ERCP E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Provides the comprehensive knowledge required to perform ERCP safely and effectively Authored by the very best in the field, this "how-to" guide to mastering the crucial yet complex gastrointestinal procedure called endoscopic retrograde cholangiopancreatography (ERCP) covers the entire range of both standard and advanced techniques, using a highly practical approach. It also places a strong emphasis on patient education, safety, and minimizing risks, offering "tips and tricks" and key points throughout to aid rapid understanding. The book is filled with over 250 illustrations Covering ERCP preparation, techniques, clinical applications, and quality and safety, ERCP: The Fundamentals, 3rd Edition begins with chapters on "getting prepared," including training and competence; facilities and equipment; risk assessment and reduction; sedation, anesthesia, and medications. It then covers "what can be done," describing standard devices and techniques; intraductal therapies; ampullectomy; and reporting and documentation. Next it has chapters on "what should be done," clinical applications of ERCP in acute cholangitis; peri-cholecystectomy; difficult bile duct stones; biliary pain; and numerous forms of pancreatitis. The book finishes with coverage of adverse events and how to ensure competent practice. * Teaches all of the standard and advanced ERCP techniques * Focuses on patient safety/comfort throughout * Brilliantly-illustrated with endoscopic, EUS and radiologic images, and anatomical drawings * Offers a step-by-step, practical approach to ERCP--highlighting potential technical and anatomical hazards * Packed with tips and tricks boxes and key points boxes to assist comprehension * 20 high-definition videos of ERCP performed by the experts, perfect to improve clinical technique * Full reference to the very latest ASGE, ACG, ASG and UEGW guidelines throughout Brought to you by world pioneers in endoscopy, ERCP: The Fundamentals, 3rd Edition is an essential purchase for gastroenterologists and endoscopists of all levels.
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Veröffentlichungsjahr: 2020
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Table of Contents
Cover
List of Contributors
Introduction: Developments in ERCP over 50 Years
Section 1: Preparation
1 Training and Assessment of Competence (Preparing the Endoscopist)
Background
Who Should Be Trained?
What Should Be Taught, and How?
Who Should Teach?
How Are Training and Competence Assessed?
What Level of Performance Is Acceptable?
Conclusion
Appendix
Cannulation
Guidewire Manipulation
Dilation (Rigid or Balloon)
Cytology
Stenting
Basket
Retrieval Balloons
Papillotomy
References
2 Preparing the Facilities and Equipment
Room Setup and Floor Plan
Modern Design of the ERCP Room
Electrosurgical Unit (Diathermy)
Additional Items
Personnel Protection
Conclusion
3 ERCP: The Team
Endoscopy Staff
The Team in the ERCP Room
The Team outside the Procedure Room
Clinical Support in the Unit
Education
Industry Partners
Motivation and Team Building
Pitfalls
Resources
Conclusion
Further Reading
4 Minimizing Duodenoscope Infections
Introduction
Patient Selection
Scope Reprocessing Steps
Staffing
What Progress Is Being Made?
Conclusion
References
5 Patient Education and Consent
Documenting the Process Is Important
Conclusion
Outstanding Issues
Further Reading
6 Risk Assessment and Reduction
Assessing and Reducing the Risks
Key Considerations in Preparing Patients for ERCP to Reduce Modifiable Risks
References
7 Sedation, Anesthesia, and Medications
Introduction
Preprocedural Preparation
Sedation Agents
Patient Monitoring
Cardiopulmonary Risk Assessment and Consequences
Are ERCP Outcomes Influenced by the Type of Sedation and Anesthesia Used?
The Patient’s Position
Propofol for Everyone? Endotracheal Intubation?
