Endoscopic ultrasonography (EUS) has gradually replaced many percutaneous image-guided interventions, such as tissue sampling of pancreatic tumors. Similarly, EUS-guided biliary therapeutics mirror percutaneous intervention on the biliary tract. Three anatomic structures can be targeted for biliary drainage under EUS guidance:…
Endoscopic retrograde cholangiopancreatography (ERCP) is generally considered the technically most difficult procedure in gastrointestinal (GI) endoscopy because of the complex maneuvers necessary to gain ductal access and perform therapies within the bile duct or pancreas. Altering the upper GI tract…
Pancreaticobiliary diseases such as choledocholithiasis and gallstone pancreatitis during pregnancy are challenging to manage because of increased risk to both the mother and fetus. Physiologic alterations during pregnancy, such as weight gain and hormonal changes, increase the risk of cholelithiasis.…
Endoscopic retrograde cholangiopancreatography (ERCP) was introduced into pediatric medicine in the late 1970s and is now routinely used for the diagnosis and treatment of biliary tract and pancreatic diseases in children throughout the world. With the advent of high-quality magnetic…
The concept of confocal microscopy was first patented in 1957. Since then, this technology has been used with much success in the laboratory, and more recently this has translated into use in various clinical settings, first described in the field…
Historically, cholangioscopy was performed with a fiberoptic mother (large-caliber duodenoscope) and daughter (cholangioscope) system requiring two endoscopists, two light sources, and two video monitors, if the endoscopy unit was fortunate enough to have two video cameras to interface with the…
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…