By Douglas G. Adler
This quantity offers a accomplished consultant to complex endoscopic strategies and strategies. basically desirous about Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS), the ebook additionally explores comparable issues comparable to cholangioscopy, pancreatoscopy, complex pancreaticobiliary imaging, stenting, and endoscopic capacity to accomplish soreness keep watch over. The textual content additionally provides a plethora of information and methods on easy methods to practice those strategies accurately, emphasizes universal error and the way to prevent them, and contours top of the range video clips illustrating key procedural elements for each chapter.
Written through most sensible specialists within the box, Advanced Pancreaticobiliary Endoscopy is a useful source for gastrointestinal endoscopists and fellows drawn to complicated endoscopic strategies.
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Additional resources for Advanced Pancreaticobiliary Endoscopy
4. 5. 6. Large size >15 mm Multiple large stones >10, stacked stones in nondilated duct Impacted and adherent stones Unusual shape Stones proximal to strictures Unusual locations—intrahepatic stones, cystic duct stones, stones in bile duct diverticulum 7. Anatomical alterations Large periampullary diverticulum Sigmoid shaped and narrow distal CBD with large stone Postsurgical anatomy—Billroth 2 anatomy and Roux-en-Y gastrojejunostomy and gastric bypass surgery Fig. 2 CT scan image of a 7 cm long stone (arrow) identiﬁed in a very dilated common bile duct 3.
Patients who have undergone Roux-en-Y gastric bypass jejunojejunostomy (RYGB) typically have a longer roux and biliopancreatic limbs when compared to patients with RYGJ and RYHJ reconstructions, making access to, and cannulation of, the biliary oriﬁce potentially more challenging to perform . Some patients with RYGB can undergo ERCP with a duodenoscope or a colonoscope, but some can only have their major papilla accessed via a standard enteroscope or a balloon-assisted enteroscope depending on the length of the roux limb.
Endoscopic management of Mirizzi syndrome can be technically challenging and is associated with varying success. In most cases, the offending stone cannot be removed endoscopically as it is lodged in the cystic duct or the gallbladder. Accordingly, surgical intervention is the mainstay of therapy for Mirizzi syndrome and is usually required for deﬁnitive treatment. Historically, ERCP was used to diagnose Mirizzi syndrome and temporarily relieve the biliary obstruction through endoscopic stenting prior to deﬁnitive surgical management .
Advanced Pancreaticobiliary Endoscopy by Douglas G. Adler