Conclusion
References
Section 2: Techniques
8 Standard Devices and Techniques
Intubation and Examination of the Stomach
Cannulation Principles
Use of Guidewires
Cannulation of the Pancreatic Duct and Pancreatography
Techniques of Sphincterotomy: Biliary, Pancreatic, Minor
Dilation of the Papillary Orifice and Strictures
Dilation of Ductal Strictures
Bile Duct Stone Extraction
Pancreatic Stone Extraction
Tissue Sampling from the Bile Duct
Tissue Sampling from the Pancreatic Duct
Nasobiliary Catheter Drainage for Bile Duct Obstruction
Biliary Stenting
Plastic Stents in the Pancreas
Sphincter Manometry
Endoscopic Management of Bile Leaks
Conclusion
References
9 When Standard Cannulation Approaches Fail
Principles of Biliary Access
Placement of Double Guidewire or Pancreatic Stent to Facilitate Biliary Access
Precut or Access Sphincterotomy
Intradiverticular Papilla
Altered Surgical Anatomy
Combined Procedures
EUS‐Guided Pancreatic Duct Access
Conclusion
References
10 Intraductal Therapies
Equipment and Techniques
Application of Cholangioscopy and Pancreatoscopy in Pancreato‐Biliary Diseases
Diagnostic Applications: Pancreatic
Intraductal Therapeutic Applications
Intraductal Therapies: Tips and Tricks for the Beginners
Conclusion
References
11 Endoscopic Ampullectomy
Introduction
Lesion Assessment and Staging
Endoscopic Resection Technique
Complications and Management
Conclusion
References
12 The Radiology of ERCP
Emerging from the Gloom
Diagnostic Radiology and ERCP
The Radiology of ERCP
Tricky Imaging Situations
Radiation Risk and Protection
Conclusion
References
13 ERCP Reporting and Documentation
Structured Reporting
Report Content
Imaging
Postprocedural Data
Report Output
Endoscopy Reporting Software
References
Section 3: Clinical Applications
14 ERCP in Acute Cholangitis
Tips and Tricks
Background
Management for Acute Cholangitis
ERCP Techniques in Acute Cholangitis
Care after ERCP for Acute Cholangitis
Conclusion
Links to Society Guidelines
References
15 ERCP Peri‐Cholecystectomy
Preoperative ERCP for Treatment of Choledocholithiasis
ERCP during Cholecystectomy
Postoperative ERCP
Summary
Conclusions
References
16 Difficult Bile Duct Stones
Introduction
Techniques That Increase the Bile Duct Opening
Techniques to Decrease the Size of CBD Stones
Stones in Difficult Positions
Additional Interventions and Collaboration
Existing Guidelines and Consensus Recommendations
References
17 Patients with Obscure Biliary Pain; Sphincter of Oddi Dysfunction
SOD Type I
SOD Type III
SOD Type II
Alternative Treatments for SOD
Goodbye, Biliary Types I, II, and III
Medical Treatments
Conclusion
References
18 Benign Biliary Strictures
Introduction
Chronic Pancreatitis (CP)
Postoperative Strictures
Inflammatory Strictures: Primary Sclerosing Cholangitis (PSC) and IgG4‐Sclerosing Cholangitis (IgG4‐SC)
Conclusions
References
19 The Role of ERCP in Pancreaticobiliary Malignancies
ERCP in Diagnosis of Pancreaticobiliary Malignancies
Palliation of Obstructive Jaundice in Pancreatic Cancer
Endoscopic Stenting for Hilar Strictures
Other Techniques of Endoscopic Palliation
Ampullary Carcinoma
ERCP after Cancer Surgery
ERCP for Cholecystitis
ERCP in Duodenal Obstruction
Conclusion
References
20 ERCP in Acute and Recurrent Acute Pancreatitis
Introduction
Acute Biliary Pancreatitis
Recurrent Acute Pancreatitis
Pancreas Divisum
Summary
References
21 Chronic Pancreatitis
Introduction
When to Do ERCP in Chronic Pancreatitis
PD Strictures
PD Stones
Pancreatic Pseudocysts
Conclusion
References
22 Role of ERCP in Complicated Pancreatitis
Introduction
Acute Interstitial Pancreatitis
Severe Acute Pancreatitis
Local Complications of AP
Pancreatic Pseudocyst
Acute Necrotic Collection
Walled‐Off Pancreatic Necrosis (WOPN)
Timing and Indications for Endoscopic Intervention of Necrosis
Necrosectomy Methods
Pancreatic Ductal Disruptions
Outcomes
Conclusions
References
Guidelines
23 ERCP in Children
Introduction
Patient Preparation
Instruments
Technique
Indications
Success Rates for ERCP in Children
Adverse Events
Biliary Findings
Miscellaneous Genetic Cholestatic Diseases
Primary Sclerosing Cholangitis
Parasitic Infestation
Choledocholithiasis
Pancreatic Findings
Chronic Pancreatitis
Pancreatic Pseudocysts
Outstanding Issues and Future Trends
References
Section 4: Quality and Safety
24 Adverse Events: Definitions, Avoidance, and Management
Adverse Events
Overall Rates and Factors Affecting Them
Pancreatitis
Perforation
Infection
Bleeding
Basket Impaction
Cardiopulmonary Complications and Sedation Issues
Late Complications of Stents
Late Complications of Sphincterotomy
Rare Complications
Care after ERCP
Managing Adverse Events
Learning from Lawsuits
Risks for Endoscopists and Staff
Conclusion
References
25 Ensuring Really Competent Practice
What Is Quality Endoscopy?
How to Recognize and Measure Excellence in Endoscopists?
Report Cards and Benchmarking Performance
What Performance Level Is Good Enough? Who Decides?
Who Is Going to Do
Your
ERCP?
