BOOK
Clinical Gastrointestinal Endoscopy E-Book
Vinay Chandrasekhara | B. Joseph Elmunzer | Mouen Khashab | V. Raman Muthusamy
(2018)
Additional Information
Book Details
Abstract
Now thoroughly up-to-date, Clinical Gastrointestinal Endoscopy, 3rd Edition, by Drs. Vinay Chandrasekhara, Mouen Khashab, B. Joseph Elmunzer, and V. Raman Muthusamy, ensures that you stay current with the latest technology and techniques in GI endoscopy. An all-new editorial team, newly updated images, and a reorganized format make this reference an easy-to-use source of reliable information on a full range of topics, including anatomy, pathophysiology, and therapeutic management options, in addition to the latest GI procedures and technologies.
- Features 1,000 revised photographs, endoscopic images, and anatomical drawings.
- Provides a fresh perspective and expert guidance from an entirely new editorial team.
- Includes many more references per chapter.
- Presents material in a newly restructured, organ-based format for quick reference.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC1 | ||
| Clinical Gastrointestinal Endoscopy | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xv | ||
| Table Of Contents | xvii | ||
| Video Contents | xix | ||
| I Equipment and General Principles of Endoscopy | 1 | ||
| 1 The History of Gastrointestinal Endoscopy | 2 | ||
| Abstract | 2.e1 | ||
| Keywords | 2.e1 | ||
| Chapter Outline | 2 | ||
| Introduction | 2 | ||
| Sequential History of Endoscopy | 2 | ||
| Rigid Gastrointestinal Endoscopes | 2 | ||
| Semiflexible Gastroscopes | 4 | ||
| Biopsy | 5 | ||
| Fiberoptics | 6 | ||
| Endoscopic Retrograde Cholangiopancreatography (ERCP) | 7 | ||
| Photography | 8 | ||
| Sigmoidoscopy and Colonoscopy | 8 | ||
| Digital Endoscopy (Videoendoscopy) | 8 | ||
| Endoscopic Ultrasonography (EUS) | 9 | ||
| Capsule Endoscopy (Wireless Endoscopy) | 10 | ||
| Enteroscopy | 10 | ||
| Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Peroral Endoscopy Myotomy (POEM) | 10 | ||
| Summary | 11 | ||
| Key References | 11 | ||
| References | 11.e1 | ||
| 2 Setting Up an Endoscopy Facility | 12 | ||
| Abstract | 12.e1 | ||
| Keywords | 12.e1 | ||
| Chapter Outline | 12 | ||
| Introduction | 12 | ||
| Exploring Possibilities | 12 | ||
| Type of Facility | 12 | ||
| Business Plan | 13 | ||
| Regulatory and Certification Issues | 13 | ||
| General Federal Health-Related Laws | 13 | ||
| State Licensure | 14 | ||
| Medicare Certification | 14 | ||
| Third-Party Accreditation | 14 | ||
| Physician Credentialing | 14 | ||
| Payer Requirements | 14 | ||
| Choosing a Site | 14 | ||
| Facility Planning and Design | 15 | ||
| Planning | 15 | ||
| Scope of Activities | 15 | ||
| Equipment | 16 | ||
| Physical Environment | 16 | ||
| Flow | 16 | ||
| Designing the Endoscopy Facility | 17 | ||
| Arrival and Waiting Areas | 18 | ||
| Business-Reception Area | 19 | ||
| Pre/Postprocedure Area | 19 | ||
| Procedure Room Area | 19 | ||
| Reprocessing Areas | 20 | ||
| Support Areas | 21 | ||
| Mechanical Areas | 21 | ||
| Staff Area | 21 | ||
| Summary of Planning and Design | 22 | ||
| Staffing and Scheduling | 22 | ||
| Staffing | 22 | ||
| Scheduling | 22 | ||
| Documentation and Information Technology | 22 | ||
| Quality Measurement and Improvement | 23 | ||
| Acknowledgments | 23 | ||
| Key References | 23 | ||
| References | 23.e1 | ||
| 3 How Endoscopes Work | 24 | ||
| Abstract | 24.e1 | ||
| Keywords | 24.e1 | ||
| Chapter Outline | 24 | ||
| Endoscope Design | 24 | ||
| The Control Section | 24 | ||
| Insertion Tube | 24 | ||
| Tip of the Endoscope | 25 | ||
| Image Processing | 26 | ||
| Types of Endoscopes | 27 | ||
| Gastroscopes and Sigmoidoscopes | 28 | ||
| Enteroscopes | 28 | ||
| Duodenoscopes | 28 | ||
| Colonoscopes | 28 | ||
| Echoendoscopes | 29 | ||
| Capsule Endoscopes | 29 | ||
| Newer Endoscopic Modalities | 30 | ||
| High-Definition Endoscopes | 30 | ||
| Digital Chromoendoscopy | 30 | ||
| Endoscope Modifications to Increase the Mucosal Surface Area Visualized | 30 | ||
| Accessories That Increase the Visualized Surface Area for Examination | 31 | ||
| Key References | 31 | ||
| References | 31.e1 | ||
| 4 Cleaning and Disinfecting Gastrointestinal Endoscopy Equipment | 32 | ||
| Abstract | 32.e1 | ||
| Keywords | 32.e1 | ||
| Chapter Outline | 32 | ||
| Introduction | 32 | ||
| Principles of Reprocessing | 32 | ||
| Cleaning | 32 | ||
| Sterilization | 32 | ||
| Disinfection | 33 | ||
| Spaulding Classification | 33 | ||
| Disinfection and GI Endoscopy | 33 | ||
| Endoscopes | 33 | ||
| Accessories | 34 | ||
| Automated Endoscope Reprocessors (AERs) | 34 | ||
| Liquid Chemical Germicides and Sterilization Technologies | 35 | ||
| GI Endoscope Reprocessing | 37 | ||
| Regulatory Changes | 38 | ||
| Efficacy of Reprocessing | 39 | ||
| Overview of Quality Systems Approach | 39 | ||
| Cleaning Monitoring (Rapid Testing of Organic Residuals and Adenosine Triphosphate [ATP]) | 39 | ||
| Surveillance Cultures | 40 | ||
| Reprocessing Personnel | 44 | ||
| Training | 44 | ||
| Ongoing Competency Assessment | 44 | ||
| Transmission of Pathogens | 44 | ||
| Nonendoscopic Pathogen Transmission | 45 | ||
| Endoscopic Transmission of Pathogens | 46 | ||
| What Pathogens Are of Concern? | 46 | ||
| Low Concern Organisms (LCO) versus High Concern Organisms (HCO) | 46 | ||
| Bacterial Infections | 46 | ||
| Viral Infections | 47 | ||
| Fungi | 47 | ||
| Parasites | 47 | ||
| Prions | 47 | ||
| Duodenoscope-Related Infections | 47 | ||
| Reprocessing Errors and Outbreak Management | 48 | ||
| Investigation of a Reprocessing Problem or Device Failure | 48 | ||
| Infection Control Issues | 48 | ||
| Transporting Instruments | 48 | ||
| Personal Protection | 49 | ||
| Key References | 49 | ||
| References | 50.e1 | ||
| 5 Tissue Sampling, Specimen Handling, and Laboratory Processing | 51 | ||
| Abstract | 51.e1 | ||
| Keywords | 51.e1 | ||
| Chapter Outline | 51 | ||
| Endoscopic Biopsy | 51 | ||
| Biopsy Techniques | 51 | ||
| Pinch Biopsy Forceps | 51 | ||
| Larger Capacity Forceps | 51 | ||
| Sampling of Submucosa | 51 | ||
| Hot Biopsy | 51 | ||
| Snare Biopsy | 51 | ||
| Endoscopic Mucosal Resection | 52 | ||
| Brush Cytology Samples | 53 | ||
| Tissue Fixation | 54 | ||
| Laboratory Tissue Processing | 54 | ||
| Disease Specific Appropriate Tissue Sampling | 55 | ||
| Esophagus | 55 | ||
| Gastroesophageal Reflux Disease | 55 | ||
| Barrett’s Esophagus | 56 | ||
| Eosinophilic Esophagitis | 58 | ||
| Infectious Esophagitis | 59 | ||
| Stomach | 59 | ||
| Helicobacter pylori | 59 | ||
| Autoimmune Atrophic Metaplastic Gastritis | 61 | ||
| Intestinal Metaplasia | 63 | ||
| Gastric Polyps | 63 | ||
| Small Intestine | 63 | ||
