Additional Information
Book Details
Abstract
Over the past 40 years, ERCP has become an effective therapeutic modality with diagnostic purposes that are continually improved.. The 3rd Edition of this practical reference helps you make the most of today’s endoscopic retrograde cholangiopancreatography in your practice. You’ll find authoritative, highly illustrated guidance on every aspect of ERCP, including coverage of the latest techniques.
- Includes new chapters that cover duodenoscope reprocessing; endomicrocopy; EUS-guided endotherapy related to pancreatobiliary disorders; and CT and MRCP related to pancreatobiliary disorders.
- Contains updated information on radiofrequency ablation for cancer, percutaneous vs. endoscopic drainage, scope cleaning practices, and pancreatic necrosis.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| ERCP | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Foreword | xi | ||
| Acknowledgment | xi | ||
| Table Of Contents | xiii | ||
| Video Contents | xv | ||
| I General Topics | 1 | ||
| 1 Approaching 50 Years | 1 | ||
| ERCP in Its Infancy: 1968 to 1980 | 1 | ||
| The Second Decade: 1980 to 1990 | 4 | ||
| The Third Decade: 1990 to 2000 | 4 | ||
| ERCP in the New Millennium | 5 | ||
| The Future of ERCP | 6 | ||
| Key Points | 6 | ||
| References | 6.e1 | ||
| 2 The ERCP Room | 7 | ||
| Evolution of the ERCP Room | 7 | ||
| Staffing for the ERCP Procedure | 7 | ||
| Room Layout | 7 | ||
| Radiologic Imaging Equipment | 8 | ||
| Room Integration Systems | 9 | ||
| Endoscopist Work Area | 10 | ||
| Intraprocedure | 10 | ||
| Preprocedure and Postprocedure Work Area | 10 | ||
| Anesthesia/Sedation Work Area | 11 | ||
| Nursing and Technician Work Area | 11 | ||
| Ergonomics | 12 | ||
| Miscellaneous Issues | 13 | ||
| References | 13.e1 | ||
| 3 Radiologic Issues and Radiation Safety During ERCP | 14 | ||
| Fluoroscopic Imaging Systems | 14 | ||
| Radiation Dose Management in Fluoroscopic Procedures | 16 | ||
| Occupational Ionizing Radiation Exposure | 17 | ||
| Creating and Viewing Images | 18 | ||
| Bile Duct Evaluation | 20 | ||
| Pancreatic Duct Evaluation | 21 | ||
| General Imaging Considerations | 24 | ||
| Additional Cancer Risks From Medical Radiation | 26 | ||
| References | 29.e1 | ||
| 4 Endoscopes, Guidewires, and Accessories | 30 | ||
| Endoscopes | 30 | ||
| Side-Viewing Endoscopes | 30 | ||
| Forward-Viewing Endoscopes | 30 | ||
| Balloon-Assisted Enteroscopes | 30 | ||
| Echoendoscopes | 30 | ||
| Accessories | 30 | ||
| Standard Cannulation Catheters | 31 | ||
| Sphincterotomes | 32 | ||
| Access Sphincterotomes | 32 | ||
| Guidewires | 33 | ||
| Wire Safety | 34 | ||
| Exchange Assistance Devices (Short-Wire ERCP Systems) | 34 | ||
| Rapid Exchange Biliary System | 34 | ||
| Fusion System | 35 | ||
| V-System | 35 | ||
| Accessories | 35 | ||
| Drainage Devices | 35 | ||
| Plastic Stents | 36 | ||
| Self-Expandable Metal Stents | 37 | ||
| Nasobiliary and Pancreatic Drainage Catheters | 37 | ||
| Tissue Sampling Devices | 38 | ||
| Stricture and Papilla Dilation Devices | 38 | ||
| Stone Extraction Accessories | 38 | ||
| Mechanical Lithotriptors | 39 | ||
| Cholangiopancreatoscopy | 39 | ||
| Intraductal Ultrasound Probes | 40 | ||
| Probe-Based Confocal Laser Endomicroscopy | 40 | ||
| Other Accessories | 40 | ||
| Radiographic Contrast Media Used in ERCP | 40 | ||
| The Use of Carbon Dioxide in ERCP | 40 | ||
| Accessories for Use in Patients With Altered Anatomy | 41 | ||
| Single-Use Versus Reusable Accessories | 41 | ||
| Storage of Accessories | 42 | ||
| Role of the U.S. Food and Drug Administration in Device Evaluation and Monitoring | 42 | ||
| Radiation Exposure | 43 | ||
| References | 43.e1 | ||
| 5 Duodenoscope Reprocessing | 44 | ||
| Background | 44 | ||
| History of MDRO in Endoscopy | 44 | ||
| High-Level Disinfection and Reprocessing | 45 | ||
| Reaction From Regulatory Bodies | 46 | ||
| Strategies for Risk Reduction | 46 | ||
| Potential Solutions | 47 | ||
| Conclusions | 47 | ||
| References | 48.e1 | ||
| 6 Sedation in ERCP | 49 | ||
| Defining the Continuum of Sedation | 49 | ||
| Defining Sedation-Related Complications (Adverse Events) | 50 | ||
| Risk Assessment | 51 | ||
| Anesthesiologist-Administered Sedation | 51 | ||
| Nonanesthesiologist (Endoscopist)–Administered Sedation | 52 | ||
| Monitoring | 52 | ||
| Room Setup and Considerations for Safety | 53 | ||
| Conclusions | 53 | ||
| References | 53.e1 | ||
| 7 Indications for and Contraindications to ERCP | 54 | ||
| Indications for and Contraindications to ERCP | 54 | ||