Credentialing and Privileges
How to Move Forward Now?
How to Recognize and Measure Excellence in Endoscopy Units?
Conclusion
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Complexity levels in ERCP.
Table 1.2 A comparison of different simulator models for advanced ERCP traini...
Table 1.3 Some suggested simulator practice score to evaluate trainees’ pract...
Table 1.4 Clinical assessment (to be filled in by trainer at completion of ER...
Table 1.5 Trainer assessment score of trainees’ performance (five‐point score...
Chapter 2
Table 2.1 Commonly used ERCP accessories.
Chapter 6
Table 6.1 Predictors of Adverse Events after ERCP.
Chapter 7
Table 7.1 Pharmacologic profile of drugs used for endoscopic sedation.
Table 7.2 ASA Physical Classification.
Table 7.3 Guidelines for anesthesiology assistance during ERCP.
Chapter 8
Table 8.1 A comparison of commonly used guidewires.
Table 8.2 A comparison of different short wire system for biliary stenting.
Table 8.3 Comparison of nasobiliary catheter versus plastic stent for biliary...
Chapter 9
Table 9.1 Precut sphincterotomy learning curve.
Chapter 10
Table 10.1 Endoscopic‐guided intraductal diagnostic and therapeutic procedure...
Table 10.2 Per‐oral cholangioscopy systems [1].
Table 10.3 Comparison of different cholangioscopy systems [21].
Chapter 11
Table 11.1 Incidence of ampullectomy complications.
Chapter 12
Table 12.1 Comparison of different imaging modalities for pancreaticobiliary ...
Chapter 15
Table 15.1 Potential indications for ERCP before cholecystectomy.
Table 15.2 Potential indications for ERCP during cholecystectomy.
Table 15.3 Potential indications for ERCP after cholecystectomy.
Table 15.4 Potential advantages and disadvantages according to timing of ERCP...
Chapter 16
Table 16.1 Possible approaches to treat large stones.
Chapter 21
Table 21.1 Selected studies of endotherapy in patients with chronic pancreati...
Table 21.2 Selected studies of endotherapy for pancreatic duct stones with or...
Table 21.3 Selected studies of endotherapy for pancreatic duct stones with pe...
Chapter 22
Table 22.1 Types of pancreatic fluid collections complicating acute pancreati...
Table 22.2 Endoscopic approaches to walled‐off pancreatic necrosis.
Chapter 23
Table 23.1 Biliary findings in ERCP in neonates and children.
Table 23.2 Pancreatic findings in ERCP in children.
Chapter 24
Table 24.1 Severity grading for adverse events.
Table 24.2 Risk factors for pancreatitis after ERCP.
List of Illustrations
Chapter 2
Figure 2.1 Room set‐up and floor plan. A, assistant; E, endoscopist; S, seda...
Figure 2.2 Space for endoscopists and trainee or assistant. Accessories orga...
Figure 2.3 Monitors for endoscopy, fluoroscopy, and vital signs are placed t...
Figure 2.4 (a) Layout of ERCP room with endoscopy tower and foot pedals, mon...
Figure 2.5 Organize accessories within easy reach for retrieval. Do not stac...
Figure 2.6 Personnel protection according to the Occupational Safety and Hea...
Chapter 3
Figure 3.1 Hands‐on educational practice between trainee and mentor. Discuss...
Figure 3.2 ERCP: The Team. Radiology tech, table nurse, ERCPist, certified r...
Chapter 5
Figure 5.1 The ERCP explanation document that I used in practice.
Chapter 8
Figure 8.1 Radiograph showing (a) short scope, (b) long scope, and (c) semi‐...
Figure 8.2 Location of papilla is where the longitudinal fold meets the vert...
Figure 8.3 (a) Displaced papilla on edge of a duodenal diverticulum and (b) ...
Figure 8.4 Keeping accessories relatively straight and looping a long guidew...
Figure 8.5 (a) V‐scope (Olympus, Tokyo, Japan) with a V‐notch on elevator ho...
Figure 8.6 (a) Fusion OSAIS stenting system with guidewire, inner catheter, ...
Figure 8.7 (a) Cutting a long guidewire; (b) inserting guidewire adaptor r i...
Figure 8.8 (a) Selective common bile duct cannulation. Stay close to papilla...
Figure 8.9 A combination of 12 different maneuvers (
arrows
), including air i...
Figure 8.10 (a) Shaping the sphincterotome allows the cutting wire to stay o...
Figure 8.11 (a) Straight guidewire protruding from sphincterotome, (b) a gen...
Figure 8.12 (a) Needle‐tip catheter with a straight tip, (b) gentle bend at ...
Figure 8.13 Perfect biliary axis along 11–12 o’clock direction (
blacked dott
...
