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Abstract
The Guest Editors have assembled key opinion leaders to provide state of the art articles on this important update on ERCP. A chapter on cannulation techniques and sphincterotomy will highlight recent literature on wire-guided cannulation, use of papillotomes, when and if to precut for entry and the use of smart circuitry for papillotomy. A chapter on surgically altered anatomy will highlight the increasing occurrence of biliary tract disease in patient’s s/p gastric bypass for obesity along with other surgery and the use of balloon enteroscopes, overtubes and intraoperative procedures A chapter on EUS assisted biliary and pancreatic access will highlight the growing experience with these combine techniques. There is growing literature on preventing post-ercp pancreatitis which is changing the standard of care and Joe Elmunzer is the best person to highlight this. Stu Sherman will review advances in the management of bile duct stones and when to intervene in gallstone pancreatitis. Peter Cotton just published a landmark study on SOD that will change the standard of care and will review the state of the science on this disease as it relates to both biliary tract and pancreatic disease. The management of benign biliary strictures and leaks is evolving with the introduction of covered metal stents and Jacques Deviere is at the forefront. Amrita Sethi will discuss diagnosis of biliary malignancy highlighting the use of FISH, molecular markers and enhanced imaging such as pCLE. Michele Kahaleh will review recent experience with biliary tumor ablation using RFA probes and PDT. Alan Barkun helps endoscopists determine when to use plastic stents, metal stents, and covered stents and when to drain one, two or three segments of liver in patients with malignant biliary obstruction. George Papachristo and Dhiraj Yadav will review most recent data on endoscopic therapy for acute recurrent and smoldering acute pancreatitis. Nagy Reddy will provide on update on endotherapy for painful chronic pancreatitis. Finally, Raj Shah will update on advances in pancreatoscopy and cholangioscopy including the use of ultra slim per-oral scopes and new digital mother/baby scopes.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Advances in ERCP\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
CONSULTING EDITOR | iii | ||
EDITOR | iii | ||
AUTHORS | iii | ||
Contents | vii | ||
Foreword: Advances in Therapeutic Endoscopic Retrograde Cholangiopancreatography: Benefits Far Outweigh the Small Risks\r | vii | ||
Preface: Advances in Endoscopic Retrograde Cholangiopancreatography\r | vii | ||
Difficult Biliary Access: Advanced Cannulation and Sphincterotomy Technique\r | vii | ||
Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy\r | vii | ||
Endoscopic Retrograde Cholangiopancreatography for the Management of Common Bile Duct Stones and Gallstone Pancreatitis\r | vii | ||
Diagnosing Biliary Malignancy\r | viii | ||
Stenting in Malignant Biliary Obstruction\r | viii | ||
Benign Biliary Strictures and Leaks\r | viii | ||
Preventing Postendoscopic Retrograde Cholangiopancreatography Pancreatitis\r | ix | ||
Endoscopic Treatment of Recurrent Acute Pancreatitis and Smoldering Acute Pancreatitis\r | ix | ||
Sphincter of Oddi Dysfunction\r | ix | ||
Pancreatic Endotherapy for Chronic Pancreatitis\r | ix | ||
Innovations in Intraductal Endoscopy: Cholangioscopy and Pancreatoscopy\r | x | ||
Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation\r | x | ||
Endoscopic Ultrasound–Assisted Pancreaticobiliary Access\r | x | ||
GASTROINTESTINAL ENDOSCOPY CLINICS\rOF NORTH AMERICA\r | xi | ||