| Indications for ERCP | 55 | ||
| Special Cases | 57 | ||
| Contraindications to ERCP | 57 | ||
| References | 58.e1 | ||
| 8 Adverse Events of ERCP | 59 | ||
| Definitions of Complications, Adverse Events, Unplanned Events, and Other Negative Outcomes | 59 | ||
| Analyses of Adverse Event Rates | 59 | ||
| Overall Adverse Events of ERCP and Sphincterotomy | 59 | ||
| Pancreatitis | 60 | ||
| Patient-Related Risk Factors for Post-ERCP Pancreatitis | 61 | ||
| Technique-Related Risk Factors for Post-ERCP Pancreatitis | 61 | ||
| Specific Techniques to Reduce Risk of Post-ERCP Pancreatitis | 62 | ||
| Pharmacologic Agents | 63 | ||
| Prevention and Treatment of Post-ERCP Pancreatitis | 64 | ||
| Hemorrhage | 64 | ||
| Risk Factors for Hemorrhage After Sphincterotomy | 64 | ||
| Methods to Prevent and Treat Hemorrhage | 65 | ||
| Perforation | 65 | ||
| Cholangitis and Cholecystitis | 66 | ||
| Duodenoscope-Associated Bacterial Infections | 66 | ||
| Long-Term Adverse Events and Sequelae | 66 | ||
| Operator Experience and Adverse Events | 66 | ||
| References | 67.e1 | ||
| 9 ERCP Training | 68 | ||
| Training in ERCP | 68 | ||
| Current Status of ERCP Training | 68 | ||
| Learning Curves and Competence in ERCP | 69 | ||
| Toward Competency-Based Medical Education | 70 | ||
| ERCP Training Using Simulation | 71 | ||
| Maintenance of ERCP Skills and Volume for ERCP | 72 | ||
| Quality Measures for Trainees | 72 | ||
| Future Directions | 72 | ||
| Conclusions | 73 | ||
| References | 73.e1 | ||
| Appendix 9.1 The EUS and ERCP Skills Assessment Tool (TEESAT) | 74 | ||
| 10 Preparation of the Patient for ERCP | 80 | ||
| Should This Patient Undergo ERCP? | 80 | ||
| When, Where, and With Whom? | 80 | ||
| Evaluation of the Patient Before ERCP | 80 | ||
| History and Physical | 80 | ||
| Laboratory Testing | 81 | ||
| Review of Imaging Studies | 81 | ||
| Preparing the Patient: Day(s) Before ERCP | 81 | ||
| Management of Antithrombotic Agents | 81 | ||
| Antiplatelet Agents | 81 | ||
| Aspirin. | 81 | ||
| Thienopyridines and dual-antiplatelet therapy. | 81 | ||
| Anticoagulants | 82 | ||
| Duration of Fasting | 82 | ||
| Method of Sedation, Proper Personnel, and Patient Monitoring | 82 | ||
| Selecting Sedation for ERCP | 82 | ||
| Proper Personnel | 83 | ||
| Proper Monitoring and Intervention Equipment | 83 | ||
| Preparing the Endoscopy Team | 83 | ||
| Preparing the Patient: the Day of the ERCP | 83 | ||
| Informed Consent | 83 | ||
| Periprocedural Antibiotics | 83 | ||
| Positioning the Patient and Preparing for Radiography | 84 | ||
| Reviewing Intravenous Access and Allergies | 84 | ||
| References | 85.e1 | ||
| 11 Principles of Electrosurgery | 86 | ||
| Electrosurgery | 86 | ||
| A Brief History of Electrosurgery and ERCP | 86 | ||
| Basics of Electricity as Applied to Electrosurgery | 86 | ||
| Basics of Electricity | 86 | ||
| The Electrosurgical Unit | 87 | ||
| Monopolar Versus Bipolar Circuits | 87 | ||
| Maximizing Safety | 87 | ||
| Pacemakers | 88 | ||
| Neuromuscular Stimulation | 88 | ||
| Current Leaks | 88 | ||
| Clinical Applications of Electrosurgery in ERCP | 88 | ||
| Types of Current | 88 | ||
| Sphincterotomy | 88 | ||
| Needle-Knife Access Papillotomy and Fistulotomy | 89 | ||
| Electrohydraulic Lithotripsy (see Chapters 19, 46, and 55) | 89 | ||
| Papillectomy | 90 | ||
| Pseudocyst Drainage and Necrosectomy | 90 | ||
| EUS Gallbladder Drainage | 91 | ||
| Radiofrequency Ablation in the Bile Duct | 92 | ||
| References | 92.e1 | ||
| 12 Quality Issues and Measures in ERCP | 93 | ||
| Preprocedure Quality Indicators | 93 | ||
| Appropriate Indication | 93 | ||
| Informed Consent | 94 | ||
| Assessment of the Difficulty of the Procedure | 95 | ||
| Prophylactic Antibiotics | 95 | ||
| Endoscopist Experience | 95 | ||
| Intraprocedure Quality Indicators | 95 | ||
| Cannulation Rates | 95 | ||
| Removal of Common Bile Duct Stones | 96 | ||
| Stent Placement for Biliary Obstruction Below the Bifurcation | 96 | ||
| Postprocedure Quality Indicators | 96 | ||
| Comprehensive Documentation | 96 | ||
| Adverse Event Rates | 96 | ||
| Fluoroscopy Duration and Radiation Dose | 97 | ||
| Initiating Quality Measurements | 97 | ||
| Conclusions | 98 | ||
| References | 98.e1 | ||
| 13 Medicolegal Issues in ERCP | 99 | ||
| How Often Are Gastroenterologists Sued? | 99 | ||
| How Common Are Lawsuits Involving ERCP? | 99 | ||
| What Are the Key Legal Principles? | 99 | ||
| Duty | 100 | ||
| Breach of Duty | 100 | ||
| Causation | 100 | ||
| Injury | 100 | ||