Figure 8.14 (a) Intraduodenal papilla and distal bile duct determines the ex...
Figure 8.15 (a) Bulging papilla from impacted stone, (b) standard sphinctero...
Figure 8.16 Balloon sphincteroplasty, (a) deep cannulation with catheter, (b...
Figure 8.17 Distal common bile duct stricture (see Figure 8.11d), (a) partia...
Figure 8.18 (a) Stricture in mid pancreatic duct (PD) from chronic pancreati...
Figure 8.19 (a) Tight pancreatic duct stricture in mid body, (b) dilation wi...
Figure 8.20 Balloon stone extraction. Extraction of small stones with balloo...
Figure 8.21 Dormia basket stone extraction, basket opened above stone and tr...
Figure 8.22 Mechanical lithotripsy (Soehendra lithotripter) or “life‐saver,”...
Figure 8.23 Through‐the‐scope mechanical lithotripter (BML, Olympus, Tokyo, ...
Figure 8.24 (a) Newly designed lithotripsy compatible basket, and (b) basket...
Figure 8.25 (a) Straight stent inserted to provide bile duct drainage bypass...
Figure 8.26 (a) Pancreatic duct (PD) stone (
dashed arrow
) causing obstructio...
Figure 8.27 Brush cytology of distal bile duct stricture. Double‐lumen cytol...
Figure 8.28 Nasobiliary catheter drainage. (a) 6.5 FG angled tip catheter wi...
Figure 8.29 (a) Biliary stenting system with large channel duodenoscope, 0.0...
Figure 8.30 Stent measurement by (a) pulling a catheter over an indwelling g...
Figure 8.31 (a) OASIS stenting system by combining inner catheter and pusher...
Figure 8.32 (a) Self‐expandable metallic stent (SEMS; Wallstent, Boston Scie...
Figure 8.33 Bilateral plastic stents for hilar obstruction (a) extensive tum...
Figure 8.34 Bilateral self‐expandable metallic stents (SEMS) for hilar obstr...
Figure 8.35 Pancreatic stent placement using a Fusion (short wire) catheter ...
Chapter 9
Figure 9.1 Fistulotomy is performed by creating a point of entry 3–5 mm supe...
Figure 9.2 Biliary access is gained by performing precut over a pancreatic d...
Figure 9.3 After cannulating the pancreatic duct, the sphincterotome is orie...
Figure 9.4 Intradiverticular papilla: The papilla was located within a deep ...
Figure 9.5 Billroth II ERCP fluoroscopy: The duodenoscope forms a “hockey st...
Figure 9.6 Roux en Y ERCP fluoroscopy: The double‐balloon enteroscope has a ...
Figure 9.7 A lumen‐apposing metal stent (
left panel
) is placed via the remna...
Figure 9.8 Endoscopic ultrasound (EUS)‐guided rendezvous: EUS‐guided rendezv...
Figure 9.9 Choledochoduodenostomy: A choledochoduodenostomy was performed in...
Chapter 10
Figure 10.1 Different cholangioscopy systems. (a) Ultra‐slim scope for direc...
Figure 10.2 Balloon‐assisted direct per‐oral cholangioscopy using an ultra‐s...
Figure 10.3 Single‐operator cholangioscopy system. (a) SpyScope attached to ...
Figure 10.4 Cholangioscopy in a case of indeterminate filling defect. (a) No...
Figure 10.5 Cholangioscopy‐assisted lithotripsy in difficult biliary calculi...
Figure 10.6 Radiofrequency ablation (RFA) in a case with cholangiocarcinoma....
Chapter 11
Figure 11.1 Significant intraductal extension suggested by magnetic resonanc...
Figure 11.2 (a) A granular or villiform exophytic ampullary adenoma. These a...
Figure 11.3 (a) The snare tip is anchored on the duodenal wall superior to t...
Figure 11.4 (a) A bulky lesion. (b) A submucosal injection is made beneath a...
Figure 11.5 (a) A 20‐mm papillary adenoma, in which there has been a small p...
Figure 11.6 (a) A 20‐mm smooth adenoma with extrapapillary extension has bee...
Chapter 12
Figure 12.1 A 70‐year‐old man with painless jaundice. (a) Axial image showin...
Figure 12.2 A 37‐year‐old woman with pain and jaundice. (a) A 20‐mm thick ra...
Figure 12.3 (a) A 40‐year‐old man who had recovered from an episode of mild ...
Figure 12.4 (a) Radiographically correct projection of ERCP image showing an...
Figure 12.5 (a) A correctly projected and collimated plain film before contr...
Figure 12.6 (a) Magnified image during sphincterotome and wire‐guided cannul...
Figure 12.7 Tight collimation of the magnified image allows clear definition...
