 patients underwent a laparoscopic Nissen fundoplicatio with a divi- sion of the short gastric vessel with a Harmonic scalpel (Ultracision) and 6 patients with a metallic clips. The conversion rate and the complication rate were 0%. The mean time of the operation was 90 min. Conclusions: With strict selection criteria and increasing experience and standardization of technique the laparoscopic approach is an effective, safe and more satisfying alternative for the patients with gastroesophageal reflux disease. V3.5 BRAVO CAPSULE pH·METRY: TECHNIQUE OF POSITIONING B. Demarchi, S. Erra, M. Pastormerlo, M. Pavesi, C. Gemme ASL 21, Casale Mon/errato (AL) Background and aim: oesophageal pH monitoring is a useful test for the diagnosis of gastro-oesophageal refl ux disease but has some limi- tations due to patient's discomfort. Recently a telemetric catheter-free system (Bravo, Medtronic) has developed. The aim of this videotape is to show the technique of capsule placement in the oesophagus. Material and methods: the bravo system consists of two primary components: a small pH capsule that is attached at the wall of the oesophagus and transmits data to receiver, and a pager-sized receiver that receives pH data from the Bravo capsule. Results: first step is to complete a capsule calibration before starting the study. Consequently it starts the oral placement connecting, first, the vacuum line to the vacuum fitting on the Bravo handle and verifying that the vacuum is properly functioning. Afterwards it needs to endo- scopically determine the desired location to place the capsule in the oesophagus. Then, with vacuum off advance the Bravo pH capsule with delivery system through the mouth to the right position being careful not to move the catheter. After proper placement, tum on vacuum source and apply a minimum of 510 mmHg to the delivery system for at least 30 seconds for the tissue to fill the suction chamber. Then depress the plunger on top of the handle to advance the locking pin and rotate the plunger a quarter of a tum clockwise to release the capsule. Verify the plunger springs back a minimum of 2 cm by manually pushing it back to its complete starting position. Remove the delivery system and confirm capsule attachment by reinserting the endoscope into the patient's oesophagus. Conclusions: Bravo pH capsule placement is easy, quick and feasible also in not referrals centres. V3.6 SUCCESSFUL MANAGEMENT OF BLEEDING DUODENAL VARICES BY ENDOSCOPIC INJECTION OF N·BUTYL·2-CYANOACRYLATE (GLUBRAN 2) C. Macor*, D. Berretti, M. Marino, R. Maieron, S. Pevere, P. Rossitti, L. Zoratti, M. Zilli SOC di Gastroenterologia AO S. Maria della Misericordia, Udine Background and aim: Bleeding from ectopic varices accounts for 1.6%-6% of all bleeding related to portal hypertension due to cirrhosis. Bleeding from the duodenal varices, although rare, is often massive and life-threatening. Treatment options include endoscopic band ligation, injection sclerotheraphy, TIPS, B-RTO (Balloon-Occluded Retrograde Transvenous Obliteration) and surgery. There is no consensus on the best management of bleeding duodenal varices, and randomized studies