| Standards of Care and Guidelines | 100 | ||
| Guidelines | 100 | ||
| Who May Be Liable? Not Only the ERCPist | 100 | ||
| Employer Liability | 100 | ||
| Preceptor | 100 | ||
| Proctor | 101 | ||
| Administrator | 101 | ||
| Hospital Liability | 101 | ||
| Summary of Vicarious Liability | 101 | ||
| Informed Consent | 101 | ||
| Material Risks | 101 | ||
| Controversial Areas | 102 | ||
| Exceptions to Informed Consent | 102 | ||
| Informed Refusal | 102 | ||
| Legal Consequences of Failing to Obtain Informed Consent | 102 | ||
| Why Do ERCP Lawsuits Occur? | 102 | ||
| Marginal Indications | 102 | ||
| Poor Communication | 102 | ||
| Poor Endoscopic Technique | 102 | ||
| Sedation/Anesthesia Problems | 103 | ||
| Poor Aftercare | 103 | ||
| Nosocomial Infection | 103 | ||
| Delay in Performing ERCP | 103 | ||
| How to Minimize the Risk of Litigation | 103 | ||
| Levels of Complexity in Training and Practice | 103 | ||
| Certification? | 104 | ||
| Recognizing Higher-Risk Situations | 104 | ||
| Higher-Risk Patients | 104 | ||
| Higher-Risk Procedures | 104 | ||
| The Context of the Procedure | 104 | ||
| Risk-Benefit | 104 | ||
| Professional Behavior | 104 | ||
| Doing Informed Consent Right | 105 | ||
| Documenting the Consent Process: “He Said, She Said” | 105 | ||
| Special Care Needed With “Open Access” and Urgent ERCP | 105 | ||
| Live Teaching Demonstrations | 105 | ||
| Managing Adverse Events | 105 | ||
| When You Are Sued | 107 | ||
| Expert Testimony | 107 | ||
| A Summary of Recommendations | 107 | ||
| Conclusions | 107 | ||
| Acknowledgments | 107 | ||
| References | 107.e1 | ||
| II Techniques | 108 | ||
| 14 Cannulation of the Major Papilla | 108 | ||
| Establishing the Duodenal Position | 108 | ||
| Devices and Equipment for Cannulation (See Also Chapter 4) | 109 | ||
| Cannulation Technique | 109 | ||
| Guidewire or Contrast? | 109 | ||
| Papilla Assessment and Basic Technique | 111 | ||
| Small Papilla | 113 | ||
| Periampullary Diverticulum | 113 | ||
| Difficult Cannulation | 117 | ||
| Repeated Cannulation of the Pancreatic Duct Without Biliary Access | 117 | ||
| Needle-Knife Sphincterotomy (See Also Chapter 15) | 118 | ||
| NKS Technique | 119 | ||
| Cannulation of the Pancreatic Duct | 121 | ||
| Quality and Enhancing Outcomes (See Also Chapter 12) | 122 | ||
| References | 122.e1 | ||
| 15 Access (Precut) Papillotomy | 123 | ||
| Indication for Precut Papillotomy | 123 | ||
| Precut Accessories | 123 | ||
| Techniques | 124 | ||
| Needle Knife From the Orifice | 124 | ||
| Needle Knife Above the Papillary Orifice (Fistulotomy) | 125 | ||
| Needle Knife With an Insulated Tip | 126 | ||
| Short-Nose Precut Sphincterotomy | 127 | ||
| Transpancreatic Sphincterotomy | 127 | ||
| Unconventional Techniques | 127 | ||
| Use of Pancreatic Stents | 128 | ||
| Adverse Events (see Chapter 8) | 129 | ||
| Pancreatitis | 129 | ||
| Bleeding | 130 | ||
| Perforation | 130 | ||
| Failed Access and Cost | 130 | ||
| Summary | 131 | ||
| References | 130.e1 | ||
| 16 Sphincter of Oddi Manometry | 132 | ||
| Method of SOM | 132 | ||
| Sedation | 132 | ||
| Equipment | 133 | ||
| Technical Performance of SOM (Video 16.1) | 134 | ||
| Interpretation Criteria | 135 | ||
| Reproducibility of SOM | 136 | ||
| Adverse Events of SOM | 136 | ||
| Summary | 136 | ||
| References | 136.e1 | ||
| 17 Biliary Sphincterotomy | 137 | ||
| Description of the Technique | 137 | ||
| Instruments | 137 | ||
| Procedure | 138 | ||
| EST in Patients With Difficult Anatomy | 142 | ||
| Alternatives to EST | 143 | ||
| Indications | 144 | ||
| Contraindications | 145 | ||
| Adverse Events and Their Management (see Chapter 8) | 145 | ||
| EST-Related Post-ERCP Pancreatitis | 145 | ||
| EST-Related Hemorrhage | 146 | ||
| EST-Related Perforation | 146 | ||
| EST-Related Cholangitis | 146 | ||
| Long-Term Consequences of EST | 147 | ||
| References | 147.e1 | ||
| 18 Balloon Dilation of the Native and Postsphincterotomy Papilla | 148 | ||
| EPLBD After EST for Removal of Large Stones | 148 | ||
| Technique of Large-Balloon Dilation of Postsphincterotomy Papilla | 148 | ||
| Adverse Events of EPLBD After EST | 149 | ||
| EPLBD Without Preceding Sphincterotomy (EST) | 152 | ||
| Technique of EPLBD Without Sphincterotomy | 152 | ||
| Adverse Events of EPLBD Without EST | 154 | ||
| Recommendations for Safe and Successful EPLBD | 154 | ||
| EPBD of the Native Papilla | 155 | ||
| Indications for EPBD | 155 | ||
| Adverse Events of EPBD | 155 | ||
| Special Situations | 156 | ||
| Summary | 159 | ||
| References | 159.e1 | ||