Figure 12.8 (a) Normal confluence of sectoral and hepatic ducts. (b) A norma...
Figure 12.9 The right posterior sectoral duct. (a) ERCP in a patient after c...
Chapter 13
Figure 13.1 Standardized terminology of the pancreato‐biliary ductal anatomy...
Chapter 14
Figure 14.1 (a) Stone impaction at papilla. (b) Exposure of the impacted sto...
Figure 14.2 Endoscopic sphincterotomy.
Figure 14.3 (a) Endoscopic papillary balloon dilation using a 10‐mm diameter...
Figure 14.4 Endoscopic papillary large balloon dilation using a 12‐13.5‐15–m...
Chapter 15
Figure 15.1 A 79‐year‐oldfemale was referred for repeat ERCP. Intraoperative...
Figure 15.2 A 23‐year‐old female presented with upper abdominal pain and jau...
Figure 15.3 A 75‐year‐old female was transferred from another institution fo...
Figure 15.4 A 28‐year‐old female with a history of biliary colic presented f...
Figure 15.5 A 53‐year‐old female presented with upper abdominal pain and inc...
Figure 15.6 Suggested algorithm for utilization and timing of ERCP related t...
Chapter 16
Figure 16.1 Large common bile duct stone demonstrated on occlusion cholangio...
Figure 16.2 Partial sphincterotomy.
Figure 16.3 Insertion of the controlled radial expansion balloon.
Figure 16.4 Inflation of the controlled radial expansion balloon.
Figure 16.5 Appearance of the papilla after partial sphincterotomy and endos...
Figure 16.6 Stones being extracted from the common bile duct.
Figure 16.7 Stones in the duodenum after extraction from the common bile duc...
Figure 16.8 Insertion of a 10 Fr, 7‐cm biliary plastic stent into the common...
Figure 16.9 Fluoroscopic image of an inserted single operator cholangioscope...
Figure 16.10 (a) A cholangiogram demonstrating a large common bile duct ston...
Figure 16.11 (a) The Spyglass single operator cholangioscope (courtesy of Bo...
Figure 16.12 Electrohydraulic lithotripsy probe in proximity to the stone an...
Figure 16.13 Mirizzi syndrome: the thin arrow shows stones in cystic duct, a...
Chapter 18
Figure 18.1 (a) Patient 1 month after liver transplant with high bilirubin, ...
Figure 18.2 (a) End of multiple stent trial, endoscopic view four stents. (b...
Figure 18.3 Magnetic resonance cholangiogram with dominant stricture of left...
Figure 18.4 (a) Magnetic resonance cholangiogram showing a tight common bile...
Figure 18.5 (a) ERCP with main duct biliary stricture (
arrow
) and (b) strict...
Figure 18.6 (a) ERCP in Type I IgG4‐associated sclerosing cholangitis (IgG4‐...
Figure 18.7 (a) ERCP with common bile duct stricture (
curved arrow
) and obst...
Chapter 19
Figure 19.1 A 70‐year‐old woman underwent cholangioscopy for evaluation of h...
Figure 19.2 A 50‐year‐old woman with metastatic breast cancer was referred f...
Figure 19.3 A 73‐year‐old woman presented with metastatic cholangiocarcinoma...
Figure 19.4 A 64‐year‐old woman with cholangiocarcinoma presented with worse...
Figure 19.5 A 79‐year‐old man presented with obstructive jaundice from suspe...
Figure 19.6 A 63‐year‐old woman was referred for evaluation of jaundice, abd...
Figure 19.7 A 70‐year‐old woman was referred for evaluation of jaundice, pai...
Chapter 20
Figure 20.1 ERCP in acute biliary pancreatitis. Algorithm for the management...
Figure 20.2 The major papilla in the setting of acute pancreatitis. Normally...
Figure 20.3 Suggested second‐tier diagnostic tests for patients with unexpla...
Figure 20.4 Autoimmune pancreatitis. A 58‐year‐old man presented with painle...
Figure 20.5 Anomalous pancreatobiliary union. A 3‐year‐old girl presented wi...
Figure 20.6 Minor papilla. Endoscopic inspection of the minor papilla can tr...
Figure 20.7 Pancreas divisum: Ventral pancreatic duct terminal arborization....
Chapter 21
Figure 21.1 (a) Main pancreatic duct stricture in the head and body of pancr...
Figure 21.2 (a) Main pancreatic duct stricture in the head and body of pancr...
Figure 21.3 (a) Initial pancreatogram showed a filling defect in the pancrea...
Figure 21.4 (a) Initial pancreatogram demonstrates a large stone obstructing...
Figure 21.5 (a) Visualization of a pancreatic duct stone during single‐opera...
