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The Guest Editors have assembled key opinion leaders to provide state of the art articles on this important update on ERCP. A chapter on cannulation techniques and sphincterotomy will highlight recent literature on wire-guided cannulation, use of papillotomes, when and if to precut for entry and the use of smart circuitry for papillotomy.  A chapter on surgically altered anatomy will highlight the increasing occurrence of biliary tract disease in patient’s s/p gastric bypass for obesity along with other surgery and the use of balloon enteroscopes, overtubes and intraoperative procedures  A chapter on EUS assisted biliary and pancreatic access will highlight the growing experience with these combine techniques. There is growing literature on preventing post-ercp pancreatitis which is changing the standard of care and Joe Elmunzer is the best person to highlight this. Stu Sherman will review advances in the management of bile duct stones and when to intervene in gallstone pancreatitis.  Peter Cotton just published a landmark study on SOD that will change the standard of care and will review the state of the science on this disease as it relates to both biliary tract and pancreatic disease. The management of benign biliary strictures and leaks is evolving with the introduction of covered metal stents and Jacques Deviere is at the forefront. Amrita Sethi will  discuss diagnosis of biliary malignancy highlighting the use of FISH, molecular markers and enhanced imaging such as pCLE.  Michele Kahaleh will review recent experience with biliary tumor ablation using RFA probes and PDT. Alan Barkun helps endoscopists determine when to use plastic stents, metal stents, and covered stents and when to drain one, two or three segments of liver in patients with malignant biliary obstruction. George Papachristo and Dhiraj Yadav will review most recent data on endoscopic therapy for acute recurrent and smoldering acute pancreatitis. Nagy Reddy will provide on update on endotherapy for painful chronic pancreatitis. Finally, Raj Shah will update on advances in pancreatoscopy and cholangioscopy including the use of ultra slim per-oral scopes and new digital mother/baby scopes.

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Published 07 January 2016
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EAN13 9780323400855
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Advances in ERCP
Gastrointestinal Endoscopy Clinics Of North
America
EDITOR
Adam Slivka, MD, PhD
University of Pittsburgh Medical Center, M-Level C-Wing, Presbyterian University Hospital,
Pittsburgh, PA, USA
COSULTING EDITOR
Charles J. Lightdale

www.giendo.theclinics.com

October 2015 • Volume 25 • Number 4Table of Contents
Cover image
Title page
Copyright
Contributors
Consulting Editor
Editor
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
Foreword. Advances in Therapeutic Endoscopic Retrograde
Cholangiopancreatography: Benefits Far Outweigh the Small Risks
References
Preface. Advances in Endoscopic Retrograde Cholangiopancreatography
Difficult Biliary Access: Advanced Cannulation and Sphincterotomy Technique
Key points
Introduction
Guidewire-assisted cannulation
Pancreatic duct techniques
Precut sphincterotomy
Transpancreatic septotomyAdditional variations on precut
Comparing techniques
Intradiverticular papilla
Devices
Summary
References
Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy
Key points
Introduction
Terminology
Preparation for endoscopic retrograde cholangiopancreatography: a checklist for
the endoscopist
Endoscopic retrograde cholangiopancreatography in altered bowel anatomy
without alteration of biliopancreatic anatomy
Endoscopic retrograde cholangiopancreatography in altered bowel anatomy with
alteration of biliopancreatic anatomy
Adverse events related to endoscopic retrograde cholangiopancreatography in
surgically altered anatomy
Summary
Acknowledgments
References
Endoscopic Retrograde Cholangiopancreatography for the Management of Common
Bile Duct Stones and Gallstone Pancreatitis
Key points
Symptomatic choledocholithiasis and biliary pancreatitis: When to image,
intervene, or observe
Standard endoscopic techniques for stone extraction and “difficult” bile duct stones
Biliary endoprosthesis
Endoscopic balloon papillary dilation
Lithotripsy
CholangioscopyDiscussion: Algorithm for the management of choledocholithiasis
References
Diagnosing Biliary Malignancy
Key points
Introduction
Causes of biliary strictures
Laboratory evaluation
Imaging evaluation
Endoscopic retrograde cholangiopancreatography
Fluorescence in situ hybridization
Endoscopic ultrasonography: fine-needle aspiration
Intraductal ultrasonography
Cholangioscopy
Confocal laser endomicroscopy
Cholangiocarcinoma in primary sclerosing cholangitis
Summary
References
Stenting in Malignant Biliary Obstruction
Key points
Introduction
Who should undergo biliary drainage?
