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1. Methods: Intra-operative cholangiogram, pancreatic histology and ultrastructure examination, serum and bile amylase measurements were carried out on 25 children with choledochal cysts.

2. ERCP and empiric sphincterotomy in patients who do not have stones on cholangiogram nor are they at high risk for stones are thus likely at greater risk of pancreatitis.

3. The investigators thus concluded that ES reduced cholangitis in patients, with 1 documented attack of cholangitis and a high risk of stones even when no stones were seen on cholangiogram.

4. Sometimes the patient looks and smells just like a common duct stone but no filling defect or stone is seen in the biliary tree on cholangiogram.

5. Siddique et al17 studied 78 patients who had a sphincterotomy despite a normal cholangiogram and found 25% to have small stones not seen on cholangiogram.

6. The present article by Lee et al1 further supports the idea that an ES may be beneficial in certain situations, even with a normal cholangiogram.

7. Methods 991 patients with cholangio-pancreatic duct diseases were collected, 990 of 991 cases underwent surgery and T-tube cholangiogram, other one underwent barium meal.

8. Three previous studies examined the issue of an ES with an inconclusive cholangiogram before the present study by Lee et al1 and found mixed results.

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9. Conclusion All of patients with cholangio-pancreatic duct diseases should be examined ordinarily by barium meal in upper digestive tract preoperatively and T-tube cholangiogram postoperatively.

10. Patients with histological, biological and clinical features of PSC but with normal cholangiogram are diagnosed as small duct PSC.

11. Cut the sphincter and sweep and explore the duct or trust your cholangiogram and not cut the sphincter?