Figure 21.6 (a) Computed tomography scan demonstrating pancreatic pseudocyst...
Chapter 22
Figure 22.1 Computed tomography findings of walled‐off necrosis obtained 8 w...
Figure 22.2 Endoscopic view of 20‐mm lumen‐apposing metal stent immediately ...
Figure 22.3 Endoscopic view within walled‐off pancreatic necrosis (WOPN) sho...
Figure 22.4 Necrotic material after removal with direct endoscopic necrosect...
Chapter 23
Figure 23.1 Variants of biliary atresia.
Figure 23.2 Biliary atresia Type 1. No visualization of biliary tree. Opacif...
Figure 23.3 Biliary atresia Type 2. Visualization of a narrow and irregular ...
Figure 23.4 Biliary atresia Type 3a in a 25‐day‐old neonate. Visualization o...
Figure 23.5 Congenital hepatic fibrosis in a 38‐day‐old infant. Normal extra...
Figure 23.6 The normal pancreaticobiliary union is located within the duoden...
Figure 23.7 There are three types of anomalous pancreaticobiliary union. Typ...
Figure 23.8 Anatomical classification by Todani et al. [38] of choledochal c...
Figure 23.9 Choledochal cyst Type I‐C in a 3‐year‐old female. Note an anomal...
Figure 23.10 Choledochal cyst Type I‐C with cystolithiasis (
arrow
).
Figure 23.11 Choledochal cyst Type IV‐A in a 12‐year‐old female. Note an ano...
Figure 23.12 Primary sclerosing cholangitis in a 16‐year‐old male. Severe na...
Figure 23.13 Choledochal cyst Type I‐A and pancreas divisum in a 5‐year‐old ...
Figure 23.14 Choledochal cyst Type IV‐A in a 6‐year‐old female with recurren...
Figure 23.15 Pancreas divisum and chronic pancreatitis in a 12‐year‐old male...
Figure 23.16 Endoscopic view of the major and minor papilla. (a) A tapered b...
Figure 23.17 Recurrent acute pancreatitis in an 8‐year‐old girl. (a) Magneti...
Figure 23.18 A 12‐year‐old girl was kicked by a horse in the abdomen with su...
Figure 23.19 Chronic pancreatitis in a 14‐year‐old female with hereditary pa...
Figure 23.20 Pancreatic pseudocyst with ductal communication treated by tran...
Chapter 24
Figure 24.1 Computed tomography scan of severe pancreatitis, taken 1 week af...
Figure 24.2 Abdominal radiograph at ERCP showing retroperitoneal air.
Figure 24.3 Computed tomography scan showing retroperitoneal air after perfo...
Figure 24.4 Bleeding immediately after starting sphincterotomy.
Guide
Cover
Table of Contents
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ERCP
The Fundamentals
Third Edition
Edited by
Peter B. Cotton, MD, FRCP, FRCS
Digestive Disease CenterMedical University of South CarolinaCharleston, SC, USA
Joseph W. Leung, MD, FRCP, FACP, MACG, FASGE
Department of Gastroenterology and HepatologyUniversity of California Davis School of MedicineSacramento, CA, USA;Section of GastroenterologyVA Northern California Health Care SystemGI Unit, Sacramento VAMCMather, CA, USA
This edition first published 2020© 2020 John Wiley & Sons Ltd
Edition HistoryWiley‐Blackwell (2e, 2015)
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Library of Congress Cataloging‐in‐Publication Data
Names: Cotton, Peter B., editor. | Leung, J. W. C., editor.Title: ERCP : the fundamentals / [edited by] Peter B. Cotton, MD FRCP FRCS, Professor of Medicine, Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, Joseph W. Leung, MD FRCP FACP MACG FASGE, Mr. & Mrs. C.W. Law Professor of Medicine, Department of Gastroenterology and Hepatology, University of California, Davis School of Medicine, Chief, Section of Gastroenterology, VA Northern California Health Care System, GI Unit, Sacramento VAMC Mather, California.Description: Third edition. | Hoboken, NJ : Wiley‐Blackwell, 2020. | Includes index.Identifiers: LCCN 2020010927 (print) | LCCN 2020010928 (ebook) | ISBN 9781119601098 (hardback) | ISBN 9781119601067 (adobe pdf) | ISBN 9781119601081 (epub)Subjects: LCSH: Endoscopic retrograde cholangiopancreatography. | Gastroscopy.Classification: LCC RC847.5.E53 A38 2020 (print) | LCC RC847.5.E53 (ebook) | DDC 616.36/07572–dc23LC record available at https://lccn.loc.gov/2020010927LC ebook record available at https://lccn.loc.gov/2020010928
Cover Design: WileyCover Image: Courtesy of Joseph W. Leung
List of Contributors
Lars Aabakken, MD, PhD, BCProfessor of MedicineChief of Gastrointestinal EndoscopyOslo University Hospital, RikshospitaletOslo, Norway
Majid A. Almadi, MB, BS, MSc, FRCDivision of GastroenterologyKing Khalid University HospitalKing Saud UniversityRiyadh, Saudi Arabia
Alan Barkun, MD, CM, MSc, FRCPCDivision of GastroenterologyMontreal General Hospital, McGill UniversityMontreal, Quebec, Canada