Biliary drainage for unresectable distal biliary lesions
Biliary drainage of hilar lesions: mapping and minimizing risk of endoscopic
drainage
Prophylactic antibiotics
Available technologies for biliary drainage
The use of sphincterotomy
Insertion of stents above versus across the sphincter of Oddi
Plastic stents versus self-expandable metal stentsHilar neoplasms: special considerations
Side-by-side method versus stent-in-stent method
Percutaneous drainage and the choice of approach: endoscopic versus
radiological
Recurrent biliary obstruction after initial drainage
Cholycystitis and cholangitis
Recent innovations
Summary
References
Benign Biliary Strictures and Leaks
Key points
Introduction
Postoperative biliary strictures and leaks
Biliary strictures secondary to chronic pancreatitis
Biliary strictures due to primary sclerosing cholangitis
Autoimmune cholangiopathy
Summary
References
Preventing Postendoscopic Retrograde Cholangiopancreatography Pancreatitis
Key points
Overview
Patient selection
Recognizing patients at increased risk for postendoscopic retrograde
cholangiopancreatography pancreatitis
Procedure technique
Prophylactic pancreatic stent placement
Pharmacoprevention
References
Endoscopic Treatment of Recurrent Acute Pancreatitis and Smoldering AcutePancreatitis
Key points
Introduction
Recurrent acute pancreatitis
Smoldering acute pancreatitis
Summary
References
Sphincter of Oddi Dysfunction
Key points
Introduction
Defining sphincter of Oddi dysfunction
Diagnostic evaluation
Treatment and predictors of response
Challenges and future considerations
Summary
References
Pancreatic Endotherapy for Chronic Pancreatitis
Key points
Introduction
Indications and contraindications of pancreatic endotherapy
Technique/Procedure
Complications
Outcomes
References
Innovations in Intraductal Endoscopy: Cholangioscopy and Pancreatoscopy
Key points
Introduction: nature of the problem
Indications/ContraindicationsTechnique/Procedure preparation
Techniques to improve visualization
Device insertion suggestions
Complications and management
Postoperative care
Reporting, follow-up, and clinical implications
Outcomes
Current controversies/future considerations
Summary
References
Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation
Key points
Introduction
Photodynamic therapy
Radiofrequency ablation
Summary
References
Endoscopic Ultrasound–Assisted Pancreaticobiliary Access
Key points
Introduction
Equipment required
Patient considerations for endoscopic ultrasound–guided anterograde
cholangiopancreatography
Technical procedural steps
Outcomes
Endoscopic ultrasound–guided pancreatic duct drainage
Standardized algorithm for endoscopic ultrasound–guided bile duct drainage
Lumen-apposing transluminal stent
Extended drainage indicationsSummary
ReferencesC o p y r i g h t
ELSEVIER
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GASTROINTESTINAL ENDOSCOPY CLINICS OF NORTH AMERICA Volume 25,
Number 4
October 2015 ISSN 1052-5157, ISBN-13: 978-0-323-40084-8
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Printed in the United States of America.Contributors
Consulting Editor
CHARLES J. LIGHTDALE, MD Professor of Medicine, Division of Digestive and
Liver Diseases, Columbia University Medical Center, New York, New York
Editor
ADAM SLIVKA, MD, PhD Professor of Medicine, Associate Chief of the Division,
Gastroenterology, Hepatology, and Nutrition; Director of the GI Service Line, University
of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Authors
MAJID A. ALMADI, MBBS, FRCPC, MSc (Clinical Epidemiology) Division of
Gastroenterology, King Khalid University Hospital, King Saud University Medical City,
King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, The McGill
University Health Center, Montreal General Hospital, McGill University, Montréal,
Quebec, Canada
ALAN N. BARKUN, MD, CM, FRCPC, MSc (Clinical Epidemiology) Divisions of
Gastroenterology and Clinical Epidemiology, The McGill University Health Center,
Montreal General Hospital, McGill University, Montréal, Quebec, Canada
JEFFREY S. BARKUN, MD, CM, FRCS, MSc Division of General Surgery, The
McGill University Health Centre, McGill University, Montréal, Quebec, Canada
KENNETH F. BINMOELLER, MD Director, Interventional Endoscopy Services,