FORTHCOMING ISSUES | xi | ||
January 2016 | xi | ||
April 2016 | xi | ||
July 2016 | xi | ||
RECENT ISSUES | xi | ||
July 2015 | xi | ||
April 2015 | xi | ||
January 2015 | xi | ||
Foreword\r | xiii | ||
REFERENCES | xiv | ||
Preface\r | xv | ||
Difficult Biliary Access | 619 | ||
Key points | 619 | ||
INTRODUCTION | 619 | ||
GUIDEWIRE-ASSISTED CANNULATION | 620 | ||
PANCREATIC DUCT TECHNIQUES | 621 | ||
PRECUT SPHINCTEROTOMY | 621 | ||
TRANSPANCREATIC SEPTOTOMY | 623 | ||
ADDITIONAL VARIATIONS ON PRECUT | 624 | ||
COMPARING TECHNIQUES | 624 | ||
INTRADIVERTICULAR PAPILLA | 624 | ||
DEVICES | 625 | ||
SUMMARY | 625 | ||
REFERENCES | 626 | ||
Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy | 631 | ||
Key points | 631 | ||
INTRODUCTION | 632 | ||
TERMINOLOGY | 633 | ||
PREPARATION FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A CHECKLIST FOR THE ENDOSCOPIST | 634 | ||
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN ALTERED BOWEL ANATOMY WITHOUT ALTERATION OF BILIOPANCREATIC ANATOMY | 635 | ||
Gastric Reconstructive Procedures | 635 | ||
Billroth I reconstruction | 635 | ||
Billroth II reconstruction | 637 | ||
Subtotal gastrectomy or gastric bypass with Roux-en-Y anastomosis | 641 | ||
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN ALTERED BOWEL ANATOMY WITH ALTERATION OF BILIOPANCREATIC ANATOMY | 646 | ||
Whipple Operation (Pancreatoduodenectomy) | 646 | ||
Roux-en-Y Hepaticojejunostomy Reconstruction | 649 | ||
ADVERSE EVENTS RELATED TO ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN SURGICALLY ALTERED ANATOMY | 650 | ||
SUMMARY | 652 | ||
ACKNOWLEDGMENTS | 652 | ||
SUPPLEMENTARY DATA | 652 | ||
REFERENCES | 652 | ||
Endoscopic Retrograde Cholangiopancreatography for the Management of Common Bile Duct Stones and Gallstone Pancreatitis | 657 | ||
Key points | 657 | ||
SYMPTOMATIC CHOLEDOCHOLITHIASIS AND BILIARY PANCREATITIS: WHEN TO IMAGE, INTERVENE, OR OBSERVE | 657 | ||
STANDARD ENDOSCOPIC TECHNIQUES FOR STONE EXTRACTION AND “DIFFICULT” BILE DUCT STONES | 659 | ||
BILIARY ENDOPROSTHESIS | 659 | ||
ENDOSCOPIC BALLOON PAPILLARY DILATION | 661 | ||
Endoscopic Balloon Papillary Dilation Without Endoscopic Sphincterotomy | 661 | ||
Endoscopic Balloon Papillary Dilation after Endoscopic Sphincterotomy | 663 | ||
LITHOTRIPSY | 663 | ||
Mechanical Lithotripsy | 663 | ||
Electrohydraulic Lithotripsy | 666 | ||
Intracorporeal Laser Lithotripsy | 666 | ||
Extracorporeal Shockwave Lithotripsy | 668 | ||
CHOLANGIOSCOPY | 668 | ||
DISCUSSION: ALGORITHM FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS | 669 | ||
REFERENCES | 671 | ||
Diagnosing Biliary Malignancy | 677 | ||
Key points | 677 | ||
INTRODUCTION | 677 | ||
CAUSES OF BILIARY STRICTURES | 678 | ||
LABORATORY EVALUATION | 678 | ||
IMAGING EVALUATION | 679 | ||
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY | 679 | ||
FLUORESCENCE IN SITU HYBRIDIZATION | 680 | ||
ENDOSCOPIC ULTRASONOGRAPHY: FINE-NEEDLE ASPIRATION | 681 | ||
INTRADUCTAL ULTRASONOGRAPHY | 681 | ||
CHOLANGIOSCOPY | 682 | ||
CONFOCAL LASER ENDOMICROSCOPY | 684 | ||
CHOLANGIOCARCINOMA IN PRIMARY SCLEROSING CHOLANGITIS | 685 | ||
SUMMARY | 686 | ||
REFERENCES | 687 | ||
Stenting in Malignant Biliary Obstruction | 691 | ||
Key points | 691 | ||
INTRODUCTION | 691 | ||
WHO SHOULD UNDERGO BILIARY DRAINAGE? | 692 | ||
BILIARY DRAINAGE FOR UNRESECTABLE DISTAL BILIARY LESIONS | 692 | ||
BILIARY DRAINAGE OF HILAR LESIONS: MAPPING AND MINIMIZING RISK OF ENDOSCOPIC DRAINAGE | 692 | ||
PROPHYLACTIC ANTIBIOTICS | 694 | ||
AVAILABLE TECHNOLOGIES FOR BILIARY DRAINAGE | 695 | ||
Plastic Stents | 695 | ||
Self-Expandable Metal Stents | 695 | ||
