Diagnostic and Therapeutic Procedures in Gastroenterology (eBook)

Diagnostic and Therapeutic Procedures in Gastroenterology 3
Dedication 5
Foreword 7
Preface 9
Contents 11
Contributors 13
1: Esophageal Strictures and Endoscopic Management 17
Introduction 17
Etiology of Esophageal Strictures 18
Diagnostic Work-up 18
Indications for Endoscopic Esophageal Dilation 19
Patient Preparation for Esophageal Dilation 19
Endoscopic Dilation Techniques 20
Complications of Esophageal Dilation 24
Alternative Management 24
Summary of Key Points 24
References 24
2: Endoscopic Management of Barrett’s Esophagus 26
Introduction 26
Endoscopy in Barrett’s Esophagus 27
Endoscopic Surveillance 28
BE Without Dysplasia 28
BE with LGD 28
BE with HGD 29
Advanced Endoscopic Imaging of Barrett’s Esophagus 29
High-Resolution/High-Definition/Magnification Endoscopy 30
Chromoendoscopy 30
Narrow Band Imaging 31
Autofluorescence Imaging 32
Confocal Laser Endomicroscopy 34
Endoscopic Therapy in Barrett’s Esophagus 35
Patient Group to Be Treated 35
Patients with LGD 35
Patients with HGD 35
Pre-endoscopic Therapy Work-up 37
Role of EUS 37
Diagnostic EMR 37
Eradication Therapies for BE 38
Photodynamic Therapy 39
Radiofrequency Ablation 39
Cryotherapy 40
Limitations of Ablative Therapies 41
Complications of Ablative Therapies 41
Endoscopic Mucosal Resection or Mucosectomy 42
Therapeutic EMR 42
Post-endoscopic Therapy BE Surveillance 44
References 44
3: Gastrointestinal Tract Stenting 48
Introduction 48
Esophageal Stent Placement 48
Indications 48
Contraindications 49
Technique 50
Complications 52
Postoperative Care 53
Outcomes 53
Benign Disease 55
Available Devices 55
Enteral Stent Placement 56
Indications 56
Contraindications 57
Technique 57
Complications 59
Postoperative Care 60
Clinical Efficacy 60
Available Devices 60
Alternative Treatments 61
Colonic Stenting 61
Indications 61
Contraindications 62
Procedure 62
Complications 63
Postoperative Care 63
Clinical Data 64
Available Devices 64
Alternative Procedures 65
References 65
4: Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding 69
Introduction 69
Causes of UGIB 70
Initial Evaluation of Patients with UGI Bleeding 70
Anatomy of a Bleeding Ulcer 71
Timing of Endoscopy 71
ENDOSCOPIC THERAPY OF BLEEDING PEPTIC ULCERS 72
Patient Monitoring 72
Patient Position 73
Gastric Lavage 74
Endoscopic Treatment 74
Thermal Therapy 74
Electrothermocoagulation 74
The Technique 75
Nonelectrothermocoagulation 75
The Technique 76
Injection Therapy 76
Agents Used 76
Thrombin/Fibrin Glue 77
The Technique 77
Mechanical Clips 77
The Technique 79
Choice of Techniques 79
Forrest Class Ia and Ib (Actively Bleeding Ulcers) 81
Forrest Class IIa (Ulcer with Nonbleeding Visible Vessel) 81
Forrest Class IIb (Ulcer with Adherent Clot) 81
Post-endoscopic Therapy 82
Mallory–Weiss Tears 83
Second-Look Endoscopy 83
Conclusions 83
References 84
5: Endoscopic Management of Varices and Variceal Hemorrhage 86
Introduction 86
Risk Assessment of Patients 87
Primary Prophylaxis 88
Secondary Prophylaxis 90
Initial Management of Acute Variceal Hemorrhage 90
Endoscopic Variceal Band Ligation 93
Technique 93
Injection Therapy 95
Technique 95
Intravariceal Injection 96
Paravariceal Injection 97
Combination of Band Ligation and Sclerotherapy 98
Argon Plasma Coagulation 98
Gastric Varices 98
Follow-up 101
References 101
6: Argon Plasma Coagulation 104
Introduction 104
Indications 104
Hemostasis 105
Ablation 105
Contraindications 106
Procedure Description 106
The Plasma Coagulator Device 106
