The Kaplan-Meier method and the log-rank test for evaluable patients at the endpoint were used for differences in stent patency and survival on an intention to treat basis. Between 05/ 2009 and 06/ 2012, 400 patients were randomized at 9 sites. Currently 390 patients are evaluable, 197 patients in nSEMS group and 193 in sSEMS have reached the endpoint. 7 patients refused follow-up and 17 patients were eventually operated upon. Median age was 77 (38-99) years in nSEMS and 78 (35-96) in sSEMS. Pancreatic cancer was the cause of obstruction in 152 (78.4%) nSEMS and 148 (78.3%) sSEMS. ERCP-related complications occurred in 15 (7.6%)

nSEMS and GSK2126458 in vivo 10 (5.3%) sSEMS, p= 0.35. Protocol violations consisted of too close distance of the stricture to hilus (<2cm), too short or wrong stent, occurred in 11 (5.9%) nSEMS and 23 (12.4%) sSEMS, p=0.03. Death within 300 days with patent stent occurred in 124 (62.9%) nSEMS and 108 (56.0%) sSEMS, p=0.18. Alive at 300 days with patent stent were 44 (22.3%) nSEMS and 38 (19.7%) sSEMS, p=0.54. Stent failure confirmed by new ERCP,

occurred in 14 (7.1%) nSEMS and 30 (15.5%) sSEMS, p=0.01. Stent dislocation was observed in 4 (2.6%) nSEMS and 14 (5.5%) sSEMS and tumour overgrowth in 7 (2.6%) nSEMS and 10 (4.4%) sSEMS. The results of this randomized trial shows significantly prolonged find more patency time and less failure rate in nSEMS compare to sSEMS in the palliation of malignant distal biliary obstruction. “
“Accurate diagnosis of indeterminate biliary strictures remains a clinical challenge. The aim of this study was to assess the operating characteristics of fluorescence in situ hybridization (FISH) compared to cholangioscopic (Spyglass) targeted biopsies for the detection

of malignancy in biliary tract strictures. We conducted a retrospective analysis of data from two tertiary medical centers of patients who underwent evaluation of indeterminate biliary strictures between 2008 to 2012. Only those patients with a final pathologic diagnosis or a conclusive >12 months follow-up were included in the final analysis. Patients were divided into 2 groups: patients who underwent biliary stricture brushing for cytology and FISH assessment (C-FISH) PFKL nd patients who underwent Spyglass targeted biopsies of biliary strictures after inconclusive brush cytology (SB). Spyglass biopsies were considered positive for malignancy when adenocarcinoma cells were identified (atypical or suspicious results were considered negative). FISH was considered positive for malignancy when either CEP3, 7, 17 polysomy and/or 9p21 deletion was observed. The comparison of the operating characteristics of FISH versus cholangioscopic targeted biopsies for the diagnosis of malignant strictures were performed with the use of a Chi-squared test and Fisher exact test.