THE USE OF SPHINCTEROTOMY | 697 | ||
INSERTION OF STENTS ABOVE VERSUS ACROSS THE SPHINCTER OF ODDI | 699 | ||
PLASTIC STENTS VERSUS SELF-EXPANDABLE METAL STENTS | 701 | ||
HILAR NEOPLASMS: SPECIAL CONSIDERATIONS | 701 | ||
SIDE-BY-SIDE METHOD VERSUS STENT-IN-STENT METHOD | 702 | ||
PERCUTANEOUS DRAINAGE AND THE CHOICE OF APPROACH: ENDOSCOPIC VERSUS RADIOLOGICAL | 703 | ||
RECURRENT BILIARY OBSTRUCTION AFTER INITIAL DRAINAGE | 704 | ||
CHOLYCYSTITIS AND CHOLANGITIS | 704 | ||
RECENT INNOVATIONS | 705 | ||
Nonconventional Approaches to Malignant Biliary Drainage | 705 | ||
Radioactive Stents | 705 | ||
Three-Dimensional Endoscopic Retrograde Cholangiopancreatography | 705 | ||
SUMMARY | 706 | ||
REFERENCES | 706 | ||
Benign Biliary Strictures and Leaks | 713 | ||
Key points | 713 | ||
INTRODUCTION | 713 | ||
POSTOPERATIVE BILIARY STRICTURES AND LEAKS | 714 | ||
BILIARY STRICTURES SECONDARY TO CHRONIC PANCREATITIS | 718 | ||
BILIARY STRICTURES DUE TO PRIMARY SCLEROSING CHOLANGITIS | 719 | ||
AUTOIMMUNE CHOLANGIOPATHY | 719 | ||
SUMMARY | 720 | ||
REFERENCES | 721 | ||
Preventing Postendoscopic Retrograde Cholangiopancreatography Pancreatitis | 725 | ||
Key points | 725 | ||
OVERVIEW | 725 | ||
PATIENT SELECTION | 726 | ||
RECOGNIZING PATIENTS AT INCREASED RISK FOR POSTENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS | 727 | ||
PROCEDURE TECHNIQUE | 728 | ||
PROPHYLACTIC PANCREATIC STENT PLACEMENT | 729 | ||
PHARMACOPREVENTION | 730 | ||
Should Rectal Nonsteroidal Anti-Inflammatory Drugs Be Given Routinely in Low-Risk Endoscopic Retrograde Cholangiopancreatog ... | 731 | ||
What Is the Optimal Dose and Timing of Administration of Rectal Nonsteroidal Anti-Inflammatory Drugs? | 731 | ||
Can Nonsteroidal Anti-Inflammatory Drugs Be Effectively Administered via Other (Nonrectal) Routes? | 731 | ||
Can Rectal Nonsteroidal Anti-Inflammatory Drugs Replace Prophylactic Pancreatic Stent Placement in High-Risk Cases? | 732 | ||
REFERENCES | 734 | ||
Endoscopic Treatment of Recurrent Acute Pancreatitis and Smoldering Acute Pancreatitis | 737 | ||
Key points | 737 | ||
INTRODUCTION | 737 | ||
RECURRENT ACUTE PANCREATITIS | 738 | ||
Pancreas Divisum–Associated Recurrent Acute Pancreatitis and the Utility of Endoscopic Therapy | 738 | ||
Characteristics of Available Studies for Endoscopic Therapy in Divisum-Associated Recurrent Acute Pancreatitis | 738 | ||
Efficacy and Complications | 739 | ||
Conclusions Regarding Endoscopic Therapy for Symptomatic Pancreas Divisum | 739 | ||
Idiopathic Recurrent Acute Pancreatitis and the Utility of Endoscopic Therapy | 742 | ||
Characteristics of Available Studies for Endoscopic Therapy in Idiopathic Recurrent Acute Pancreatitis | 742 | ||
Efficacy and Complications | 742 | ||
Conclusions Regarding the Utility of Endoscopic Therapy in Idiopathic Recurrent Acute Pancreatitis | 744 | ||
SMOLDERING ACUTE PANCREATITIS | 745 | ||
SUMMARY | 746 | ||
REFERENCES | 746 | ||
Sphincter of Oddi Dysfunction | 749 | ||
Key points | 749 | ||
INTRODUCTION | 749 | ||
DEFINING SPHINCTER OF ODDI DYSFUNCTION | 750 | ||
Pathogenesis | 750 | ||
Epidemiology | 751 | ||
Classification of Sphincter of Oddi | 751 | ||
DIAGNOSTIC EVALUATION | 752 | ||
Clinical Features | 752 | ||
Diagnostic Testing | 753 | ||
E1. Functional Gallbladder Disorder | 754 | ||
E2. Functional Biliary SOD | 754 | ||
E3. Functional Pancreatic SOD | 754 | ||
TREATMENT AND PREDICTORS OF RESPONSE | 755 | ||
Medical Treatment | 755 | ||
Endoscopic Treatment | 755 | ||
Predictors of Response | 757 | ||
Surgical Treatment | 758 | ||
CHALLENGES AND FUTURE CONSIDERATIONS | 758 | ||
SUMMARY | 759 | ||
REFERENCES | 759 | ||
Pancreatic Endotherapy for Chronic Pancreatitis | 765 | ||