| 19 Stone Extraction | 160 | ||
| Introduction and Scientific Basis | 160 | ||
| Biliary Stone Disease and Contraindications to ERCP (see Chapter 7) | 161 | ||
| Biliary Stone Disease: Indications and Considerations | 161 | ||
| Contraindications | 161 | ||
| DescriptionS of Techniques | 161 | ||
| Removal of an Impacted Ampullary Stone | 161 | ||
| Balloon Stone Extraction | 161 | ||
| Basket Stone Extraction | 162 | ||
| Mechanical Lithotripsy | 164 | ||
| Intraductal Electrohydraulic Lithotripsy | 168 | ||
| Endoscopic Papillary Balloon Dilation | 168 | ||
| Adverse Events and Their Management (see Chapter 8) | 169 | ||
| Adverse Events of Extraction Balloons | 169 | ||
| Adverse Events of Extraction Baskets | 169 | ||
| Adverse Events of Mechanical Lithotripsy | 169 | ||
| Adverse Events of Intraductal Lithotripsy | 170 | ||
| Relative Cost | 170 | ||
| Conclusions | 170 | ||
| References | 170.e1 | ||
| 20 Pancreatic Sphincterotomy | 171 | ||
| Endoscopic Pancreatic Sphincterotomy | 171 | ||
| Preparation | 171 | ||
| Equipment | 171 | ||
| The Endoscopic Technique | 172 | ||
| Pull-Type Sphincterotomy | 173 | ||
| Needle-Knife Sphincterotomy | 174 | ||
| Precut Pancreatic Sphincterotomy | 175 | ||
| Indications for Pancreatic Sphincterotomy | 175 | ||
| Pancreatic Sphincterotomy as Primary Therapy | 176 | ||
| Pancreas Divisum, Sphincter of Oddi Dysfunction, and Recurrent Acute Pancreatitis | 176 | ||
| Chronic Pancreatitis | 178 | ||
| Pancreatic Sphincterotomy as Secondary Therapy | 179 | ||
| Adverse Events of Pancreatic Sphincterotomy | 180 | ||
| The Cost of Pancreatic Sphincterotomy | 181 | ||
| References | 181.e1 | ||
| 21 Minor Papilla Cannulation and Sphincterotomy | 182 | ||
| Indications for Minor Papilla Cannulation and Sphincterotomy | 182 | ||
| Sedation, Supplemental Drugs, and ERCP Accessories | 182 | ||
| Sedation | 182 | ||
| Antispasmodic Drugs | 182 | ||
| Supplemental Agents | 183 | ||
| ERCP Accessories | 183 | ||
| Recognition of the Minor Papilla | 183 | ||
| Supplemental Techniques to Identify the Minor Papilla in Difficult Cases | 184 | ||
| Dyeing Solutions | 184 | ||
| Secretin | 184 | ||
| Minor Papilla Cannulation (Video 21.1) | 185 | ||
| Cannulating the Minor Papilla in Difficult Cases | 186 | ||
| Minor Papilla Sphincterotomy | 187 | ||
| Techniques for Minor Papilla Sphincterotomy | 187 | ||
| Sphincterotomy With Pull-Type Sphincterotome | 188 | ||
| Sphincterotomy With Needle Knife Over Pancreatic Stent | 189 | ||
| Sphincterotomy With Wire-Assisted Needle Knife | 189 | ||
| Pull-Type or Needle-Knife Sphincterotome: Pros and Cons | 189 | ||
| Precut Sphincterotomy in Case of Failed Dorsal Duct Cannulation | 190 | ||
| Postprocedural Stenting of the Minor Papilla | 191 | ||
| Repeat Minor Papilla Sphincterotomy | 192 | ||
| Outcomes of Minor Papilla Sphincterotomy | 192 | ||
| Adverse Events (See Chapter 8) | 192 | ||
| References | 195.e1 | ||
| 22 Plastic Pancreaticobiliary Stents and Nasopancreaticobiliary Tubes | 196 | ||
| Stent Systems | 196 | ||
| Endoscope Requirements | 196 | ||
| Description of Technique: Biliary | 196 | ||
| Distal Biliary Obstruction | 196 | ||
| Stents for Irretrievable Bile Duct Stones | 198 | ||
| Hilar Biliary Obstruction | 200 | ||
| Nasobiliary Tubes | 200 | ||
| Pancreatic Duct Stent Insertion | 201 | ||
| Nasopancreatic Tubes | 202 | ||
| Drainage of Pancreatic Fluid Collections | 202 | ||
| Indications and Contraindications | 202 | ||
| Biliary Indications | 202 | ||
| Pancreatic Indications | 203 | ||
| Adverse Events | 203 | ||
| Relative Cost | 205 | ||
| References | 205.e1 | ||
| 23 Biliary Metal Stent Insertion | 206 | ||
| Indications | 206 | ||
| SEMS for Malignant Biliary Stricture | 206 | ||
| SEMS Versus PS | 206 | ||
| Covered Versus Uncovered SEMS for Malignant Biliary Obstruction | 206 | ||
| Preoperative Use of SEMS in Malignant Biliary Disease | 207 | ||
| SEMS for Benign Biliary Disease | 207 | ||
| Description of Technique | 208 | ||
| Currently Available SEMS | 208 | ||
| Techniques for SEMS Placement | 211 | ||
| Guidewire | 211 | ||
| Stent Size, Positioning, and Sphincterotomy | 211 | ||
| Endoscopic and Fluoroscopic Deployment of SEMS | 211 | ||
| Hilar Strictures | 212 | ||
| Duodenal Obstruction | 212 | ||
| Adverse Events and Their Management | 215 | ||
| Relative Cost | 215 | ||
| References | 215.e1 | ||
| 24 Pancreaticobiliary Stent Retrieval | 216 | ||
| Removal of Biliary Stents | 216 | ||
| Plastic Biliary Stents (see Chapter 22) | 216 | ||
| Self-Expandable Metal Stents | 216 | ||