| Celiac Disease | 63 | ||
| Colon | 65 | ||
| Inflammatory Bowel Disease | 65 | ||
| Microscopic Colitis | 66 | ||
| Graft Versus Host Disease | 67 | ||
| Key References | 68 | ||
| References | 68.e1 | ||
| 6 Electrosurgery in Therapeutic Endoscopy | 69 | ||
| Abstract | 69.e1 | ||
| Keywords | 69.e1 | ||
| Chapter Outline | 69 | ||
| Introduction | 69 | ||
| Fundamental Principles of Electrosurgery | 69 | ||
| Variables That Impact Tissue Effect, Microprocessor Controls, and Waveforms | 70 | ||
| Methods for Quantifying Waveforms | 73 | ||
| Monopolar and Bipolar Circuits | 74 | ||
| Radio Frequency Ablation Devices | 75 | ||
| Contact and Noncontact Applications | 75 | ||
| Argon-Assisted Coagulation | 75 | ||
| Electrical Hazards | 76 | ||
| Electrosurgery With Implanted Devices | 77 | ||
| Bowel Explosion Risk | 77 | ||
| Fundamentals in Practice | 77 | ||
| Biliary and Pancreatic Sphincterotomy | 77 | ||
| Needle-Knife Sphincterotomy | 78 | ||
| Complications of Sphincterotomy—Link With Electrosurgery | 78 | ||
| Pancreatitis. | 78 | ||
| Hemorrhage. | 78 | ||
| Perforation. | 78 | ||
| Polypectomy | 78 | ||
| Hot Biopsy Forceps | 78 | ||
| Endoscopic Mucosal Resection | 78 | ||
| Endoscopic Submucosal Dissection | 79 | ||
| Peroral Endoscopic Myotomy | 79 | ||
| Summary | 79 | ||
| Key References | 79 | ||
| References | 80.e1 | ||
| 7 Sedation and Monitoring in Endoscopy | 81 | ||
| Abstract | 81.e1 | ||
| Keywords | 81.e1 | ||
| Chapter Outline | 81 | ||
| Introduction | 81 | ||
| Patient Evaluation, Preparation, and Risk Stratification | 82 | ||
| Procedural Monitoring | 82 | ||
| Level of Consciousness | 82 | ||
| Pulse Oximetry | 82 | ||
| Pulmonary Ventilation | 83 | ||
| Hemodynamic Measurements | 83 | ||
| Supplemental Oxygen | 83 | ||
| Intravenous Access | 83 | ||
| Sedation and Consent | 83 | ||
| Staffing Levels and Training | 83 | ||
| Postprocedural Monitoring | 84 | ||
| Drugs for Sedation | 84 | ||
| Propofol and Deep Sedation | 85 | ||
| Newer Agents | 85 | ||
| Sedation Providers | 85 | ||
| SEDASYS | 86 | ||
| Patient-Controlled Sedation (PCS) | 86 | ||
| Gastroenterologist-Directed Propofol Sedation | 86 | ||
| Sedation in Different Patient Populations | 86 | ||
| Endoscopy in Patients With Cirrhosis | 86 | ||
| Endoscopy Without Sedation | 86 | ||
| Endoscopy and Pregnancy | 86 | ||
| Endoscopy in Obese Patients | 87 | ||
| Sedation for Different Endoscopic Procedures | 87 | ||
| Standard Endoscopic Procedures | 87 | ||
| Propofol Use in Complex Endoscopic Procedures | 87 | ||
| Pharyngeal Anesthesia in Sedation | 87 | ||
| Management of Oversedation | 87 | ||
| Review of Specific Drugs | 88 | ||
| Benzodiazepines | 88 | ||
| Midazolam | 88 | ||
| II Luminal Gastrointestinal Disorders | 152 | ||
| One Gastrointestinal Bleeding | 152 | ||
| 14 Nonvariceal Upper Gastrointestinal Bleeding | 153 | ||
| Abstract | 153.e1 | ||
| Keywords | 153.e1 | ||
| Chapter Outline | 153 | ||
| Introduction | 153 | ||
| Clinical Presentation | 154 | ||
| Initial Evaluation | 154 | ||
| Laboratory Data | 154 | ||
| Role of Nasogastric Aspirate | 154 | ||
| Risk Stratification | 154 | ||
| Red Blood Cell Transfusion | 155 | ||
| Platelet Transfusion | 155 | ||
| Reversal of Anticoagulation | 156 | ||
| Timing of Endoscopy | 156 | ||
| Prokinetics | 156 | ||
| Preendoscopic Proton Pump Inhibitors | 156 | ||
| Etiology of Nonvariceal Upper Gastrointestinal Bleeding | 157 | ||
| Indications for Endoscopic Therapy for Gastroduodenal Ulcers | 157 | ||
| Nonbleeding Adherent Clot | 158 | ||
| Modalities for Endoscopic Therapy | 158 | ||
| Injection Therapy | 158 | ||
| Technique for Injection | 159 | ||
| Thermal Coaptive Therapy | 159 | ||
| Bipolar Probe Technique | 160 | ||
| Heater Probe Technique | 160 | ||
| Argon Plasma Coagulator | 160 | ||
| Endoscopic Clipping | 161 | ||
| Combination Therapy | 161 | ||
| Hemostatic Powders | 161 | ||
| Postendoscopic Proton Pump Inhibitors | 162 | ||
| Second-Look Endoscopy | 162 | ||
| Prevention of Recurrent Bleeding | 163 | ||
| NSAID Therapy | 163 | ||
| Antiplatelet Therapy | 163 | ||
| Restarting Anticoagulation | 163 | ||
| Helicobacter Pylori | 164 | ||
| Iron Replacement Therapy | 165 | ||
| Vascular Lesions | 165 | ||
| Dieulafoy Lesion | 165 | ||
| Angiodysplasia | 165 | ||
| Gastric Antral Vascular Ectasia (GAVE) | 166 | ||
| Mallory-Weiss Tears | 166 | ||
| Epidemiology and Risk Factors | 166 | ||
| Risk Stratification | 166 | ||
| Endoscopic Stigmata | 167 | ||
| Endoscopic Therapy | 167 | ||
| Malignant Bleeding | 167 | ||
| Complications of Endoscopic Therapy | 168 | ||
| Failure of Endoscopic Therapy | 168 | ||
| Transcatheter Arterial Embolization | 168 | ||
| Emergency Surgery | 168 | ||
| Future Directions for Endoscopic Therapy | 169 | ||
| Over-the-Scope Clip | 169 | ||
| Doppler Endoscopic Probe | 169 | ||
| Conclusions | 169 | ||
| Key References | 169 | ||
| References | 170.e1 | ||
| 15 Portal Hypertensive Bleeding | 171 | ||
| Abstract | 171.e1 | ||
| Keywords | 171.e1 | ||
| Chapter Outline | 171 | ||
| Introduction | 171 | ||
| Natural History of Varices in Cirrhosis | 171 | ||
| Prevention of First Bleeding From Esophageal Varices | 171 | ||
| Screening for Esophageal Varices | 171 | ||
| Nonselective β-Blockers Versus Endoscopic Banding Ligation for Primary Prophylaxis | 172 | ||
| General Management of Acute Variceal Bleeding (AVB) | 172 | ||
| Hemostatic Therapies | 173 | ||
| Pharmacological Treatment | 173 | ||
| Endoscopic Therapy | 174 | ||
| Prevention of Recurrent Bleeding From Esophageal Varices | 175 | ||
| Failure to Control Bleeding | 175 | ||
| Gastric Variceal Bleeding | 176 | ||
| Prevention of First Hemorrhage From Gastric Varices | 177 | ||
| Management of Gastric Variceal Bleeding | 177 | ||
| Prevention of Rebleeding From Gastric Varices | 177 | ||
| Endoscopic Variceal Obturation (CYA Glue Injection) | 177 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 177 | ||
| Balloon Occluded Retrograde Transvenous Obliteration (BRTO) | 177 | ||
| Portal Hypertensive Gastropathy | 177 | ||
| Summary (Fig. 15.8) | 177 | ||
| Key References | 178 | ||
| References | 179.e1 | ||
| 16 Lower Gastrointestinal Bleeding | 180 | ||
| Abstract | 180.e1 | ||
| Keywords | 180.e1 | ||
| Chapter Outline | 180 | ||
| Introduction | 180 | ||
| Epidemiology | 180 | ||
| Initial Approach to a Patient With Hematochezia | 180 | ||
| Early Predictors of Severity in Acute Lower Gastrointestinal Bleeding | 181 | ||
| Diagnostic Options | 181 | ||
| Anoscopy | 181 | ||
| Flexible Sigmoidoscopy | 181 | ||
| Nuclear Medicine Scintigraphy | 181 | ||
| Angiography | 182 | ||
| Computed Tomography | 182 | ||
| Colonoscopy | 182 | ||
| Surgery | 182 | ||
