By Linda S. Lee
This textual content offers a entire overview of ERCP and EUS and the scientific stipulations for which they're hired. awarded in a case-based layout with accompanying video clips, it's going to function a necessary functional scientific source for gastroenterologists with an curiosity in ERCP and EUS. The textual content highlights significant ideas excited about ERCP, experiences problems and up to date info on combating post-ERCP pancreatitis, and discusses very important matters in education in ERCP together with use of endoscopic simulators and review of competency as emphasised within the new ACGME guidance. For biliary illnesses, new suggestions for dealing with biliary stones, novel applied sciences for diagnosing indeterminate biliary strictures, and new units for treating benign and malignant strictures also are highlighted. For pancreatic ailments, advances in minimally invasive endoscopic strategies for pancreatic stones and strictures, and administration of the problems of pancreatitis are reviewed. in addition, ERCP isn't really constrained through age, being pregnant or heritage of stomach surgical procedures and exact issues specific to those sufferer populations also are discussed.
The EUS chapters assessment the breadth of kit on hand for appearing EUS and EUS-FNA, element the means of acting EUS-FNA, and discover pertinent concerns with education and assessing competency analogous to ERCP education. invaluable insights at the fundamentals of cytopathology suitable to the endosonographer are summarized. The vintage indication for EUS of staging luminal cancers is tested intimately whereas pancreaticobiliary symptoms are mentioned highlighting more moderen adjunctive applied sciences together with elastography and contrast-enhanced EUS. even if in its infancy, the courageous new global of healing EUS is explored with a spotlight on endoscopic necrosectomy, EUS-guided biliary and pancreatic entry in addition to the fascinating chances of EUS-guided radiofrequency ablation and injection of anti-tumor agents.
ERCP and EUS: A Case dependent Approach will function a truly resource for physicians who practice or refer sufferers for ERCP and EUS. It presents a concise but entire precis of the present prestige of ERCP and EUS that would support consultant sufferer administration and stimulate scientific study.
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Extra info for ERCP and EUS: A Case-Based Approach
The debate regarding the procedural volume needed for trainees to reach these quality standards has been highlighted previously in this chapter. Of note, there is a paucity of data regarding how competent trainees are as they complete fellowship and begin practice in ERCP. One very revealing study surveyed third year trainees at 155 general gastroenterology fellowship programs across the US. Among the 69 respondents, it was found that 64 % did not achieve competence defined by having 180 ERCPs, and 33 % did not feel their training was adequate; yet, 91 % planned to perform ERCP independently in practice following completion of fellowship.
Questions to ask prior to ERCP include: 1. Is this procedure justified? Is SOD suspected? If so, am I ready to use methods for pancreatitis prophylaxis (pancreatic duct stent, rectal indomethacin)? Is my patient optimized in terms of cardiopulmonary condition? Should I recommend intubation versus conscious sedation? When did the patient last eat and does the patient have a history of gastroparesis or gastric outlet obstruction? 6. What position is safest for the patient? Is the patient of child-bearing age in which pelvic radiation protection must be provided?
Patients who are “high risk” benefit the most from ERCP as opposed to other noninvasive modalities. In support, the American Society for Gastrointestinal Endoscopy (ASGE) recommends that only patients meeting the criteria for high suspicion undergo an ERCP for choledocholithiasis since it allows for immediate diagnosis and treatment . Sphincterotomy and stone extraction with or without lithotripsy can be performed using the numerous tools now available in order to relieve biliary or pancreatic ductal obstruction caused by stones.