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Endoscopic Treatment of Pancreatic Disease

Since the first report of ERCP and endoscopic biliary sphincterotomy in 1974, there have been numerous advances in ERCP techniques. Less invasive diagnostic modalities including EUS, CT, and MRCP have replaced diagnostic ERCP. However, therapeutic ERCP remains useful for the treatment of pancreatic diseases, and continually evolves. This chapter reviews the endoscopic treatment of acute pancreatitis and its complications, as well as the endoscopic treatment of…

Pancreatic Cancer, Cystic Pancreatic Neoplasms, and Other Nonendocrine Pancreatic Tumors

Pancreatic cancer The most common malignancy arising from the pancreas is a ductal adenocarcinoma. Pancreatic adenocarcinoma is a highly lethal malignancy representing 3% of all cancer cases in the USA but representing 7% of all cancer deaths. There were approximately 53,760 new cases with 43,090 deaths expected in 2017. Despite its relatively low incidence compared with other malignancies, it represents the 4th leading cause of cancer…

Chronic Pancreatitis

Chronic pancreatitis is a syndrome, encompassing a spectrum of conditions which culminate in a similar phenotype. The traditional definition of chronic pancreatitis has been based on histology, demonstrating chronic and irreversible damage to the pancreas. Chronic inflammation, fibrosis, and eventual destruction of ductal, exocrine (acinar cell), and endocrine (islets of Langerhans) tissue ( Fig. 59.1 ) characterize the histology of chronic pancreatitis, producing varying degrees of…

Acute Pancreatitis

Incidence and Burden of Disease The human and financial burden of acute pancreatitis (AP) continues to grow, and it is now one of the most common reason for hospitalization with a GI condition. Many studies demonstrate a variable yet consistent increasing worldwide incidence, generally in the range of 20 to 40 per 100,000 population. Studies from Europe suggest an increase overall, with differences in underlying etiology…

Genetic Disorders of the Pancreas and Pancreatic Disorders in Childhood

Acknowledgment The authors would like to acknowledge the contribution of Celeste Shelton CGC, PhD, Mark Haupt MD, and Brandon Blobner PhD for critically reviewing of this chapter. Background The new paradigm of precision medicine provides a robust framework for understanding pancreatic diseases and leads to new insights into disease mechanisms. This framework has resulted in a series of breakthroughs in clinical and translational sciences. International consensus…

Pancreatic Secretion

The exocrine pancreas has been of considerable interest to physiologists and other scientists for quite some time; in fact, the first demonstration of a hormone action was in the pancreas around the turn of the 20th century. The pancreas has been the major organ used to demonstrate general mechanisms of synthesis and transport for exportable proteins, ion and water secretion, , and signaling pathways involved in…

Anatomy, Histology, Embryology, and Developmental Anomalies of the Pancreas

History of the Pancreas Although the identity of the pancreas has been known for some time, its critical digestive functions were only recently appreciated. , The first description of the pancreas was made by the Greek physician Herophilos at around 300 bc . In the late first century ad , another Greek authority, Rufus of Ephesus, named the organ the “pancreas.” The term literally means “all…

Adenocarcinoma of the Stomach and Other Gastric Tumors

Gastric cancer remains a major cause of cancer-related mortality in the world, despite declining rates of incidence in many industrialized countries. In this chapter, we mainly discuss gastric adenocarcinoma, which makes up most of gastric malignancies. Epidemiology Gastric cancer is the third leading cause of cancer mortality in the world, although the overall incidence is declining. In Western countries, the incidence of gastric cancer has decreased…

Gastritis and Gastropathy

Acknowledgment The authors thank Douglas R. Morgan, Sheila E. Crowe, and Edward L. Lee who previously contributed to parts of this chapter. Definitions Patients, clinicians, endoscopists, and pathologists often define gastritis differently. Some define it as a symptom complex, others as an abnormal endoscopic appearance of the stomach, and still others use the term to connote microscopic inflammation of the stomach, usually its mucosa. This last…

Gastric Secretion

As discussed in the preceding chapter, the stomach is an active reservoir that stores, grinds, and slowly dispenses partially digested food to the intestine for further digestion and absorption. Its main secretory function is the production of hydrochloric acid. Gastric acid secretion is present on the first day of life and increases as infants become more mature. By 2 years of age, acid secretion is similar…