| Etiology and Pathogenesis of Severe Lower Gastrointestinal Bleeding | 182 | ||
| Diverticular Bleeding | 182 | ||
| Colon Cancer | 184 | ||
| Colitis | 184 | ||
| Angiodysplasia | 185 | ||
| Postpolypectomy Bleeding | 186 | ||
| Radiation Proctitis | 186 | ||
| Hemorrhoids | 186 | ||
| Rectal Varices | 188 | ||
| Dieulafoy’s Lesion | 188 | ||
| Summary | 188 | ||
| Key References | 188 | ||
| References | 189.e1 | ||
| 17 Middle Gastrointestinal Bleeding | 190 | ||
| Abstract | 190.e1 | ||
| Keywords | 190.e1 | ||
| Chapter Outline | 190 | ||
| Introduction | 190 | ||
| Investigating Suspected Middle Gastrointestinal Bleeding | 190 | ||
| Push Enteroscopy | 190 | ||
| Video Capsule Endoscopy | 191 | ||
| Device-Assisted Enteroscopy | 194 | ||
| Single-Balloon Enteroscopy | 195 | ||
| Spiral Enteroscopy | 196 | ||
| On-Demand Enteroscopy | 196 | ||
| Intraoperative Enteroscopy | 197 | ||
| Radiographic Imaging Studies | 197 | ||
| Small Bowel Contrast Radiography | 197 | ||
| Cross-Sectional Imaging | 197 | ||
| Nuclear Medicine Studies | 198 | ||
| CT Angiography | 198 | ||
| Angiography | 198 | ||
| Proposed Diagnostic Strategy | 199 | ||
| Suspected Overt Middle GI Bleeding | 199 | ||
| Treatment of Small Bowel Vascular Lesions | 199 | ||
| Endoscopic Therapy | 199 | ||
| Medical Therapy of Middle GI Bleeding | 200 | ||
| Hormonal Therapy | 200 | ||
| Somatostatin Analogs | 200 | ||
| Thalidomide | 200 | ||
| Surgical Treatment | 200 | ||
| Key References | 200 | ||
| References | 201.e1 | ||
| 18 Occult and Unexplained Chronic Gastrointestinal Bleeding | 202 | ||
| Abstract | 202.e1 | ||
| Keywords | 202.e1 | ||
| Chapter Outline | 202 | ||
| Introduction | 202 | ||
| Investigating Chronic Unexplained Gastrointestinal Bleeding | 203 | ||
| Endoscopic Investigations | 203 | ||
| Repeat EGD and Colonoscopy | 203 | ||
| Angiodysplasia of the Gastrointestinal Tract | 203 | ||
| Pathogenesis | 204 | ||
| Epidemiology and Natural History | 204 | ||
| Clinical Manifestations | 204 | ||
| Conditions With Increased Prevalence | 204 | ||
| End-Stage Renal Disease | 204 | ||
| von Willebrand’s Disease | 204 | ||
| Aortic Stenosis | 204 | ||
| Progressive Systemic Sclerosis | 205 | ||
| Left Ventricular Assist Devices | 205 | ||
| Diagnosis | 205 | ||
| Endoscopic Imaging: Standard Upper Endoscopy and Colonoscopy | 205 | ||
| Assessment of the Small Bowel | 206 | ||
| Diagnostic Algorithm for Endoscopy in Suspected Middle Gastrointestinal Bleeding | 207 | ||
| Management | 207 | ||
| Pharmacologic Treatment | 207 | ||
| Endoscopic Treatment | 208 | ||
| Bipolar or heater probe coagulation. | 208 | ||
| Sclerotherapy. | 208 | ||
| Band ligation. | 208 | ||
| Endoscopic resection. | 208 | ||
| Lasers. | 208 | ||
| Endoscopic clips. | 208 | ||
| Argon plasma coagulation. | 208 | ||
| Cryotherapy. | 208 | ||
| Tips to get the best results with endoscopic treatment of GIAD. | 208 | ||
| Hereditary Hemorrhagic Telangiectasia | 209 | ||
| Gastric Vascular Lesions in Patients With Cirrhosis | 209 | ||
| Portal Hypertensive Gastropathy | 209 | ||
| Classification | 209 | ||
| Prevalence and Risk Factors | 210 | ||
| Natural History and Complications | 210 | ||
| Management | 210 | ||
| Pharmacologic treatment. | 210 | ||
| Nonselective β-blockers. | 210 | ||
| Vasoactive agents. | 211 | ||
| Endoscopic treatment. | 211 | ||
| Gastric Antral Vascular Ectasia | 211 | ||
| Management | 212 | ||
| Lesions Resembling PHG in Other Gastrointestinal Regions | 213 | ||
| Hemangiomas | 213 | ||
| Clinical Manifestations | 213 | ||
| Management | 213 | ||
| Cavernous Hemangioma of the Rectum | 214 | ||
| Blue Rubber Bleb Nevus Syndrome | 214 | ||
| Klippel-Trénaunay-Weber Syndrome | 215 | ||
| Radiation Injury of the Gastrointestinal Tract | 215 | ||
| Radiation Proctopathy | 215 | ||
| Clinical Manifestations | 215 | ||
| Treatment | 216 | ||
| Medical therapies. | 216 | ||
| Endoscopic therapies | 216 | ||
| Topical formalin. | 216 | ||
| Laser. | 216 | ||
| Argon plasma coagulation. | 216 | ||
| Endoscopic cryotherapy. | 217 | ||
| Radiofrequency ablation. | 217 | ||
| Radiation Gastropathy | 217 | ||
| Treatment | 217 | ||
| Radiation Injury of the Small Bowel | 218 | ||
| Cameron Ulcers and Erosions | 218 | ||
| Key References | 218 | ||
| References | 219.e1 | ||
| Two Esophageal Disorders | 220 | ||
| 19 Esophageal Motility Disorders | 220 | ||
| Abstract | 220.e1 | ||
| Keywords | 220.e1 | ||
| Chapter Outline | 220 | ||
| Introduction | 220 | ||
| Achalasia | 220 | ||
| Etiology and Pathophysiology | 220 | ||
| Clinical Manifestations | 221 | ||
| Diagnosis | 221 | ||
| Endoscopy | 221 | ||
| Radiology | 221 | ||
| Manometry | 222 | ||
| Impedance | 225 | ||
| Functional Lumen Imaging Probe | 225 | ||
| Therapy | 226 | ||
| Medical Therapy | 226 | ||
| Botulinum Toxin | 226 | ||
| Pneumatic Dilatation | 227 | ||
| Heller Myotomy | 228 | ||
| Peroral Endoscopic Myotomy | 228 | ||
| Stent Placement | 229 | ||
| Esophagectomy | 229 | ||
| Other Motility Disorders | 229 | ||
| EGJ Outflow Obstruction | 229 | ||
| Distal Esophageal Spasm | 231 | ||
| Hypercontractile Esophagus | 231 | ||
| Ineffective Esophageal Motility | 232 | ||
| Novel Endoscopic Applications | 232 | ||
| Future Directions | 233 | ||
| Conclusion | 233 | ||
| Key References | 233 | ||
| References | 233.e1 | ||
| 20 Endoscopic Diagnosis and Management of Zenker’s Diverticula | 234 | ||
| Abstract | 234.e1 | ||
| Keywords | 234.e1 | ||
| Chapter Outline | 234 | ||
| Introduction | 234 | ||
| Clinical Presentation and Diagnosis | 234 | ||
| Pathophysiology | 234 | ||
| Diagnostic Evaluation | 235 | ||
| Therapeutic Options | 236 | ||
| Open Surgical Approach | 236 | ||
| Transoral Endoscopic Approaches | 236 | ||
| Rigid Endoscopic Approach | 236 | ||
| Flexible Endoscopic Approach | 237 | ||
| Training in Flexible Endoscopic Cricopharyngeal Myotomy | 239 | ||
| Conclusions | 239 | ||
| Key References | 239 | ||
| References | 240.e1 | ||
| 21 Benign Esophageal Strictures | 241 | ||
| Abstract | 241.e1 | ||
| Keywords | 241.e1 | ||
| Chapter Outline | 241 | ||
| Introduction | 241 | ||
| Initial Evaluation | 241 | ||
| Preprocedure Planning | 243 | ||
| Risks/Adverse Events | 244 | ||
| Initial Inspection | 247 | ||
| Types of Dilators | 247 | ||
| Selection of Dilating Devices: Balloons Versus Bougies | 247 | ||
| Dilation | 248 | ||
| Foreign Body Removal | 249 | ||
| Postdilation Follow-Up | 249 | ||
| Refractory or Recurrent Strictures | 250 | ||
| Adjunctive Therapies | 250 | ||
| Intralesional Steroid Injection | 250 | ||
| Endoscopic Incisional Therapy | 251 | ||
| Endoprosthetics | 252 | ||
| Self-Dilation | 253 | ||
| Esophageal Luminal Reconstitution | 253 | ||
| Summary | 254 | ||
