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Advances in ERCP, An Issue of Gastrointestinal Endoscopy Clinics, E-Book

Advances in ERCP, An Issue of Gastrointestinal Endoscopy Clinics, E-Book

Adam Slivka

(2016)

Additional Information

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