| Indications and Contraindications | 217 | ||
| Timing of Stent Retrieval | 218 | ||
| Techniques | 218 | ||
| Direct Grasping Technique | 218 | ||
| Indirect Grasping Technique | 218 | ||
| Lasso Technique | 219 | ||
| Soehendra Stent Retriever Technique | 219 | ||
| Dilating Balloon Extraction Technique | 219 | ||
| Stent-in-Stent Technique | 220 | ||
| Trimming of SEMS | 221 | ||
| Other Novel Techniques | 221 | ||
| Adverse Events and Management | 222 | ||
| Relative Costs and Choice of Technique | 222 | ||
| Removal of Pancreatic Stents | 223 | ||
| Indications and Contraindications | 223 | ||
| Timing of Stent Retrieval | 224 | ||
| Techniques | 224 | ||
| Adverse Events and Management | 226 | ||
| Relative Costs and Choice of Technique | 226 | ||
| Removal of Lumen-Apposing Metal Stents | 226 | ||
| Indications, Contraindications, and Timing of Stent Retrieval | 227 | ||
| Techniques | 228 | ||
| Summary | 229 | ||
| References | 229.e1 | ||
| 25 Papillectomy and Ampullectomy | 230 | ||
| Treatment Options | 230 | ||
| Considerations in FAP | 230 | ||
| Technique (Box 25.1) | 231 | ||
| Initial Endoscopic Assessment | 231 | ||
| Conventional Endoscopy | 231 | ||
| Endoscopic Ultrasonography and Intraductal Endoscopic Ultrasonography | 232 | ||
| Endoscopic Retrograde Cholangiopancreatography | 233 | ||
| Endoscopic Papillectomy | 233 | ||
| Snare Excision | 233 | ||
| Electrosurgical Currents: Cutting Versus Coagulation | 234 | ||
| En Bloc Versus Piecemeal Resection | 234 | ||
| Role of Submucosal Injection | 234 | ||
| Infrequently Performed Novel Techniques | 235 | ||
| Specimen Retrieval and Preparation | 235 | ||
| Preresection Sphincterotomy | 235 | ||
| Postpapillectomy Sphincterotomy | 235 | ||
| Postpapillectomy Stents: Pancreatic and Biliary | 235 | ||
| Adjunctive Therapy and Thermal Ablation | 236 | ||
| Postpapillectomy Surveillance | 237 | ||
| Indications and Contraindications (Box 25.2) | 237 | ||
| Adverse Events and Their Management (Boxes 25.3 and 25.4) | 238 | ||
| Success | 239 | ||
| Relative Cost Savings | 239 | ||
| Subepithelial Lesions | 240 | ||
| Summary | 241 | ||
| References | 241.e1 | ||
| 26 Pancreatoscopy | 242 | ||
| Equipment and Technique | 242 | ||
| Video Pancreatoscope | 242 | ||
| Two-Operator “Mother–Baby” Method | 242 | ||
| Single-Operator Cholangiopancreatoscopy | 243 | ||
| Other Techniques | 244 | ||
| Diagnostic Indications | 244 | ||
| Intraductal Papillary Mucinous Neoplasm | 244 | ||
| Indeterminate Pancreatic Duct Strictures (Benign or Malignant) | 246 | ||
| Sampling | 247 | ||
| Therapeutic Indications | 247 | ||
| Intraductal Lithotripsy in Patients With Chronic Pancreatitis | 247 | ||
| Adverse Events and Management | 247 | ||
| Relative Cost | 247 | ||
| Conclusions | 248 | ||
| References | 248 | ||
| 27 Cholangioscopy | 249 | ||
| Single-Operator Cholangioscopy | 249 | ||
| Introduction | 249 | ||
| Equipment | 249 | ||
| Technique | 249 | ||
| Clinical Use and Efficacy | 249 | ||
| Intraductal Lithotripsy | 249 | ||
| Clearance of Difficult Biliary Stone Clearance Using FSOC | 250 | ||
| Pancreatic Stone Therapy Using FSOC | 251 | ||
| FSOC Evaluation of Indeterminate Biliary Strictures | 252 | ||
| Reimbursement and Limitations | 254 | ||
| Adverse Events | 254 | ||
| Summary | 254 | ||
| Videocholangioscopy Using the Mother–Baby System | 254 | ||
| Description of the Technique | 254 | ||
| Technique: Diagnostic and Therapeutic | 255 | ||
| Adverse Events and Limitations | 255 | ||
| Videocholangioscopy by the Direct Insertion System | 256 | ||
| Description of the Technique | 256 | ||
| Technique: Diagnostic and Therapeutic | 257 | ||
| Adverse Events and Limitations | 258 | ||
| Acknowledgment | 258 | ||
| References | 258.e1 | ||
| 28 Endomicroscopy in the Pancreaticobiliary Tree | 259 | ||
| Confocal Laser Endomicroscopy | 259 | ||
| Technique | 259 | ||
| Diagnostic and Safety Data | 259 | ||
| Optical Coherence Tomography | 262 | ||
| Conclusion | 262 | ||
| References | 262.e1 | ||
| 29 ERCP in Children | 263 | ||
| Description of Technique | 263 | ||
| Patient and Family Preparation | 263 | ||
| Procedure Environment | 263 | ||
| Endoscopist | 263 | ||
| Sedation | 264 | ||
| Fluoroscopy (see Chapter 3) | 264 | ||
| Supplemental Medications | 264 | ||
| Endoscopic Equipment | 264 | ||
| Technique | 265 | ||
| Indications and Contraindications (Box 29.1) | 265 | ||
| Diagnostic and Therapeutic Indications | 265 | ||
| Biliary Indications | 266 | ||
| Neonatal Cholestasis | 266 | ||
| Cholelithiasis and Choledocholithiasis | 266 | ||