| Key References | 254 | ||
| References | 254.e1 | ||
| 22 Ingested Foreign Objects and Food Bolus Impactions | 255 | ||
| Abstract | 255.e1 | ||
| Keywords | 255.e1 | ||
| Chapter Outline | 255 | ||
| Introduction | 255 | ||
| Nonendoscopic Therapies | 255 | ||
| Endoscopic Methods | 256 | ||
| Specific Foreign Bodies | 257 | ||
| Food Impaction | 257 | ||
| True Foreign Bodies | 259 | ||
| Sharp and Pointed Objects | 259 | ||
| Long Objects | 259 | ||
| Blunt Objects: Coins, Batteries, and Magnets | 259 | ||
| Narcotic Packets | 261 | ||
| Colorectal Foreign Bodies | 261 | ||
| Procedure-Related Complications | 261 | ||
| Key References | 261 | ||
| References | 262.e1 | ||
| 23 Eosinophilic Esophagitis | 263 | ||
| Abstract | 263.e1 | ||
| Keywords | 263.e1 | ||
| Chapter Outline | 263 | ||
| Introduction | 263 | ||
| Limitations to Endoscopic Assessment of Eoe | 263 | ||
| Importance of Standardized Nomenclature and Definitions | 263 | ||
| Eoe Endoscopic Reference Score (EREFS) | 264 | ||
| Endoscopic Findings as Therapeutic Endpoints | 265 | ||
| Alternatives and Adjuncts to Endoscopic Assessment | 266 | ||
| Conclusion | 266 | ||
| Key References | 266 | ||
| References | 267.e1 | ||
| 24 Gastroesophageal Reflux Disease | 268 | ||
| Abstract | 268.e1 | ||
| Keywords | 268.e1 | ||
| Chapter Outline | 268 | ||
| Introduction | 268 | ||
| Etiology | 268 | ||
| Diagnosis | 270 | ||
| Symptoms | 271 | ||
| Endoscopy | 271 | ||
| Esophageal pH Testing | 273 | ||
| Treatment | 274 | ||
| Medical Management | 275 | ||
| Surgical Treatment | 276 | ||
| Emerging Treatments | 277 | ||
| Treatment Summary | 277 | ||
| Key References | 278 | ||
| References | 278.e1 | ||
| 25 Barrett’s Esophagus | 279 | ||
| Abstract | 279.e1 | ||
| Keywords | 279.e1 | ||
| Chapter Outline | 279 | ||
| Introduction | 279 | ||
| Epidemiology | 279 | ||
| Diagnosis | 279 | ||
| Screening | 280 | ||
| Surveillance | 281 | ||
| Rationale for Surveillance | 281 | ||
| Candidates for Endoscopic Surveillance | 281 | ||
| Surveillance Technique | 281 | ||
| Surveillance Intervals | 282 | ||
| Limitations of Surveillance | 282 | ||
| Potential Strategies to Enhance Surveillance | 282 | ||
| Uniform Grading Systems | 282 | ||
| Cognitive Knowledge, Learning Curves, and Training | 282 | ||
| Imaging Modalities to Enhance Surveillance | 282 | ||
| High-definition white light endoscopy. | 283 | ||
| Optical electronic chromoendoscopy. | 284 | ||
| Chromoendoscopy. | 285 | ||
| Confocal laser endomicroscopy. | 285 | ||
| Future emerging technologies. | 286 | ||
| Current Status of Real-Time Imaging-Assisted Endoscopic Targeted Biopsy During Surveillance | 286 | ||
| Biomarkers of Increased Risk of Progression | 287 | ||
| Risk Stratification and Prediction Tools | 288 | ||
| Clinical and endoscopic predictors of progression. | 288 | ||
| Dysplasia and risk of progression. | 288 | ||
| Predictors of progression in patients with low-grade dysplasia. | 288 | ||
| Prediction models. | 288 | ||
| Management | 288 | ||
| Medical Therapy | 288 | ||
| Antireflux Surgery | 289 | ||
| Chemoprevention | 289 | ||
| Quality Indicators in Diagnosis and Management | 289 | ||
| Key References | 289 | ||
| References | 290.e1 | ||
| 26 Screening for Esophageal Squamous Cell Carcinoma | 291 | ||
| Abstract | 291.e1 | ||
| Keywords | 291.e1 | ||
| Chapter Outline | 291 | ||
| Introduction and Epidemiology | 291 | ||
| Risk Factors for ESCC and Unique Populations at Risk | 291 | ||
| Rationale for Population Screening for ESCC | 293 | ||
| Precursors of ESCC | 293 | ||
| Endoscopic Screening | 294 | ||
| Disruptive and Nonendoscopic Screening Techniques | 297 | ||
| Endoscopic Treatment of Superficial ESCC | 298 | ||
| Summary of Current Rationale for Screening: Effectiveness and Cost-Effectiveness | 298 | ||
| Future Directions for Noninvasive Screening: Serologic and Stool Testing; Microbiota | 299 | ||
| Conclusions | 300 | ||
| Key References | 301 | ||
| References | 301.e1 | ||
| 27 Endoscopic Treatment of Early Esophageal Neoplasia | 302 | ||
| Abstract | 302.e1 | ||
| Keywords | 302.e1 | ||
| Chapter Outline | 302 | ||
| Introduction | 302 | ||
| Endoscopic Detection and Diagnosis | 302 | ||
| Staging of Early Esophageal Cancer | 303 | ||
| Endoscopic Inspection | 305 | ||
| Endoscopic Resection | 305 | ||
| Endoscopic Ultrasound and PET/CT | 305 | ||
| Methods of Endoscopic Treatment of Esophageal Cancer | 305 | ||
| Endoscopic Resection | 306 | ||
| Endoscopic Mucosal Resection | 306 | ||
| Endoscopic Submucosal Dissection | 310 | ||
| Ablative Therapies | 311 | ||
| Radiofrequency Ablation | 311 | ||
| Cryoablation | 313 | ||
| Photodynamic Therapy | 313 | ||
| Argon Plasma Coagulation | 314 | ||
| Combined EMR and Ablation | 314 | ||
| Follow-Up | 314 | ||
| Key References | 314 | ||
| References | 315.e1 | ||
| 28 Palliation of Malignant Dysphagia and Esophageal Fistulas | 316 | ||
| Abstract | 316.e1 | ||
| Keywords | 316.e1 | ||
| Chapter Outline | 316 | ||
| Introduction | 316 | ||
| Esophageal Stents | 316 | ||
| Management of Nonoperable Esophageal Malignancy | 317 | ||
| Techniques of Stent Placement | 317 | ||
| Stent Complications | 318 | ||
| Stent Migration | 318 | ||
| Perforation | 318 | ||
| Bleeding | 319 | ||
| Stent Obstruction | 319 | ||
| Esophagorespiratory Fistula | 320 | ||
| Stent Placement After Radiotherapy and/or Chemotherapy | 320 | ||
| Clinical Outcomes | 321 | ||
| Conclusion | 321 | ||
| Key References | 321 | ||
| References | 321.e1 | ||
| Three Gastric Disorders | 322 | ||
| 29 Endoscopic Approaches for Gastroparesis | 322 | ||
| Abstract | 322.e1 | ||
| Keywords | 322.e1 | ||
| Chapter Outline | 322 | ||
| Introduction | 322 | ||
| Physiology of Gastroparesis | 322 | ||
| The Role of Endoscopy | 323 | ||
| Pyloric Dysfunction | 323 | ||
| Endoscopic Diagnostic Options for Pyloric Dysfunction | 323 | ||
| Endoscopic Therapeutic Options for Pyloric Dysfunction | 325 | ||
| Full-Thickness Gastric Biopsy | 327 | ||
| Temporary Gastric Electrical Stimulation | 327 | ||
| Enteral Tubes | 328 | ||
| Future Directions | 328 | ||
| Conclusions | 329 | ||
| Key References | 329 | ||
| References | 329.e1 | ||
| 30 Gastric Polyps and Thickened Gastric Folds | 330 | ||
| Abstract | 330.e1 | ||
| Keywords | 330.e1 | ||
| Chapter Outline | 330 | ||
| Introduction | 330 | ||
| Gastric Polyps | 330 | ||
| Fundic Gland Polyps | 330 | ||
| Hyperplastic Polyps | 331 | ||
| Gastric Adenoma | 331 | ||
| Gastric Carcinoma | 332 | ||
| Gastric Carcinoid | 332 | ||
| Endoscopic Resection | 333 | ||
| Thickened Gastric Folds | 333 | ||
| Malignancy | 334 | ||
| Menetrier’s Disease | 335 | ||
| Conclusion | 335 | ||
| Key References | 335 | ||
| References | 336.e1 | ||
