Peroral pancreatoscopy, in which a small-caliber fiberscope (“baby scope”) is inserted into the pancreatic duct from the papilla through the working channel of a duodenoscope (“mother scope”), was first described by Japanese investigators Takagi and Takegoshi in 1974. Although the…
Ampullary neoplasms (see Chapter 38 ) are rare, with an annual incidence of 3000 in the United States and a reported prevalence of 0.04% to 0.12% in autopsy series. Endoscopically the papilla can appear enlarged and abnormal because of various…
Pancreaticobiliary stenting is an efficacious and safe method to address biliary manifestations of benign and malignant disease. At present, indications for stent placement include palliative biliary decompression, adjunctive preoperative decompression, treatment of benign biliary and pancreatic strictures, refractory lithiasis, bile…
Self-expandable metal stents (SEMS), classified as uncovered (uSEMS), partially covered (pcSEMS), or fully covered (fcSEMS), offer a more durable means to overcome biliary stenosis compared with fixed-diameter plastic stents (PS), which occlude in 30% and 50% of patients within 3…
The use of plastic pancreaticobiliary stents for drainage of the bile duct was described more than 3 decades ago. These stents are used for a variety of indications, including malignant and benign conditions, and have proven reliable and safe for…
Pancreas divisum (literally “divided pancreas”) is a congenital anatomic variant in which the dorsal and ventral pancreatic ducts completely or partially fail to fuse, and drain separately into the medial wall of the duodenum. Thus in most patients with pancreas…
Since its initial application in 1974, endoscopic biliary sphincterotomy (see Chapter 17 ) has revolutionized the approach to patients with biliary tract diseases. Biliary sphincterotomy has been used in conjunction with other techniques such as stent placement, balloon and basket…
Introduction and Scientific Basis Biliary stone disease is the most common reason for undertaking therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In Western countries, choledocholithiasis is primarily related to passage of gallstones from the gallbladder into the common bile duct. The clinical…
Endoscopic sphincterotomy (EST; see Chapter 17 ) has become the procedure of choice for removal of stones from the bile duct, especially in postcholecystectomy patients. The procedure is successful in 90% to 98% of patients, and 86% to 91% of…
Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) has been widely replaced by computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasonography (EUS) as noninvasive or less invasive imaging techniques. Indications for diagnostic ERCP should be limited to selected patients with indeterminate…