Todd H. Baron, MD, FASGEDirector of Advanced Therapeutic EndoscopyProfessor of MedicineDivision of Gastroenterology & HepatologyUniversity of North CarolinaChapel Hill, NC, USA
Catherine Bauer, RNBS, MSN, MBA, CGRN, CFERDirector of Digestive HealthUniversity of Virginia Medical CenterCharlottesville, VA, USA;Society of Gastroenterology Nurses and Associate President 2018–2019
Benjamin L. Bick, MDIndiana University School of MedicineIndianapolis, IN, USA
Michael Bourke, MD, PhDClinical Professor of MedicineUniversity of SydneySydney;Director of Gastrointestinal EndoscopyWestmead HospitalWestmead, Australia
Gregory A. Coté, MD, MSProfessor of MedicineMedical University of South CarolinaCharleston, SC, USA
Peter B. Cotton, MD, FRCP, FRCSProfessor of MedicineDigestive Disease CenterMedical University of South CarolinaCharleston, SC, USA
John T. Cunningham, MDProfessor Emeritus of MedicineSection of Gastroenterology and HepatologyUniversity of Arizona School of MedicineTucson, AZ, USA
B. Joseph Elmunzer, MD, MScThe Peter B. Cotton Endowed Chair in Endoscopic InnovationProfessor of Medicine and Endoscopic InnovationDivision or Gastroenterology and HepatologyMedical University of South CarolinaCharleston, SC, USA
Evan L. Fogel, MDIndiana University School of MedicineIndianapolis, IN, USA
Erin Forster, MD, MPHDepartment of MedicineDivision of Gastroenterology and HepatologyMedical University of South CarolinaCharleston, SC, USA
Andres Gelrud, MD, MMScGastro Health and Miami Cancer InstituteMiami, FL, USA
Moises Guelrud, MDGastro Health and Miami Cancer InstituteMiami, FL, USA
Sundeep Lakhtakia, MD, DMAsian Institute of GastroenterologyHyderabad, India
John G. Lee, MDH. H. Chao Comprehensive Digestive Disease CenterUniversity of California at Irvine Medical Center, Irvine, CA, USA
Joseph W. Leung, MD, FRCP, FACP, MACG, FASGEEmeritus Professor of MedicineDepartment of Gastroenterology and HepatologyUniversity of California Davis School of MedicineSacramento, CA;Chief of GastroenterologySection of GastroenterologyVA Northern California Health Care SystemGI Unit, Sacramento VAMCMather, CA, USA
Wei‐Chih Liao, MD, PhDAssociate ProfessorDepartment of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipei, Taiwan
Phyllis Malpas, MA, RN, CGRNDigestive Disease CenterMedical University of South Carolina Charleston, SC, USA
Derrick Martin, FRCR, FRCP, Mb, CHbRadiology DepartmentWythenshawe HospitalManchester, UK
Robert A. Moran, MDMedical University of South CarolinaCharleston, SC, USA
Zaheer Nabi, MD, DNB GastroenterologyConsultant GastroenterologistAsian Institute of GastroenterologyHyderabad, India
D. Nageshwar Reddy, MD, DM, DSc, FRCPChairman and Chief of GastroenterologyAsian Institute of GastroenterologyHyderabad, India
Stuart Ashley Roberts, MDRadiology DepartmentUniversity Hospital of WalesCardiff, UK
Joseph Romagnuolo, MD, MSc, FRCPCDepartment of MedicineDivision of Gastroenterology and HepatologyMedical University of South CarolinaCharleston, SC, USA
Stuart Sherman, MDIndiana University School of MedicineIndianapolis, IN, USA
Paul R. Tarnasky, MDDigestive Health Associates of TexasProgram Director GastroenterologyMethodist Dallas Medical CenterDallas, TX, USA
Shyam Varadarajulu, MDCenter for Interventional EndoscopyFlorida HospitalOrlando, FL, USA
John J. Vargo, II, MD, MPHCleveland ClinicCleveland, OH, USA
Hsiu‐Po Wang, MDDepartment of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipei, Taiwan
Andrew Yen, MD, FACG, FASGEChief of Endoscopy and Associate Chief of GastroenterologySection of GastroenterologyVA Northern California Health Care SystemGI Unit, Sacramento VAMCMather, CA, USA
Introduction: Developments in ERCP over 50 Years
The History
Attempts at endoscopic cannulation of the papilla of Vater were first reported in 1968. However, the method was put on the map shortly afterward by Japanese gastroenterologists working with instrument manufacturers to develop appropriate long side‐viewing instruments. The name “ERCP” (endoscopic retrograde cholangiopancreatography) was agreed at a symposium at the World Congress in Mexico City in 1974. The technique gradually became established worldwide as a valuable diagnostic technique, although some were skeptical about its feasibility and role, and the potential for serious complications soon became clear. It was given a tremendous boost by the development of the therapeutic applications, notably biliary sphincterotomy in 1974 and biliary stenting 5 years later.