| 31 Subepithelial Tumors of the Esophagus and Stomach | 337 | ||
| Abstract | 337.e1 | ||
| Keywords | 337.e1 | ||
| Chapter Outline | 337 | ||
| Introduction | 337 | ||
| Epidemiology | 337 | ||
| Clinical Features | 338 | ||
| Pathology | 338 | ||
| Gastrointestinal Stromal Tumor | 339 | ||
| Glomus Tumors | 340 | ||
| Neural Tumors | 341 | ||
| Neuroma and Neurofibroma | 341 | ||
| Gangliocytic Paraganglioma | 341 | ||
| Endothelial and Vascular Tumors | 341 | ||
| Lipocytic Tumors: Lipoma and Liposarcoma | 341 | ||
| Granular Cell Tumor | 341 | ||
| Inflammatory Fibroid Polyp | 341 | ||
| Fibrous (Fibrovascular) Polyp | 342 | ||
| Metastatic Tumors | 342 | ||
| Cystic Tumors | 342 | ||
| Differential Diagnosis | 342 | ||
| Conventional Endoscopy, Computed Tomography, and Transabdominal Ultrasound | 342 | ||
| Endoscopic Ultrasound | 343 | ||
| Fine-Needle Aspiration | 345 | ||
| Treatment | 345 | ||
| Indications and Contraindications | 346 | ||
| Preoperative History and Considerations | 346 | ||
| Description of Techniques | 347 | ||
| Future Trends | 348 | ||
| Key References | 348 | ||
| References | 348.e1 | ||
| 32 Diagnosis and Treatment of Superficial Gastric Neoplasms | 349 | ||
| Abstract | 349.e1 | ||
| Keywords | 349.e1 | ||
| Chapter Outline | 349 | ||
| Introduction | 349 | ||
| Epidemiology | 349 | ||
| Helicobacter pylori | 349 | ||
| Background of Diagnosis for Early Gastric Cancer | 349 | ||
| Description of EGC | 351 | ||
| Tumor Location | 351 | ||
| Macroscopic Type | 351 | ||
| Tumor Invasion Depth | 351 | ||
| Endoscopic Diagnosis of EGC | 351 | ||
| Preparation | 351 | ||
| Systematic Examination | 351 | ||
| Identification and Diagnosis of EGC | 352 | ||
| Chromoendoscopy | 352 | ||
| Recent Advanced Techniques and Magnifying Endoscopy | 354 | ||
| Histology | 355 | ||
| Targeted and Negative Biopsy | 356 | ||
| Endoscopic Staging of Invasion Depth | 356 | ||
| Correlations Between Macroscopic Type and Invasion Depth | 356 | ||
| Cases | 356 | ||
| Endoscopic Ultrasonography | 360 | ||
| Depth Predictive Score | 360 | ||
| Summary of Diagnosis | 361 | ||
| Background of Endoscopic Resection for EGC | 361 | ||
| Indications of ESD for EGC | 362 | ||
| Clinical Results | 363 | ||
| Technical Tips Regarding ESD Performed for EGC | 363 | ||
| Basic Movement Is Dependent on ESD Device | 363 | ||
| ESD Strategy | 363 | ||
| Training for ESD | 364 | ||
| Complications | 364 | ||
| Perforation | 364 | ||
| Bleeding | 365 | ||
| Summary of Endoscopic Treatment | 365 | ||
| Key References | 365 | ||
| References | 366.e1 | ||
| 33 Palliation of Gastric Outlet Obstruction | 367 | ||
| Abstract | 367.e1 | ||
| Keywords | 367.e1 | ||
| Chapter Outline | 367 | ||
| Malignant Gastric Outlet Obstruction | 367 | ||
| Palliative Treatment: Surgical Bypass Versus Endoscopic Stent Placement | 367 | ||
| The Endoscopic Procedure | 367 | ||
| Preparation and Materials | 367 | ||
| Cannulation | 369 | ||
| SEMS Deployment | 369 | ||
| Self-Expandable Metal Stents | 369 | ||
| Predictors for Stent Failure | 371 | ||
| Stent Patency and Adverse Events | 371 | ||
| Biliary Drainage | 371 | ||
| New Developments | 372 | ||
| Key References | 373 | ||
| References | 373.e1 | ||
| Four Duodenal Disorders | 374 | ||
| 34 Duodenal and Papillary Adenomas | 374 | ||
| Abstract | 374.e1 | ||
| Keywords | 374.e1 | ||
| Chapter Outline | 374 | ||
| Introduction | 374 | ||
| Epidemiology and Natural History | 374 | ||
| Clinical Presentation | 375 | ||
| Indications and Patient Selection | 375 | ||
| Lesion Assessment and Staging | 375 | ||
| Resection Principles and Techniques | 376 | ||
| Duodenal Adenoma | 376 | ||
| Papillary Adenoma | 376 | ||
| Postprocedure Care | 377 | ||
| Adverse Events | 379 | ||
| Unique Site-Specific Complications | 380 | ||
| Endoscopic Outcomes | 381 | ||
| Conclusion | 381 | ||
| Key References | 381 | ||
| References | 381.e1 | ||
| Five Colonic Disorders | 382 | ||
| 35 Acute Colonic Pseudo-Obstruction | 382 | ||
| Abstract | 382.e1 | ||
| Keywords | 382.e1 | ||
| Chapter Outline | 382 | ||
| Introduction | 382 | ||
| Epidemiology | 382 | ||
| Pathogenesis | 383 | ||
| Clinical Features | 384 | ||
| Differential Diagnosis | 384 | ||
| Treatment | 385 | ||
| Conservative Therapy | 385 | ||
| Medical Therapy | 386 | ||
| Colonoscopy | 388 | ||
| Surgery | 389 | ||
| Future Trends | 390 | ||
| Key References | 390 | ||
| References | 391.e1 | ||
| 36 Colorectal Cancer Screening and Surveillance | 392 | ||
| Abstract | 392.e1 | ||
| Keywords | 392.e1 | ||
| Chapter Outline | 392 | ||
| Introduction | 392 | ||
| Epidemiology | 392 | ||
| Global Perspective | 392 | ||
| Demographic Factors | 392 | ||
| Modifiable Risk Factors | 393 | ||
| Pathogenesis | 393 | ||
| Screening Strategies: General Approach | 394 | ||
| Screening in Average-Risk Individuals | 394 | ||
| Stool-Based Colorectal Cancer Screening Tests | 394 | ||
| Serological Biomarkers | 396 | ||
| Tests for Structural Examination of the Colon | 397 | ||
| Sigmoidoscopy | 397 | ||
| Colonoscopy | 397 | ||
| Computed Tomography Colonography | 398 | ||
| Colon Capsule Endoscopy | 399 | ||
| Surveillance | 400 | ||
| Acknowledgment | 400 | ||
| Key References | 400 | ||
| References | 401.e1 | ||
| 37 Colonoscopic Polypectomy, Mucosal Resection, and Submucosal Dissection | 402 | ||
| Abstract | 402.e1 | ||
| Keywords | 402.e1 | ||
| Chapter Outline | 402 | ||
| Introduction | 402 | ||
| Differential Diagnosis | 402 | ||
| Considerations Before Polyp Resection | 403 | ||
| Indications and Contraindications | 403 | ||
| Management of Antithrombotic Agents | 403 | ||
| Anticoagulant Agents | 403 | ||
| Antiplatelet Agents | 403 | ||
| Antibiotic Prophylaxis for Endocarditis | 403 | ||
| Instruments and Equipment | 403 | ||
| Colonoscope | 403 | ||
| CO2 Insufflation | 403 | ||
| Snares | 403 | ||
| Injection Fluid | 404 | ||
| Electrocautery | 404 | ||
| Argon Plasma Coagulation | 404 | ||
| Other Instruments | 404 | ||
| General Approach to Removing a Colorectal Polyp | 404 | ||
| Assessment of the Polyp | 404 | ||
| Size | 405 | ||
| Morphology | 405 | ||
| Surface Pattern | 406 | ||
| Nonlifting Sign | 406 | ||
| Decision to Resect a Polyp | 406 | ||
| Colonoscope Position | 407 | ||
| Method of Resection | 408 | ||
| Completeness of Resection | 408 | ||
| Retrieval and Preparation for Pathology | 409 | ||
| Resection Techniques | 409 | ||
| Basic Polypectomy | 409 | ||
| Definition | 409 | ||
| Resection Tools | 410 | ||
| Cold Forceps Technique | 410 | ||
| Cold Snare Technique | 410 | ||
| Hot Snare Technique | 411 | ||
| Advanced Polyp Resection | 412 | ||
| Snare-Loop Polypectomy | 412 | ||
| Endoscopic Mucosal Resection | 413 | ||
