Gastric outlet obstruction (GOO) and biliary obstruction (BO) occur commonly in patients with primary or metastatic periampullary malignancies. In pancreatic cancer, for example, GOO occurs in up to 10% to 25% of patients, whereas 70% of the patients present with…
Biliary obstruction results from diverse benign and malignant processes, and patients can present with acute or chronic signs and symptoms that vary greatly in severity ( Table 41.1 ). The nature of an obstruction is often immediately clear at the…
Malignant biliary obstruction of the hilum and proximal intrahepatic bile ducts can result from primary pancreaticobiliary cancers, primary liver cancers, portal lymphadenopathy, or metastatic disease. Primary pancreaticobiliary cancers affecting the proximal bile ducts and hilum include cholangiocarcinoma (CCA) and gallbladder…
Malignant strictures of the pancreaticobiliary tree are often difficult to diagnose and treat. Therefore the majority present in more advanced stages of disease, contributing to poor prognosis and outcome. Jaundice is the most common presenting sign and symptom of malignant…
Malignant tumors of the ampulla of Vater are uncommon. Fewer than 1 in 50,000 people older than 40 years are diagnosed with ampullary malignancy each year. Much more common is a heterogeneous group of malignancies occurring in the peri ampullary…
Background and Definitions The pancreas arises in utero from the fusion of the ventral and dorsal pancreatic buds. The dorsal pancreatic bud gives rise to the pancreatic body and tail, and the ventral pancreatic bud gives rise to the pancreatic…
Dilated Bile Duct Defining Dilated Bile Ducts There is no consensus definition for what constitutes a dilated bile duct. Rather, it is important to understand that the definition is contextual and depends on the site of measurement, the imaging modality…
Anomalies of the biliary and pancreatic ducts are commonly encountered during endoscopic retrograde cholangiopancreatography (ERCP) and are important to both surgeons and gastroenterologists. This chapter reviews the diagnosis, clinical relevance, and therapy of these variants. Ampullary Anomalies Ectopic Major Papilla…
Endoscopic retrograde cholangiopancreatography (ERCP) was first described in 1968 (see Chapter 1 ). Despite being technically challenging because of the limited range of available endoscopes and accessories at that time, it became an important modality for diagnostic evaluation of the…
Overview Endoscopic ultrasonography (EUS) was first introduced in the 1980s and has since become a cornerstone of endoscopic diagnosis of pancreaticobiliary disease, tissue acquisition via fine-needle aspiration (FNA), and staging of gastrointestinal malignancy. As experience with directed needle access into…