It is difficult for most gastroenterologists today to imagine the diagnostic and therapeutic challenges of pancreatic and biliary medicine 50 years ago. There were no scans. The pancreas was a black box and its diseases diagnosed only at a late stage. Biliary obstruction was diagnosed and treated surgically with substantial operative mortality.
The period of 20 or so years from the mid‐1970s was a “golden age” for ERCP. Despite significant risks, it was quite obvious to everyone that ERCP management of bile duct stones, strictures, and leaks was easier, cheaper, and safer than available surgical alternatives. Percutaneous transhepatic cholangiography (PTC) and its drainage applications were also developed during this time but were used (with the exception of a few units) only when ERCP failed or was not available.
The situation has evolved progressively in many ways during recent decades. There are some new techniques (such as expandable and biodegradable stents, simpler cholangioscopy, balloon sphincteroplasty, pseudocyst debridement, and laparoscopic‐ and endoscopic ultrasound [EUS]‐guided cannulation) and improvements in safety (e.g. pancreatic stents, nonsteroidal anti‐inflammatory drugs [NSAIDs], anesthesia, and carbon dioxide [CO2]).
Other important changes in ERCP practice have been driven by improvements in radiology and surgery and the increasing focus on quality.
Radiology
Imaging modalities for the biliary tree and pancreas have proliferated. High‐quality ultrasound, computed tomography (CT), EUS, and magnetic resonance scanning (with magnetic resonance cholangiopancreatography [MRCP]) have greatly facilitated the noninvasive evaluation of patients with known and suspected biliary and pancreatic disease. As a result, ERCP is now almost exclusively used for treatment of conditions already documented by less‐invasive techniques. There have also been some improvements in interventional radiology techniques in the biliary tree, which are useful adjuncts when ERCP is unsuccessful or impractical.
Surgery
There has been substantial and progressive reduction in the risks associated with surgery as a result of minimally invasive techniques and better perioperative and anesthesia care. It is no longer correct to assume that ERCP is always safer than surgery. Surgery should be considered as a legitimate alternative to ERCP and not only when ERCP is unsuccessful.
Patient Empowerment
Another relevant development in this field is the increased participation of patients in decisions about their care. Patients are right in demanding information about their potential interventionists and the likely benefits, risks, and limitations of all of the possible approaches to their problems.
The Quality Imperative
The term ERCP is now inaccurate. It was invented to describe a method for obtaining radiographs of the biliary and pancreatic trees. It is now a broad therapeutic platform, like laparoscopy. It may be better remodeled as “Ensuring Really Competent Practice,” because quality is now the main challenge. We have to make sure that the right things are done and in the right way. There is increasing attention on who should be trained and to what level of expertise. How many ERCPists are really needed? Previously, most gastroenterology trainees did some ERCP and continued to dabble in practice. Now the focus is on ensuring that there is a smaller cadre of properly trained ERCPists with sufficient numbers to maintain and enhance their skills and to be able to address the more complex cases. These issues come into clearest focus where the role of ERCP is still not firmly established (e.g. in the management of recurrent acute and chronic pancreatitis and of possible sphincter of Oddi dysfunction). Such issues are being addressed by increasingly stringent research.
This Book
This is the third edition of this book devoted to ERCP. The first, Advanced Digestive Endoscopy: ERCP was published on gastrohep.com in 2002 and printed by Blackwell in 2006 and again in 2015. This edition owes much to its predecessors, but the title ERCP: The Fundamentals emphasizes our attempt to provide core information for trainees and practitioners, rather than a scholarly review of the (now) massive literature. Note that we have largely separated the technical aspects (how it can be done) from the clinical aspects, to allow the authors of the latter chapters to review the complex questions of when they might be done (and when best not).
We greatly appreciate the efforts of all the contributors and look forward to constructive feedback.
Peter B. Cotton, MD, FRCS, FRCP
Joseph W. Leung, MD, FRCP, FACP, MACG, FASGE
April 2020