| Modified EMR Techniques | 414 | ||
| Underwater resection. | 414 | ||
| Cold snare resection EMR. | 415 | ||
| Submucosal resection with band ligation. | 416 | ||
| Special Considerations | 416 | ||
| Location in the ileocecal (IC) valve. | 416 | ||
| Location in the appendiceal orifice. | 416 | ||
| Location at the anorectal junction. | 416 | ||
| Circumferential extension. | 418 | ||
| Submucosal lesions. | 418 | ||
| Endoscopic Submucosal Dissection | 418 | ||
| Techniques to Improve Efficacy and Safety of Polypectomy | 419 | ||
| Prevention and Treatment of Recurrence | 419 | ||
| Reducing the Risk of Delayed Bleeding | 420 | ||
| Marking the Polypectomy Site | 421 | ||
| Retrieving the Specimen | 421 | ||
| Management and Surveillance After Polypectomy | 421 | ||
| Complications | 422 | ||
| Postpolypectomy Bleeding | 422 | ||
| Postpolypectomy Syndrome | 422 | ||
| Perforation | 423 | ||
| Future Trends | 423 | ||
| Key References | 424 | ||
| References | 424.e1 | ||
| 38 Endoscopic Diagnosis and Staging of Inflammatory Bowel Disease | 425 | ||
| Abstract | 425.e1 | ||
| Keywords | 425.e1 | ||
| Chapter Outline | 425 | ||
| Introduction | 425 | ||
| Endoscopic Evaluation of Inflammatory Bowel Disease | 425 | ||
| Diagnosing and Assessing Disease Presentation | 425 | ||
| Staging Disease Activity | 427 | ||
| Definition of Mucosal Healing | 427 | ||
| Endoscopic Scoring Systems in Ulcerative Colitis | 428 | ||
| Endoscopic Scoring Systems in CD | 430 | ||
| Crohn’s Disease Small Bowel Endoscopic Scores | 431 | ||
| The Role of Endoscopy in Diagnosing and Staging Complications of IBD | 432 | ||
| Strictures | 432 | ||
| Perianal Fistulas | 432 | ||
| Role of the Latest Endoscopic Advances for Diagnosing and Staging Disease Activity in IBD | 432 | ||
| Summary | 433 | ||
| Key References | 434 | ||
| References | 434.e1 | ||
| 39 Dysplasia Surveillance in Inflammatory Bowel Disease | 435 | ||
| Abstract | 435.e1 | ||
| Keywords | 435.e1 | ||
| Chapter Outline | 435 | ||
| Introduction | 435 | ||
| Epidemiology of CRC in IBD | 435 | ||
| Risk Factors for CRC in IBD | 435 | ||
| Dysplasia | 436 | ||
| Dysplasia Surveillance | 437 | ||
| Other Advanced Imaging Modalities | 441 | ||
| Narrow Band Imaging | 441 | ||
| Confocal Laser Endomicroscopy | 441 | ||
| Endocytoscopy | 441 | ||
| Molecular Imaging | 441 | ||
| Stool DNA Testing | 442 | ||
| Management of Dysplasia | 442 | ||
| Conclusion | 443 | ||
| Key References | 445 | ||
| References | 445.e1 | ||
| 40 Colonic Strictures | 446 | ||
| Abstract | 446.e1 | ||
| Keywords | 446.e1 | ||
| Chapter Outline | 446 | ||
| Introduction | 446 | ||
| Initial Evaluation | 446 | ||
| Technical Considerations for Balloon Dilation | 446 | ||
| Technical Considerations for Use of SEMS | 448 | ||
| Management of Benign Colonic Strictures | 448 | ||
| Management of Malignant Colonic Strictures | 450 | ||
| Palliative Stenting | 450 | ||
| Stenting as a Bridge to Surgery | 451 | ||
| Other SEMS-Related Adverse Events | 452 | ||
| Conclusion | 452 | ||
| Key References | 452 | ||
| References | 453.e1 | ||
| Six Miscellaneous | 454 | ||
| 41 Infections of the Luminal Digestive Tract | 454 | ||
| Abstract | 454.e1 | ||
| Keywords | 454.e1 | ||
| Chapter Outline | 454 | ||
| Introduction | 454 | ||
| Epidemiology | 454 | ||
| Immune Competent Patients | 454 | ||
| Immune Suppressed Patients | 454 | ||
| Pathogenesis | 455 | ||
| Clinical and Endoscopic Features | 456 | ||
| Esophagus | 456 | ||
| Clinical Features | 456 | ||
| Endoscopic Features | 457 | ||
| Stomach | 457 | ||
| Clinical Features | 457 | ||
| Endoscopic Features | 459 | ||
| Small Intestine | 459 | ||
| Clinical Features | 459 | ||
| Endoscopic Features | 460 | ||
| Colon | 461 | ||
| Clinical Features | 461 | ||
| Evaluation. | 461 | ||
| Endoscopic Features | 461 | ||
| Pathology | 461 | ||
| Esophagus | 461 | ||
| Stomach | 464 | ||
| Small Bowel | 464 | ||
| Colon | 464 | ||
| Special Stains | 464 | ||
| Differential Diagnosis | 464 | ||
| Description of Techniques | 464 | ||
| Key References | 466 | ||
| References | 466.e1 | ||
| 42 Techniques in Enteral Access | 467 | ||
| Abstract | 467.e1 | ||
| Keywords | 467.e1 | ||
| Chapter Outline | 467 | ||
| Introduction | 467 | ||
| How to Establish an Endoscopy Service for Enteral Access | 468 | ||
| Endoscopic Nasoenteric Tubes | 469 | ||
| Over-the-Guidewire Technique | 469 | ||
| Drag and Pull Technique | 469 | ||
| Transnasal Technique | 471 | ||
| Alternate Options | 471 | ||
| Securing Tube With Nasal Bridle | 472 | ||
| Percutaneous Endoscopic Gastrostomy | 472 | ||
| Ponsky Pull and Sachs-Vine Push Technique | 475 | ||
| Russell Introducer Technique | 475 | ||
| Percutaneous Endoscopic Gastrojejunostomy | 476 | ||
| Through-the-Snare Technique | 477 | ||
| Over-the-Guidewire Technique | 478 | ||
| Trans-PEG Gastroscopy Technique | 478 | ||
| Securing the PEGJ | 478 | ||
| Direct Percutaneous Endoscopic Jejunostomy | 480 | ||
| Postprocedure Care | 482 | ||
| ENET Complications | 483 | ||
| PEG Complications | 484 | ||
| PEGJ and DPEJ Complications | 486 | ||
| Conclusion | 486 | ||
| Key References | 486 | ||
| References | 487.e1 | ||
| 43 Endoscopic Techniques for Weight Loss | 488 | ||
| Abstract | 488.e1 | ||
| Keywords | 488.e1 | ||
| Chapter Outline | 488 | ||
| Introduction | 488 | ||
| Endoscopic Options for Endoluminal Primary Treatment of Obesity | 488 | ||
| Restrictive Procedures | 488 | ||
| Intragastric Balloons | 488 | ||
| Suturing/Stapling Procedures | 490 | ||
| Endoluminal vertical gastroplasty. | 490 | ||
| Transoral gastroplasty. | 490 | ||
| Endoscopic Sleeve Gastroplasty | 490 | ||
| Primary obesity surgery endoluminal. | 490 | ||
| Endoluminal suturing device. | 490 | ||
| Articulating circular endoscopic (ACE) stapling procedure. | 490 | ||
| Malabsorptive Procedures | 490 | ||
| Aspiration Therapy | 490 | ||
| Duodenojejunal Bypass Liner or EndoBarrier Device | 491 | ||
| Gastroduodenojejunal Bypass Sleeve | 492 | ||
| Other Procedures | 492 | ||
| Electrical Stimulation | 492 | ||
| Injections: Botulinum Toxin | 492 | ||
| Conclusion | 493 | ||
| Key References | 493 | ||
| References | 493.e1 | ||
| 44 Management of Post-Bariatric Complications | 494 | ||
| Abstract | 494.e1 | ||
| Keywords | 494.e1 | ||
| Chapter Outline | 494 | ||
| Introduction | 494 | ||
| Roux-en-Y Gastric Bypass (RYGB) | 494 | ||
| Marginal Ulcerations | 494 | ||
| Stomal Stenosis | 496 | ||
| Leaks | 497 | ||
| Gastrogastric Fistula | 497 | ||
| Gastrointestinal Bleeding | 497 | ||
| Cholelithiasis and Choledocholithiasis | 497 | ||
| Dumping Syndrome | 498 | ||
| Failure to Lose Weight or Weight Regain | 498 | ||
| Laparoscopic Adjustable Gastric Banding | 498 | ||