Key points | 765 | ||
INDICATIONS AND CONTRAINDICATIONS OF PANCREATIC ENDOTHERAPY | 766 | ||
TECHNIQUE/PROCEDURE | 767 | ||
Endotherapy for Pancreatic Ductal Calculi | 767 | ||
Endotherapy for Main Pancreatic Duct Stricture | 767 | ||
Endotherapy for Pancreatic Pseudocysts | 768 | ||
Endoscopic Ultrasound–Guided Access and Drainage After Failed Endoscopic Retrograde Cholangiopancreatography | 769 | ||
Endoscopic Ultrasound–Guided Celiac Plexus Block | 769 | ||
COMPLICATIONS | 769 | ||
OUTCOMES | 769 | ||
Extracorporeal Shock Wave Lithotripsy | 769 | ||
Pancreatic Duct Stenting for Strictures | 771 | ||
Drainage of Pancreatic Pseudocysts | 772 | ||
Endoscopic Ultrasound–Guided Access and Drainage After Failed Endoscopic Retrograde Cholangiopancreatography | 772 | ||
Endoscopic Ultrasound–Guided Celiac Plexus Block | 773 | ||
REFERENCES | 773 | ||
Innovations in Intraductal Endoscopy | 779 | ||
Key points | 779 | ||
INTRODUCTION: NATURE OF THE PROBLEM | 779 | ||
INDICATIONS/CONTRAINDICATIONS | 779 | ||
TECHNIQUE/PROCEDURE PREPARATION | 780 | ||
Sedation | 780 | ||
Antibiotic Prophylaxis | 780 | ||
Patient Positioning | 780 | ||
Equipment | 780 | ||
Technique | 781 | ||
Scope insertion | 781 | ||
TECHNIQUES TO IMPROVE VISUALIZATION | 781 | ||
Intraductal Lithotripsy | 781 | ||
Intraductal Biopsy | 782 | ||
DEVICE INSERTION SUGGESTIONS | 782 | ||
COMPLICATIONS AND MANAGEMENT | 782 | ||
POSTOPERATIVE CARE | 782 | ||
REPORTING, FOLLOW-UP, AND CLINICAL IMPLICATIONS | 783 | ||
OUTCOMES | 783 | ||
Cholangioscopy Outcomes | 783 | ||
Bile duct stones | 783 | ||
Suspected biliary malignancies | 783 | ||
Primary sclerosing cholangitis | 784 | ||
Pancreatic stones | 785 | ||
Intraductal papillary mucinous neoplasia | 787 | ||
CURRENT CONTROVERSIES/FUTURE CONSIDERATIONS | 788 | ||
SUMMARY | 788 | ||
REFERENCES | 789 | ||
Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation | 793 | ||
Key points | 793 | ||
INTRODUCTION | 794 | ||
PHOTODYNAMIC THERAPY | 794 | ||
Photodynamic Therapy Technique | 794 | ||
Preparation | 794 | ||
Patient position/approach | 794 | ||
Technique/procedure | 795 | ||
Photodynamic Therapy Complications/Management | 795 | ||
Postoperative Care | 796 | ||
Outcomes | 797 | ||
Current Controversy/Future Considerations | 798 | ||
RADIOFREQUENCY ABLATION | 799 | ||
Radiofrequency Ablation Technique | 799 | ||
Preparation | 799 | ||
Patient position/approach | 799 | ||
Technique/procedure | 799 | ||
Radiofrequency Ablation Complications/Management | 799 | ||
Outcomes | 802 | ||
Current Controversy/Future Considerations | 802 | ||
SUMMARY | 802 | ||
REFERENCES | 802 | ||
Endoscopic Ultrasound–Assisted Pancreaticobiliary Access | 805 | ||
Key points | 805 | ||
INTRODUCTION | 805 | ||
Background | 806 | ||
EQUIPMENT REQUIRED | 807 | ||
Echoendoscopes | 807 | ||
Fine-Needle Aspiration Needles for Ductal Access | 807 | ||
Guidewires | 808 | ||
Stents | 808 | ||
PATIENT CONSIDERATIONS FOR ENDOSCOPIC ULTRASOUND–GUIDED ANTEROGRADE CHOLANGIOPANCREATOGRAPHY | 808 | ||
TECHNICAL PROCEDURAL STEPS | 809 | ||
OUTCOMES | 809 | ||
Transpapillary Rendezvous Procedure (Anterograde Access and Retrograde Drainage) | 809 | ||
Anterograde Access and Downstream Transductal Drainage | 810 | ||
Anterograde Access and Upstream Transenteric Drainage (Hepaticogastrostomy and Choledochoduodenostomy) | 813 | ||
ENDOSCOPIC ULTRASOUND–GUIDED PANCREATIC DUCT DRAINAGE | 813 | ||
STANDARDIZED ALGORITHM FOR ENDOSCOPIC ULTRASOUND–GUIDED BILE DUCT DRAINAGE | 818 | ||
LUMEN-APPOSING TRANSLUMINAL STENT | 820 | ||
EXTENDED DRAINAGE INDICATIONS | 821 | ||
SUMMARY | 821 | ||
SUPPLEMENTARY DATA | 822 | ||
REFERENCES | 822 |