| Choledochal Anomalies (see also Chapter 35) | 266 | ||
| Biliary Strictures and Leaks | 268 | ||
| Unusual Biliary Infections | 274 | ||
| Sphincter of Oddi Dysmotility (see Chapters 16 and 47) | 274 | ||
| Pancreatic Indications | 275 | ||
| Acute Pancreatitis | 275 | ||
| Chronic Pancreatitis (see Chapter 55) | 278 | ||
| Pancreatic Fluid Collections | 278 | ||
| Adverse Events | 278 | ||
| Relative Costs | 281 | ||
| References | 281.e1 | ||
| 30 ERCP in Pregnancy | 282 | ||
| Indication | 282 | ||
| Diagnostic Imaging Modalities | 282 | ||
| Timing | 283 | ||
| Radiation Exposure During ERCP (see Chapter 3) | 283 | ||
| Strategies to Minimize Radiation Risk to the Fetus | 284 | ||
| Positioning, Sedation, and Medications | 284 | ||
| Techniques | 285 | ||
| Outcomes After ERCP During Pregnancy | 286 | ||
| Conclusions | 287 | ||
| References | 287.e1 | ||
| 31 ERCP in Surgically Altered Anatomy | 288 | ||
| Surgery That May Affect the Performance or Interpretation of ERCP | 288 | ||
| Esophageal Resection | 288 | ||
| Gastric Resection | 288 | ||
| Billroth I | 288 | ||
| Billroth II | 288 | ||
| Roux-en-Y Gastrectomy | 293 | ||
| Total Gastrectomy | 294 | ||
| Upper GI Bypass Surgery Without Resection | 294 | ||
| Loop Gastrojejunostomy | 294 | ||
| Duodenal Bypass | 296 | ||
| Bariatric Surgery | 296 | ||
| Malabsorptive Jejunoileal Bypass | 296 | ||
| Biliopancreatic Diversion and Duodenal Switch | 296 | ||
| Restrictive Surgery | 296 | ||
| Roux-en-Y Gastric Bypass | 298 | ||
| Pancreatic Resection | 299 | ||
| Conventional Whipple Procedure | 299 | ||
| Pylorus-Preserving Whipple Procedure | 301 | ||
| Pancreaticogastrostomy | 301 | ||
| Other Pancreatic Resective Surgery (see also Chapter 45) | 301 | ||
| Pancreatic Duct Drainage Procedures | 301 | ||
| Puestow Procedure | 301 | ||
| Frey Procedure | 302 | ||
| Duval Procedure | 302 | ||
| Biliary Surgery | 302 | ||
| Choledochoduodenostomy | 302 | ||
| Roux-en-Y Hepaticojejunostomy | 302 | ||
| Cholecystojejunostomy | 302 | ||
| Liver Transplantation (see Chapter 44) | 304 | ||
| Hepaticocutaneous Jejunostomy | 304 | ||
| Endoscopic Techniques Commonly Employed for ERCP in Surgically Altered Anatomy | 304 | ||
| External Rendezvous Procedure | 304 | ||
| Selection of an Anastomotic Limb to Enter | 305 | ||
| Navigation Through the Small Intestine | 306 | ||
| ERCP Accessories | 306 | ||
| Conclusions | 306 | ||
| References | 307.e1 | ||
| 32 Endoscopic Ultrasonography–Guided Biliary Drainage | 308 | ||
| Description of Technique | 308 | ||
| Steps and Devices Common to Different EUS-BD Procedures | 309 | ||
| Target Identification Under EUS | 309 | ||
| Needle Access Into the Target Organ | 309 | ||
| Contrast Injection and Guidewire Insertion | 310 | ||
| Puncture Tract Dilation | 310 | ||
| Transmural Stent Placement | 313 | ||
| Specific Considerations for EUS-BD (Therapeutic ESCP) | 313 | ||
| Choice of Approach | 313 | ||
| Transpapillary Drainage | 314 | ||
| Transmural Drainage | 317 | ||
| EUS-guided choledochoduodenostomy. | 317 | ||
| EUS-guided hepaticogastrostomy. | 317 | ||
| Indications and Contraindications | 317 | ||
| Procedural Outcomes and Adverse Events | 319 | ||
| References | 320.e1 | ||
| 33 Endoscopic Ultrasound and EUS-Guided Endotherapy | 321 | ||
| Overview | 321 | ||
| Endoscopic Ultrasonography | 321 | ||
| Celiac Nerve Block and Neurolysis | 321 | ||
| Technique | 321 | ||
| Efficacy | 322 | ||
| Adverse Events | 322 | ||
| Drainage of Pancreatic Fluid Collections | 322 | ||
| Technique | 323 | ||
| Efficacy | 323 | ||
| Adverse Events | 324 | ||
| Pancreatic Duct Access and Drainage | 324 | ||
| Technique | 324 | ||
| Biliary Drainage | 324 | ||
| Technique | 325 | ||
| Adverse Events | 326 | ||
| Gallbladder Drainage | 326 | ||
| Technique | 326 | ||
| Efficacy | 327 | ||
| Adverse Events | 327 | ||
| EUS-Guided Ablation and Cancer Therapy | 327 | ||
| Conclusions | 327 | ||
| References | 327.e1 | ||
| III Approach to Clinical Problems | 328 | ||
| 34 Pancreaticobiliary Disorders | 328 | ||
| Role of Noninvasive Imaging and EUS Compared With ERCP in Benign Hepatobiliary Diseases | 328 | ||
| Stone Disease | 328 | ||
| Chronic Pancreatitis | 330 | ||
| Role in Diagnosis | 330 | ||
| Pain Management | 330 | ||
| Symptomatic Pancreatic and Peripancreatic Fluid Collections | 331 | ||
| Suspected Pancreaticobiliary Malignancy | 332 | ||
| Conclusions | 333 | ||
| References | 334.e1 | ||
| 35 Pancreas Divisum, Biliary Cysts, and Other Congenital Anomalies | 335 | ||