| Band-Related Complications | 498 | ||
| Esophageal-Related Complications | 498 | ||
| Sleeve Gastrectomy | 499 | ||
| Stenosis | 499 | ||
| Anastomotic Leaks | 499 | ||
| Vertical Banded Gastroplasty | 499 | ||
| Staple Line Dehiscence | 500 | ||
| Band Erosion | 500 | ||
| Obstruction/Pouch Dilation | 500 | ||
| Conclusion | 500 | ||
| Key References | 500 | ||
| References | 500.e1 | ||
| 45 Intramural and Transmural Endoscopy | 501 | ||
| Abstract | 501.e1 | ||
| Keywords | 501.e1 | ||
| Chapter Outline | 501 | ||
| Introduction | 501 | ||
| Intramural Endoscopy Techniques | 501 | ||
| Techniques for Creation of a Submucosal Working Space | 501 | ||
| Submucosal Endoscopy With Mucosal Safety Valve Technique | 501 | ||
| Chemically Assisted Submucosal Dissection Technique | 501 | ||
| Peroral Endoscopic Myotomy | 501 | ||
| Technique | 502 | ||
| Results | 502 | ||
| Transgastric Endoscopic Surgery | 503 | ||
| Technique of Transgastric Surgery | 503 | ||
| TG Cholecystectomy | 503 | ||
| TG Appendectomy | 504 | ||
| Clinical Transgastric Endoscopic Surgical Results | 504 | ||
| Transvaginal Endoscopic Surgery | 504 | ||
| Transvaginal Access Technique | 504 | ||
| Transrectal NOTES and TAMIS Total Mesorectal Excision | 505 | ||
| Human Transanal Down-to-Up TME | 506 | ||
| Down-to-Up Transanal NOTES TME Using a Single-Port Platform | 506 | ||
| Flexible Down-to-Up NOTES TME | 507 | ||
| Intragastric Single-Port Surgery | 507 | ||
| Intragastric Single-Port Resection of Large Benign Tumors | 507 | ||
| Transgastric ERCP in Excluded Stomach for Altered Anatomy After Roux-en-Y Gastric Bypass | 507 | ||
| Expectations of Natural Orifice Surgery | 507 | ||
| Key References | 508 | ||
| References | 509.e1 | ||
| 46 Endoscopic Full-Thickness Resection of Subepithelial Lesions of the GI Tract | 510 | ||
| Abstract | 510.e1 | ||
| Keywords | 510.e1 | ||
| Chapter Outline | 510 | ||
| Introduction | 510 | ||
| Indications and Contraindications for EFTR | 510 | ||
| EFTR of Subepithelial Tumors Arising From the Muscularis Propria | 510 | ||
| Earlier EFTR Techniques | 511 | ||
| Description of EFTR Technique | 512 | ||
| EFTR Outcomes | 512 | ||
| Summary | 515 | ||
| Key References | 516 | ||
| References | 516.e1 | ||
| 47 Extraintestinal Endosonography | 517 | ||
| Abstract | 517.e1 | ||
| Keywords | 517.e1 | ||
| Chapter Outline | 517 | ||
| Introduction | 517 | ||
| Lung Cancer | 517 | ||
| Staging and Staging Modalities | 517 | ||
| Endoscopic Ultrasound and Endobronchial Ultrasound | 520 | ||
| Endoscopic Ultrasound Technique for Imaging the Mediastinum | 521 | ||
| Techniques for Staging Non–Small-Cell Lung Cancer With Endoscopic Ultrasound | 522 | ||
| Technique for Performing Endoscopic Ultrasound-Guided Fine-Needle Aspiration | 524 | ||
| Mediastinal Lymph Nodes | 524 | ||
| Other Malignant Mediastinal Disease | 524 | ||
| Nonmalignant Mediastinal Disease | 525 | ||
| Adrenal and Renal Lesions | 527 | ||
| Ascites and Pleural Fluid | 528 | ||
| Liver Lesions | 529 | ||
| Miscellaneous | 529 | ||
| Complications | 530 | ||
| Conclusion | 530 | ||
| Key References | 531 | ||
| References | 531.e1 | ||
| III Pancreaticobiliary Disorders | 532 | ||
| One General Considerations and Techniques | 532 | ||
| 48 Preparation for Pancreaticobiliary Endoscopy | 533 | ||
| Abstract | 533.e1 | ||
| Keywords | 533.e1 | ||
| Chapter Outline | 533 | ||
| Introduction | 533 | ||
| Patient-Related Preparation | 533 | ||
| Preprocedure Visit | 533 | ||
| Informed Consent | 534 | ||
| Interdisciplinary Communication | 534 | ||
| Provider-Related Preparation | 534 | ||
| Provider Competence | 534 | ||
| Endoscopy Unit–Related Preparation | 535 | ||
| Endoscopy Unit Design | 535 | ||
| Staff Training | 535 | ||
| Preprocedure Checklist | 536 | ||
| Postprocedure Care | 536 | ||
| Conclusion | 536 | ||
| Key References | 536 | ||
| References | 537.e1 | ||
| 49 Cholangiography and Pancreatography | 538 | ||
| Abstract | 538.e1 | ||
| Keywords | 538.e1 | ||
| Chapter Outline | 538 | ||
| Introduction | 538 | ||
| Indications and Contraindications for ERCP | 538 | ||
| Endoscopic Equipment | 539 | ||
| Digital Imaging and Radiation Safety | 540 | ||
| Endoscopic Technique | 540 | ||
| Upper Gastrointestinal Endoscopy | 540 | ||
| Selective Cannulation of the Desired Duct | 541 | ||
| Contrast Medium and Image Acquisition | 543 | ||
| Cholangiogram Technique and Image Interpretation | 544 | ||
| Features of a Normal Cholangiogram | 546 | ||
| Biliary Stones and Acute Pancreatitis | 546 | ||
| Biliary Strictures | 548 | ||
| Biliary Leaks | 553 | ||
| Anomalous Pancreaticobiliary Ductal Union | 554 | ||
| Pancreatogram Technique and Image Interpretation | 554 | ||
| Features of a Normal Pancreatogram | 555 | ||
| Anatomic Variants of the Pancreatic Duct | 555 | ||
| Overview of Radiographic Patterns of Pathology Seen During Pancreatography | 557 | ||
| Features of Pancreatic Neoplasia | 557 | ||
| Acute Pancreatitis, Recurrent Acute Pancreatitis, and Pancreatic Duct Disruption | 558 | ||
| Chronic Pancreatitis | 559 | ||
| Cholangiopancreatography in Patients With Surgically Altered Anatomy | 560 | ||
| Complications of Cholangiography and Pancreatography | 561 | ||
| Acknowledgements | 561 | ||
| Key References | 561 | ||
| References | 562.e1 | ||
| 50 Difficult Cannulation and Sphincterotomy | 563 | ||
| Abstract | 563.e1 | ||
| Keywords | 563.e1 | ||
| Chapter Outline | 563 | ||
| Introduction | 563 | ||
| Standard Accessories | 563 | ||
| Standard Cannulas | 563 | ||
| Sphincterotomes | 563 | ||
| Catheter Versus Sphincterotome for Cannulation | 563 | ||
| Guidewires | 564 | ||
| Difficulties in Cannulation of the Papilla | 564 | ||
| Access Sphincterotomy in Difficult Papillary Cannulation | 565 | ||
| Periampullary Duodenal Diverticula | 566 | ||
| Special Cannulation Techniques in Periampullary Duodenal Diverticula | 566 | ||
| Two devices in one channel method. | 566 | ||
| Reversed guidewire method. | 566 | ||
| Endoscopic clip placement. | 566 | ||
| “Clip and line”-assisted papillary cannulation (Video 50.3). | 566 | ||
| Double-endoscope method. | 567 | ||
| Balloon dilatation of the narrow diverticular neck. | 567 | ||
| Cap-assisted cannulation. | 567 | ||
| Percutaneous transhepatic access and rendezvous. | 567 | ||
| EUS-guided rendezvous technique. | 567 | ||
| ERCP in Surgically Altered Anatomy | 567 | ||
| Billroth I | 567 | ||
| Billroth II | 567 | ||
| Sphincterotomy in BII cases. | 567 | ||
| Roux-en-Y Gastric Bypass | 567 | ||
| Double-balloon enteroscopy for patients with Roux-en-Y anatomy. | 568 | ||
| Conventional Whipple Procedure | 569 | ||
| Cannulation of the Minor Papilla | 569 | ||
| Major Papilla Sphincterotomy | 569 | ||