California Pacific Medical Center, San Francisco, California
ROHIT DAS, MD Fellow, Division of Gastroenterology, Hepatology and Nutrition,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JACQUES DEVIÈRE, MD, PhD Head, Medical Surgical, Department of
Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University
Hospital; Professor of Medicine, Université Libre de Bruxelles, Brussels, Belgium
JEFFREY J. EASLER, MD Division of Gastroenterology and Hepatology, Indiana
University School of Medicine, Indianapolis, Indiana
B. JOSEPH ELMUNZER, MD Associate Professor of Medicine, Division of
Gastroenterology and Hepatology, Medical University of South Carolina, Charleston,
South Carolina
VICTORIA GÓMEZ, MD Assistant Professor of Medicine, Division of
Gastroenterology, Mayo Clinic, Jacksonville, Florida
GREGORY HABER, MD Director, Division of Gastroenterology; Director, The
Center for Advanced Therapeutic Endoscopy, Lenox Hill Hospital, New York, New YorkMICHEL KAHALEH, MD Professor of Medicine, Chief of Endoscopy, Division of
Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
RICHARD A. KOZAREK, MD Division of Gastroenterology, Executive Director,
Digestive Disease Institute, Virginia Mason Medical Center, Clinical Professor of
Medicine, University of Washington, Seattle, Washington
ANISH MAMMEN, MD Advanced Fellow, Lenox Hill Hospital, New York, New York
GEORGIOS I. PAPACHRISTOU, MD Associate Professor, Division of
Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania
BRET T. PETERSEN, MD Professor of Medicine, Division of Gastroenterology,
Mayo Clinic, Rochester, Minnesota
DUVVUR NAGESHWAR REDDY, MD, DM Director, Chairman, Asian Institute of
Gastroenterology, Hyderabad, India
AMRITA SETHI, MD Assistant Professor of Medicine, Division of Digestive and Liver
Diseases, Columbia University Medical Center, New York, New York
RAJ J. SHAH, MD, FASGE, AGAF Professor of Medicine, University of Colorado
School of Medicine, Director, Pancreaticobiliary Endoscopy, University of Colorado
Anschutz Medical Campus, Aurora, Colorado
STUART SHERMAN, MD Division of Gastroenterology and Hepatology, Indiana
University School of Medicine, Indianapolis, Indiana
AARON J. SMALL, MD, MSCE Division of Gastroenterology, Digestive Disease
Institute, Virginia Mason Medical Center, Seattle, Washington
IOANA SMITH, MD Internal Medicine Resident, Division of Gastroenterology and
Hepatology, University of Alabama at Birmingham, Birmingham, Alabama
RUPJYOTI TALUKDAR, MD Clinical Pancreatologist and Clinician Scientist, Asian
Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
FRANK WEILERT, MD Waikato Hospital, Waikato District Health Board, Hamilton,
New Zealand
MING-MING XU, MD Gastroenterology Fellow, Division of Digestive and Liver
Diseases, Columbia University Medical Center, New York, New York
DHIRAJ YADAV, MD, MPH Associate Professor, Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh,
PennsylvaniaForthcoming Issues
Forthcoming Issues
January 2016
Pediatric Endoscopy
Jenifer R. Lightdale, E d i t o r
April 2016
The New NOTES
Stavros N. Stavropoulos, E d i t o r
July 2016
Sedation and Monitoring in Gastrointestinal Endoscopy
John Vargo, E d i t o r
Recent Issues
July 2015
Upper Gastrointestinal Bleeding Management
John R. Saltzman, E d i t o r
April 2015
Advances in Colonoscopy
Charles J. Kahi and Douglas K. Rex, E d i t o r s
January 2015
Minimizing, Recognizing, and Managing Endoscopic Adverse Events
Uzma D. Siddiqui and Christopher J. Gostout, E d i t o r s&
F O R E W O R D
Advances in Therapeutic
Endoscopic Retrograde
Cholangiopancreatography:
Benefits Far Outweigh the
Small Risks
Charles J. Lightdale, MD, Division of Digestive and Liver Diseases, Columbia
University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
Charles J. Lightdale, MD, Consulting Editor
When endoscopic retrograde cholangiopancreatography (ERCP) was initially
performed in the late 1960s and early 1970s, it was intended to be a purely
1diagnostic tool. Even then, this hybrid procedure combining endoscopy with
%uoroscopy was felt to be among the most di cult endoscopic procedures, and it
was not without its complications. In a survey conducted in 1974 by the American