This volume presents the technical and cultural state of the art of two of the riskiest, most complex and operator-dependent digestive operative techniques: endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS). The authors compare old and new techniques, shedding light on the most recent and innovative scientific findings, including those in the field of anatomic pathology and molecular biology considered relevant for the analysis of tissue samples collected during EUS. In view of the technical difficulties specific to these techniques, the book also offers access to online-videos and numerous images, making it a valuable resource both for physicians approaching these techniques for the first time as well as for those already using them. Organized into 7 sections, it describes in detail all techniques related to ERCP/EUS, together with any specific technical equipment required. It also presents a new paradigm based on the latest results in the areas of prevention, diagnosis and management of the most common complications. Clinical outcomes presented in international literature, as well as algorithms – both based on scientific evidence and expert findings – are illustrated and compared to alternative treatments.

This book aims to provide the basic technology and recent advances in biliopancreatic endoscopy. The method of Endoscopic retrograde cholangiopancreatography (ERCP) is popularly applied to enlarge the papillary orifice for removal of biliary and pancreatic stones, to relieve obstruction of distal bile duct or pancreatic duct by nasobiliary / nasopancreatic drainage or stenting, and to remove the premalignant tumor of papilla in recent four decades. The diagnostic role of ERCP is already replaced by the noninvasive images such as abdominal sonography, computed tomography, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS). This book will be contributed by the senior members of the Digestive Endoscopy Society of Taiwan (DEST) who are the leading ERCPists of the medical centers and teaching hospitals in Taiwan. There are 21 chapters, including the various techniques of therapeutic ERCP and EUS, how to approach the difficult cases and prevent complications. Recently, many new facilities and techniques develop to solve the difficult problems, but those new methods may have potential hazard to the patients, particularly in the inexperienced hands. We will share our clinical experience and comments on the recent literatures, to illustrate the standard operative procedures of biliopancreatic endoscopy, and focus on the patients’ safety as well as efficacy. We hope this book will be helpful for the readers in clinical application and facilitate the junior doctors to choose the cost-effective and safe procedure to help their patients in the future.

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.

This text provides a comprehensive review of ERCP and the clinical conditions managed by ERCP Presented in a case-based format, it will serve as a valuable practical clinical resource for clinicians with an interest in ERCP. The text reviews the remarkable history of ERCP with its transformation from a diagnostic to therapeutic procedure, discusses important issues in training in ERCP including use of endoscopic simulators and assessment of competency as emphasized in the new ACGME guidelines, reviews complications and new data on preventing post-ERCP pancreatitis with medication, and highlights major techniques involved in ERCP. For biliary diseases, new techniques for managing biliary stones, novel technologies for diagnosing indeterminate biliary strictures, and new devices for treating biliary strictures are highlighted. For pancreatic diseases, advances in minimally invasive endoscopic procedures for management of the various forms of pancreatitis and its complications are reviewed including a recent randomized controlled trial of endoscopic necrosectomy. ERCP is not limited by age, pregnancy, or history of abdominal surgeries and considerations particular to these special patient populations are also reviewed. Endoscopic Retrograde Cholangiopancreatography: A Case Based Approach will serve as a very useful resource for physicians who perform or refer patients for ERCP. It provides a concise yet comprehensive summary of the current status of ERCP that will help guide patient management and stimulate clinical research and device development.

Recent years have brought major shifts in the way endoscopic retrograde cholangiopancreatography is used in everyday practice, including the incorporation of endoscopic ultrasound (EUS) techniques with ERCP. The 4th Edition of this practical reference helps you make the most of today’s ERCP in your practice, with authoritative, highly illustrated guidance on every aspect of this complex tool, including coverage of the latest techniques both in print and on video. Provides detailed, full-color illustrations and in-depth instructions for performing all procedures. Depicts each procedure in dozens of step-by-step videos that clearly show ERCP techniques and imaging interpretation, including many new or recently improved procedures. Covers recent advancements in balloon assisted endoscopy, and provides guidance on performing ERCP on patients with surgically altered anatomy. Includes new chapters on endoscopic disinfection to address antibiotic resistant bacterial infections traced back to duodenoscopes; the environmental implications of ERCP; and magnetic biliary anastomosis. Contains clear therapeutic guidelines that help you determine when and when not to perform ERCP. Any additional digital ancillary content may publish up to 6 weeks following the publication date.

This text provides a comprehensive review of ERCP and EUS and the clinical conditions for which they are employed. Presented in a case-based format with accompanying videos, it will serve as a valuable practical clinical resource for gastroenterologists with an interest in ERCP and EUS. The text highlights major techniques involved in ERCP, reviews complications and recent data on preventing post-ERCP pancreatitis, and discusses important issues in training in ERCP including use of endoscopic simulators and assessment of competency as emphasized in the new ACGME guidelines. For biliary diseases, new techniques for managing biliary stones, novel technologies for diagnosing indeterminate biliary strictures, and new devices for treating benign and malignant strictures are also highlighted. For pancreatic diseases, advances in minimally invasive endoscopic techniques for pancreatic stones and strictures, and management of the complications of pancreatitis are reviewed. Furthermore, ERCP is not limited by age, pregnancy or history of abdominal surgeries and special considerations particular to these patient populations are also discussed. The EUS chapters review the breadth of equipment available for performing EUS and EUS-FNA, detail the technique of performing EUS-FNA, and explore pertinent issues with training and assessing competency analogous to ERCP training. Valuable insights on the basics of cytopathology relevant to the endosonographer are summarized. The classic indication for EUS of staging luminal cancers is examined in detail while pancreaticobiliary indications are discussed highlighting newer adjunctive technologies including elastography and contrast-enhanced EUS. Although in its infancy, the brave new world of therapeutic EUS is explored with a focus on endoscopic necrosectomy, EUS-guided biliary and pancreatic access as well as the exciting possibilities of EUS-guided radiofrequency ablation and injection of anti-tumor agents. ERCP and EUS: A Case Based Approach will serve as a very useful resource for physicians who perform or refer patients for ERCP and EUS. It provides a concise yet comprehensive summary of the current status of ERCP and EUS that will help guide patient management and stimulate clinical research. ​

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.