Gastric Neuromuscular Function and Neuromuscular Disorders

Gastric neuromuscular function refers to the contractions, relaxations, and peristaltic activities of the stomach. The 3 major neuromuscular activities of the stomach are (1) receptive relaxation of the fundus, (2) recurrent peristaltic waves of the corpus and antrum, and (3) antral peristalsis with antropyloroduodenal coordination. These major neuromuscular activities of the stomach accomplish 3 key functions: (1) to receive the ingested food that we eat (receptive…

Anatomy, Histology, and Developmental Anomalies of the Stomach and Duodenum

Embryology and Anatomy Of the Stomach The stomach, as a J-shaped dilation of the alimentary canal, is continuous with the esophagus proximally and the duodenum distally. It functions primarily as a reservoir to store large quantities of recently ingested food, therefore allowing intermittent feedings, initiating the digestive process, and releasing its contents in a controlled fashion downstream to accommodate the much smaller capacity of the duodenum.…

Esophageal Tumors

Conflicts of Interest and Acknowledgement SW: Supported by the University of Colorado Department of Medicine Outstanding Early Scholars Program, Consultant—Medtronic, Boston Scientific. HH: Consultant—Medtronic. Neal C. Patel and Francisco C. Ramirez contributed to earlier versions of this chapter. Esophageal cancer is the eighth most common cancer worldwide with an estimated 456,000 incident cases representing 3.2% of all cancer cases diagnosed annually. It is also the sixth…

Barrett Esophagus

Barrett esophagus is the condition in which an abnormal columnar epithelium that has both gastric and intestinal features and that is predisposed to malignancy replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition is named for Norman Barrett, an Australian surgeon who drew attention to the columnar-lined esophagus in 1950. Barrett esophagus is a consequence of chronic GERD, which damages the esophageal…

Gastroesophageal Reflux Disease

Gastroesophageal reflux (GER) is a physiologic process by which gastric contents move retrograde from the stomach to the esophagus. GER itself is not a disease and occurs multiple times each day without producing symptoms or mucosal damage. In contrast, GERD is a spectrum of disease usually producing symptoms of heartburn and acid regurgitation. GERD is a consequence of the failure of the normal antireflux barrier to…

Esophageal Disorders Caused by Medications, Trauma, and Infection

Medication-Induced Esophageal Injury Medication-induced esophageal injury occurs at any age and from a variety of commonly used medications. Nevertheless, medication-induced esophageal injury is likely underdiagnosed in clinical practice for several reasons. First, common and more serious problems such as acute coronary syndrome and pulmonary embolism might be considered initially because of the severe chest pain, often pleuritic in nature, associated with pill-induced esophagitis. Second, patients may…

Esophageal Neuromuscular Function and Motility Disorders

The esophagus is a muscular tube with a sphincter at each end joining the hypopharynx to the stomach with the simple function of transporting food, fluid, and gas between these endpoints. As such, the esophagus encompasses the anatomic and physiologic transition from the striated muscle oropharynx and the smooth muscle gut. Neurologically, the oropharynx is controlled by the cerebral cortex and medulla and capable of precise…

Anatomy, Histology, Embryology, and Developmental Anomalies of the Esophagus

Anatomy and Histology The esophagus acts as a conduit for the transport of food from the oral cavity to the stomach. To carry out this task safely and effectively, the esophagus is constructed as an 18- to 26-cm long hollow muscular tube with an inner “skin-like” lining of stratified squamous epithelium ( Fig. 43.1 ). Between swallows the esophagus is collapsed, but the lumen distends up…

Preparation for and Complications of Gastrointestinal Endoscopy

Complications of Newer Endoscopic Techniques GI endoscopy plays an integral part in the diagnosis and management of a variety of GI ailments. Risks and benefits are inherent to the performance of any procedure. In recent years, the “scope” of GI endoscopy keeps expanding to include procedures such as peroral endoscopic myotomy (POEM), endoscopic submucosal dissection (ESD) of tumors, and endoscopic bariatric procedures. With such expansion comes…