| Ampullary Anomalies | 335 | ||
| Ectopic Major Papilla | 335 | ||
| Anomalous Pancreaticobiliary Junction | 335 | ||
| Biliary Anomalies | 335 | ||
| Variations of Bile Duct Anatomy | 335 | ||
| Biliary Cysts | 336 | ||
| Pancreatic Anomalies | 341 | ||
| Pancreas Divisum | 341 | ||
| Embryology and Terminology | 341 | ||
| Diagnosis | 341 | ||
| Association with Pancreatitis (see also Chapter 52) | 341 | ||
| Incomplete Pancreas Divisum | 344 | ||
| Annular Pancreas | 344 | ||
| References | 345.e1 | ||
| 36 Dilated Bile Duct and Pneumobilia | 346 | ||
| Dilated Bile Duct | 346 | ||
| Defining Dilated Bile Ducts | 346 | ||
| Etiology | 346 | ||
| Clinical Evaluation | 346 | ||
| Biochemical Evaluation | 347 | ||
| Imaging | 348 | ||
| Transabdominal Ultrasonography | 348 | ||
| Computed Tomography | 348 | ||
| Magnetic Resonance Imaging | 348 | ||
| Endoscopic Ultrasonography | 349 | ||
| Cholangiography | 350 | ||
| Biliary Scintigraphy | 350 | ||
| Approach to the Dilated Duct | 350 | ||
| Pneumobilia | 351 | ||
| Defining and Imaging Pneumobilia | 351 | ||
| Etiology | 352 | ||
| Clinical Evaluation | 352 | ||
| Approach to the Patient With Pneumobilia | 353 | ||
| References | 353.e1 | ||
| 37 The Dilated Pancreatic Duct | 354 | ||
| Background and Definitions | 354 | ||
| Evaluation | 354 | ||
| Clinical | 354 | ||
| Laboratory Evaluation | 355 | ||
| Serum Amylase and Lipase | 355 | ||
| Fecal Fat | 355 | ||
| Fecal Elastase-1 and Chymotrypsin | 355 | ||
| Serum CA 19-9 | 355 | ||
| Fluid Carcinoembryonic Antigen | 355 | ||
| Imaging and Endoscopy | 355 | ||
| Treatment | 357 | ||
| Endoscopic Therapy | 357 | ||
| Surgical Therapy | 359 | ||
| Conclusions | 360 | ||
| References | 360.e1 | ||
| 38 Ampullary Neoplasia | 361 | ||
| Symptoms and Signs | 361 | ||
| Diagnostic Workup and Evaluation | 361 | ||
| Endoscopy | 361 | ||
| Endoscopic Retrograde Cholangiopancreatography | 362 | ||
| Forceps Biopsy | 363 | ||
| Transabdominal Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging | 363 | ||
| Endoscopic Ultrasonography | 363 | ||
| Intraductal Ultrasonography | 364 | ||
| Colonoscopy | 364 | ||
| Pathology | 364 | ||
| Adenoma | 364 | ||
| Carcinoma | 365 | ||
| Neuroendocrine Tumors | 365 | ||
| Lymphoma | 367 | ||
| Gastrointestinal Stromal Tumor | 367 | ||
| Ampullary Adenomas and FAP Syndrome | 367 | ||
| Pathogenesis of Ampullary Adenoma and FAP Syndrome | 367 | ||
| Treatment | 368 | ||
| Adenomas | 368 | ||
| Carcinomas | 371 | ||
| Conclusions | 371 | ||
| References | 371.e1 | ||
| 39 Malignant Biliary Obstruction | 372 | ||
| Epidemiology | 372 | ||
| Natural History | 373 | ||
| Clinical Features and Initial Evaluation | 373 | ||
| Differential Diagnosis of Distal Biliary Malignancies and Imaging Techniques | 374 | ||
| Ampullary Carcinoma | 374 | ||
| Pancreatic Cancer | 374 | ||
| Cholangiocarcinoma | 376 | ||
| Metastatic Disease | 376 | ||
| An Approach to the Management of Patients With Distal Biliary Malignancies | 376 | ||
| Curative Surgery | 377 | ||
| Palliation | 377 | ||
| Endoscopic Stenting | 377 | ||
| Background. | 377 | ||
| Indications for biliary stenting. | 378 | ||
| Plastic stents. | 378 | ||
| Self-expandable metal stents. | 379 | ||
| Stent choices for palliation of malignant biliary obstruction. | 381 | ||
| Percutaneous Approach to Biliary Drainage | 382 | ||
| Surgical Palliation | 383 | ||
| Adjuvant Chemotherapy | 383 | ||
| Summary | 384 | ||
| References | 384.e1 | ||
| 40 Malignant Biliary Obstruction of the Hilum and Proximal Bile Ducts | 385 | ||
| Cholangiocarcinoma | 385 | ||
| Risk Factors | 385 | ||
| Anatomy of the Bile Ducts | 385 | ||
| Bismuth-Corlette Classification | 385 | ||
| Diagnostic Evaluation | 386 | ||
| Serologic Testing | 386 | ||
| Cytology | 387 | ||
| Pathology | 387 | ||
| Radiologic Evaluation | 388 | ||
| Endoscopic Evaluation | 388 | ||
| Endoscopic Ultrasonography With Fine-Needle Aspiration | 388 | ||
| Intraductal Ultrasonography | 388 | ||
| Cholangioscopy | 388 | ||
| Confocal Laser Endomicroscopy (see also Chapter 28) | 388 | ||
| Narrow Band Imaging and Chromoendoscopy | 389 | ||
| Management | 389 | ||
| Surgical Resection | 389 | ||
| Preoperative Biliary Drainage | 389 | ||
| Surgical Drainage | 390 | ||
| Biliary Drainage in Patients With Hilar or Proximal Biliary Obstruction | 390 | ||
| General Principles for ERCP in Hilar and Proximal Cholangiocarcinoma | 390 | ||
| Percutaneous versus Endoscopic Biliary Drainage | 390 | ||
| EUS-Guided Biliary Drainage | 391 | ||
| SEMS versus Plastic Stents | 391 | ||
