Endoscopic therapy and radiologic treatment of biliary disease have evolved in separate but parallel manners. Endoscopic therapy is performed using ERCP and EUS-guided techniques. ERCP is performed primarily by endoscopists trained in a gastroenterology fellowship program, but in some centers…
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…
Endoscopic retrograde cholangiopancreatography (ERCP) is a combined endoscopic and radiologic procedure used for diagnostic and, more commonly, therapeutic interventions within the pancreatic and biliary tree. Although interventional radiology and interventional endoscopic ultrasound (EUS) approaches exist, ERCP has been and remains…
Pancreatic pseudocysts, abscesses, and walled-off necrosis (WON) are types of pancreatic fluid collections (PFCs) that arise as a consequence of pancreatic injury. These sequelae of pancreatic injury result from a disruption of the main pancreatic duct (PD) and/or side branches.…
Chronic pancreatitis (CP) is a rare disease in Western countries (incidence 2 to 10/100,000 per year). It ultimately leads to irreversible damage of the pancreas, with exocrine and endocrine insufficiency. In the majority of cases pain is the major clinical…
Chronic pancreatitis, cystic neoplasms, and suspected or established malignancy are the main indications for pancreatic surgery. The various types of pancreatic surgery are outlined in Box 45.1 . This chapter focuses on types of pancreatic surgery, their associated adverse events,…
Iatrogenic bile duct injury (BDI) continues to be an important clinical problem after biliary surgery, resulting in serious morbidity and occasional mortality. The management, operative risk, and outcome of BDIs vary considerably and are highly dependent on the type of…
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…
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…
Introduction Zenker's diverticulum (ZD) is a posterior pharyngoesophageal mucosal outpouching that forms through Killian's triangle. Poor upper esophageal sphincter (UES) compliance is the acknowledged pathophysiologic mechanism of action, leading to creation of a high-pressure zone, ultimately resulting in diverticulum formation.…