| Pancreatic Sphincterotomy | 569 | ||
| Minor Papillotomy | 570 | ||
| Key References | 570 | ||
| References | 570.e1 | ||
| 51 Endoscopic Ultrasound and Fine-Needle Aspiration for Pancreatic and Biliary Disorders | 571 | ||
| Abstract | 571.e1 | ||
| Keywords | 571.e1 | ||
| Chapter Outline | 571 | ||
| Introduction | 571 | ||
| Linear Versus Radial Endoscopic Ultrasound Imaging | 571 | ||
| Preparation for EUS Examination | 572 | ||
| Esophageal Intubation | 572 | ||
| Principles of Linear and Radial Pancreatic and Biliary Imaging | 572 | ||
| Gallbladder Stones, Sludge, and Polyps | 572 | ||
| Bile Duct Stones | 573 | ||
| Bile Duct Strictures | 574 | ||
| Ampulla of Vater | 575 | ||
| Ampullary Neoplasms | 575 | ||
| Acute Pancreatitis | 577 | ||
| Chronic Pancreatitis | 577 | ||
| Autoimmune Pancreatitis | 579 | ||
| EUS-Guided Fine-Needle Aspiration and Biopsy Technique | 580 | ||
| Lesion Targeting | 580 | ||
| Prioritizing Lesions for Fine-Needle Aspiration | 580 | ||
| Needle Selection | 580 | ||
| EUS-Guided FNA for Cytology | 580 | ||
| Needle Size | 580 | ||
| Number of Passes | 581 | ||
| Needle Insertion and Fanning | 582 | ||
| Suction Methods | 582 | ||
| Rapid On-Site Evaluation and Macroscopic On-Site Evaluation | 583 | ||
| Specimen Handling | 583 | ||
| EUS-FNB for Histology | 583 | ||
| Needle Type | 583 | ||
| EUS-FNB Technique | 584 | ||
| Complications of EUS-Guided FNA of Pancreaticobiliary Lesions | 585 | ||
| Conclusions | 586 | ||
| EUS-Guided Fine-Needle Therapy | 586 | ||
| EUS-Guided Celiac Plexus and Ganglia Interventions | 586 | ||
| Relevant Anatomy | 586 | ||
| Non-EUS Methods for Celiac Plexus Neurolysis and Celiac Plexus Block | 586 | ||
| Patient Preparation and Technique for the EUS-Guided Approach | 586 | ||
| EUS-Guided Direct Celiac Ganglion Neurolysis | 587 | ||
| Clinical Trial Data | 587 | ||
| Complications | 588 | ||
| EUS-Guided Radiofrequency Ablation | 588 | ||
| Animal Studies | 588 | ||
| Human Studies | 589 | ||
| EUS-Guided Fiducial Marker Placement | 589 | ||
| Fiducial Characteristics | 589 | ||
| Technique for Fiducial Marker Placement | 590 | ||
| Ideal Fiducial Geometry | 590 | ||
| Complications | 590 | ||
| EUS-Guided Antitumor Agents | 590 | ||
| Key References | 590 | ||
| References | 591.e1 | ||
| 52 Endoscopic Ultrasound–Guided Access and Drainage of the Pancreaticobiliary Ductal Systems | 592 | ||
| Abstract | 592.e1 | ||
| Keywords | 592.e1 | ||
| Chapter Outline | 592 | ||
| Introduction | 592 | ||
| EUS-Guided Biliary Drainage (EUS-BD) | 592 | ||
| Technical Considerations | 592 | ||
| EUS-Guided Extrahepatic Bile Duct Drainage | 592 | ||
| EUS-Guided Intrahepatic Bile Duct Drainage | 593 | ||
| EUS-Guided Rendezvous | 594 | ||
| EUS-Guided Antegrade Stenting | 594 | ||
| Clinical Outcomes | 594 | ||
| Clinical Algorithm | 596 | ||
| Conclusion | 596 | ||
| Interventional EUS-Guided Pancreatic Duct Drainage | 596 | ||
| Technical Considerations | 596 | ||
| Clinical Outcomes | 597 | ||
| Clinical Algorithm | 600 | ||
| Conclusion | 600 | ||
| Key References | 600 | ||
| References | 600.e1 | ||
| Two Benign Biliary Disorders | 601 | ||
| 53 Gallstone Disease | 601 | ||
| Abstract | 601.e1 | ||
| Keywords | 601.e1 | ||
| Chapter Outline | 601 | ||
| Introduction | 601 | ||
| Biliary Stone Disease | 601 | ||
| Stone Types | 601 | ||
| Cholecystitis | 602 | ||
| Diagnosis | 602 | ||
| Other Gallstone-Related Conditions | 603 | ||
| Therapy for Cholecystitis and Symptomatic Cholelithiasis | 604 | ||
| Choledocholithiasis | 608 | ||
| Epidemiology/Incidence/Risk Factors/Pathophysiology | 608 | ||
| Symptoms | 608 | ||
| Diagnosis | 609 | ||
| Treatment | 610 | ||
| ERCP | 610 | ||
| Percutaneous Transhepatic Biliary Drainage (PTBD) | 612 | ||
| Surgery | 612 | ||
| Special Situations | 613 | ||
| Cystic Duct Stones and Hepatolithiasis | 613 | ||
| Treatment of Choledocholithiasis in Surgically Altered Anatomy | 613 | ||
| Treatment of Choledocholithiasis in Pregnancy | 614 | ||
| Posttreatment Recurrence | 614 | ||
| Gallstone Pancreatitis | 616 | ||
| Incidence/Epidemiology | 616 | ||
| Pathophysiology | 616 | ||
| Diagnosis | 616 | ||
| Treatment | 616 | ||
| ERCP | 616 | ||
| Cholecystectomy | 617 | ||
| Key References | 617 | ||
| References | 618.e1 | ||
| 54 Postoperative Biliary Strictures and Leaks | 619 | ||
| Abstract | 619.e1 | ||
| Keywords | 619.e1 | ||
| Chapter Outline | 619 | ||
| Introduction | 619 | ||
| Epidemiology | 619 | ||
| Pathogenesis | 620 | ||
| Clincial Features | 621 | ||
| Diagnostic Approach and Differential Diagnosis | 622 | ||
| Treatment | 623 | ||
| Endoscopic Retrograde Cholangiopancreatography and Biliary Leak | 623 | ||
| Interpretation of Intrahepatic Cholangiography | 623 | ||
| Endoscopic Treatment of Minor Lesions | 626 | ||
| Endoscopic Treatment of Major Lesions | 627 | ||
| Biliary Strictures | 628 | ||
| Description of Technique | 630 | ||
| Traversing the Stricture | 630 | ||
| Dilation of the Stricture | 630 | ||
| Strictures After LC | 630 | ||
| Strictures After LT | 632 | ||
| Complications | 634 | ||
| Future Trends | 634 | ||
| Key References | 634 | ||
| References | 635.e1 | ||
| 55 Infections of the Biliary Tract | 636 | ||
| Abstract | 636.e1 | ||
| Keywords | 636.e1 | ||
| Chapter Outline | 636 | ||
| Introduction | 636 | ||
| Endoscopic Retrograde Cholangiopancreatography | 636 | ||
| Indications | 636 | ||
| Contraindications | 636 | ||
| Equipment | 636 | ||
| Preparation | 637 | ||
| Postprocedure Care | 637 | ||
| Complications | 637 | ||
| ERCP and Biliary Tract Infections (Iatrogenic Cholangitis) | 637 | ||
| Prevention | 638 | ||
| Acute Cholangitis | 638 | ||
| Diagnosis and Grading of Severity | 638 | ||
| Management | 638 | ||
| Postoperative Cholangitis | 638 | ||
| Biliary Strictures (Chronic Pancreatitis Related and Malignant) | 639 | ||
| Choledocholithiasis | 640 | ||
| Recurrent Pyogenic Cholangitis | 640 | ||
| Diagnosis | 641 | ||
| Management | 642 | ||
| Endoscopic Management | 642 | ||
| Role of Cholangioscopy | 642 | ||
| Percutaneous Approach | 643 | ||
| Role of Surgery | 643 | ||
| Parasitic Cholangitis | 643 | ||
| Ascaris Cholangitis | 643 | ||
| Indications of ERCP | 644 | ||
| Preparation. | 644 | ||
| Procedure. | 644 | ||
| Complications. | 644 | ||
| Index | 748 | ||
| A | 748 | ||
| B | 749 | ||
| C | 751 | ||
| D | 754 | ||
| E | 755 | ||
| F | 759 | ||
| G | 760 | ||
| H | 761 | ||
| I | 762 | ||
| J | 763 | ||
| K | 763 | ||
| L | 763 | ||
| M | 764 | ||
| N | 765 | ||
| O | 765 | ||
| P | 766 | ||
| Q | 769 | ||
| R | 769 | ||
| S | 769 | ||
| T | 772 | ||
| U | 773 | ||
| V | 773 | ||
| W | 774 | ||
| X | 774 | ||
| Y | 774 | ||
| Z | 774 | ||
| Endsheet 7 | IBC1 |