| Local Ablative Techniques | 391 | ||
| Photodynamic Therapy | 392 | ||
| Radiofrequency Ablation | 392 | ||
| Conclusions | 392 | ||
| Acknowledgments | 393 | ||
| References | 393.e1 | ||
| 41 Indeterminate Biliary Stricture | 394 | ||
| Historical Features | 394 | ||
| Laboratory Features | 394 | ||
| Noninvasive Cross-Sectional Imaging | 395 | ||
| Invasive Imaging Techniques | 395 | ||
| Tissue Acquisition and Pathologic Investigations | 400 | ||
| Brush Cytology | 400 | ||
| Intraductal Transmucosal Fine-Needle Aspiration | 401 | ||
| Intraductal Forceps Biopsies | 401 | ||
| Ancillary Techniques | 402 | ||
| References | 404.e1 | ||
| 42 Endoscopic Approaches to Concomitant Malignant Biliary Obstruction and Gastric Outlet Obstruction | 405 | ||
| Anatomic and Clinical Scenarios | 405 | ||
| Anatomic Scenarios of Biliary and Duodenal Obstruction | 405 | ||
| Clinical Scenarios | 408 | ||
| Results | 409 | ||
| EUS-Guided Gastroenterostomy | 409 | ||
| Technical Approaches | 409 | ||
| Direct EUS-GE | 409 | ||
| Direct Technique With a Non–Cautery-Tip-Assisted LAMS. | 409 | ||
| Direct Technique With an Electrocautery Tip–Assisted LAMS. | 410 | ||
| Balloon-Assisted EUS-GE | 411 | ||
| EUS-Guided Double-Balloon–Occluded Gastrojejunostomy Bypass | 411 | ||
| Indications and Contraindications to EUS-GE | 412 | ||
| Clinical Data on EUS-GE | 412 | ||
| EUS-BD Technical Approaches | 412 | ||
| Rendezvous | 412 | ||
| Direct Transluminal Approach | 413 | ||
| Choledochoduodenostomy. | 413 | ||
| Hepatogastrostomy. | 413 | ||
| Antegrade Stenting | 414 | ||
| Indications for and Contraindications to EUS-BD in Malignant Obstruction | 414 | ||
| Selecting the Optimal Technical Approach to EUS-BD in Malignant Biliary Obstruction With Gastric Outlet Obstruction | 414 | ||
| Clinical Outcome With EUS-Biliary Drainage in Malignant Biliary Obstruction | 414 | ||
| Adverse Events and Their Management | 415 | ||
| EUS-GE | 415 | ||
| EUS-BD | 415 | ||
| Conclusions | 416 | ||
| References | 416.e1 | ||
| 43 Benign Biliary Strictures | 417 | ||
| Clinical Features and Diagnosis | 417 | ||
| Endoscopic Technique | 417 | ||
| Outcomes of Endotherapy | 418 | ||
| Postcholecystectomy Strictures | 418 | ||
| Anastomotic Strictures After Liver Transplantation (See Also Chapter 44) | 420 | ||
| Chronic Pancreatitis (See Also Chapter 45) | 420 | ||
| Primary Sclerosing Cholangitis (See Also Chapter 55) | 421 | ||
| Autoimmune Cholangiopathy | 421 | ||
| Conclusions | 421 | ||
| References | 421.e1 | ||
| 44 Biliary Surgery Adverse Events, Including Liver Transplantation | 422 | ||
| Laparoscopic Cholecystectomy | 422 | ||
| Bile Leak | 425 | ||
| Biloma | 426 | ||
| Liver Resection | 426 | ||
| Bile Leak | 426 | ||
| Strictures | 427 | ||
| Sump Syndrome After Choledochoduodenostomy | 427 | ||
| Liver Transplantation | 427 | ||
| Strictures | 429 | ||
| Bile Leak | 430 | ||
| Living-Related-Donor Transplants | 430 | ||
| Retained Surgical Stents | 430 | ||
| Summary | 431 | ||
| References | 431.e1 | ||
| 45 ERCP and EUS for Acute and Chronic Adverse Events of Pancreatic Surgery and Pancreatic Trauma | 432 | ||
| Pancreaticoduodenectomy (Whipple Operation) With and Without Pylorus Preservation | 432 | ||
| Anatomy | 432 | ||
| Role of Endoscopy in the Management of Adverse Events | 432 | ||
| Biliary Obstruction | 434 | ||
| Bilioenteric Anastomotic Stricture | 434 | ||
| Afferent Limb Obstruction | 434 | ||
| Efferent Limb Obstruction | 434 | ||
| Miscellaneous | 434 | ||
| Other Treatment Options for Biliary and Pancreatic Ductal Obstruction | 434 | ||
| Interventional Radiology and ERCP | 434 | ||
| EUS-Guided Techniques for Biliary Obstruction | 435 | ||
| EUS-Guided Techniques for Pancreatic Duct Obstruction | 435 | ||
| EUS-Guided Rendezvous | 435 | ||
| EUS-guided antegrade drainage. | 436 | ||
| Pancreatic antegrade needle knife. | 436 | ||
| Retained stents. | 436 | ||
| Distal and Central Pancreatectomy | 436 | ||
| Anatomy | 436 | ||
| Adverse Events | 437 | ||
| Role of Endoscopy in Patients With Distal Pancreatectomy | 437 | ||
| Puestow or Longitudinal Pancreatojejunostomy | 437 | ||
| Anatomy | 437 | ||
| Index | 539 | ||
| A | 539 | ||
| B | 540 | ||
| C | 541 | ||
| D | 542 | ||
| E | 543 | ||
| F | 544 | ||
| G | 545 | ||
| H | 545 | ||
| I | 545 | ||
| J | 546 | ||
| K | 546 | ||
| L | 546 | ||
| M | 546 | ||
| N | 547 | ||
| O | 547 | ||
| P | 547 | ||
| Q | 550 | ||
| R | 550 | ||
| S | 550 | ||
| T | 552 | ||
| U | 552 | ||
| V | 552 | ||
| W | 552 | ||
| Z | 552 | ||
| Inside Back Cover | ibc1 |