The Circuit: Monopolar Versus Bipolar 106
Mechanics 107
First- and Second-Generation APCs 108
Technique 109
Complications 109
Minor Complications 109
Major Complications 110
Postoperative Care 110
Alternative Procedures 110
Costs 111
Summary of Key Points 111
References 112
7: Endoscopic Mucosal Resection 113
Introduction 113
Indications 114
Defining the Lateral Margins of the Lesion 114
Determining the Depth of Tumor Invasion 116
Endoscopic Appearances 116
Endoscopic Ultrasound 117
Contraindications 117
Procedure Description 118
Define the Margins of the Lesion for Resection 118
Submucosal Injection 118
Resection Techniques 118
Injection-Assisted EMR 118
Cap-Assisted EMR 118
Ligation-Assisted EMR 119
Retrieval of Resected Lesion 121
Complications 121
Postoperative Care 122
Results 122
Esophagus 122
Squamous Cell Carcinoma 122
Barrett’s Esophagus with High-Grade Dysplasia and Early Cancer 122
Stomach 122
Colorectum 123
Alternative Procedures 123
Cost 124
Conclusions 124
Summary of Key Points 124
References 125
8: Enteral Nutrition: From Formulations to Delivery 128
Enteral Feeding Formulas 129
Standard Formulas 129
Fiber Containing Formulas 131
High Protein Formulas 131
Peptide-Based Formulas 131
Elemental Formulas 131
Disease Specific 131
Enteral Formula Delivery Methods 133
Monitoring Tube Feeding 134
Gastrointestinal Tolerance 134
Nausea and Vomiting 135
Gastric Residual Volume 136
Diarrhea 137
Bloating and Distention 138
Determination of Adequate Gut Function 139
Summary of Key Points 140
References 140
9: Capsule Endoscopy 142
Introduction 142
Box 1Limitations of all VCE 144
Obscure GI Bleeding 144
Box 2Small bowel VCE indications 144
Small Bowel Tumors 149
Crohn’s Disease 151
Celiac Disease 153
Contraindications 154
Box 3Small bowel VCE contraindications 154
Equipment 154
Technique 157
Box 4Small bowel VCE technique 157
Reading 158
Outcomes 158
Problems 160
Box 5 Small bowel VCE problems 161
Overcoming the Problems 162
Esophageal VCE 164
Introduction 164
Indications 164
Box 6 Esophageal VCE indications 164
Gastroesophageal Reflux and Barrett’s Esophagus 165
Contraindications 169
Box 7Esophageal VCE contraindications 169
Technique 169
Box 8Esophageal VCE technique 170
Colon VCE 170
Box 9 Review 171
Box 10Indications for VCE 171
Box 11 Relative contraindications and solutions 172
Box 12VCE procedure checklist 172
Summary of Key Points 172
References 172
10: Double Balloon Enteroscopy 175
Introduction 175
Principle of DBE 176
Device Description 176
Preprocedure Preparation 178
Sedation 178
Procedure 178
Route of Insertion 180
Indications 180
Diagnosis 180
Therapeutic 180
Salvage Therapy 180
Contraindications 182
Disadvantages 183
Complications 184
Alternative Procedures 184
Wireless Video Capsule Endoscopy 184
Enteroscopy 185
Single Balloon Enteroscopy 185
Spiral Enteroscopy 185
Push-Enteroscopy 186
Intraoperative Enteroscopy 186
Small Bowel Series 186
Costs 187
References 187
11: Sphincterotomy and Stents in Benign and Malignant Disorders and Biliary ERCP 192
Introduction 192
Sphincterotomy 192
Bile Duct Stenting 195
Pancreatic Duct Sphincterotomy and Stents 197
Cystgastrostomy 198
References 201
12: The Use of SpyGlass Direct Visualization System in the Management of Pancreato Biliary Disease 203
Introduction 203
Procedure Description 205
Indications 206
Diagnostic Indications 206
Therapeutic Indications 209
Contraindications 211
Complications and Safety 211
Post-Procedure Care 212
Comparative Procedures 212
Cost 213
Summary of Key Points 213
References 213
13: Endoscopic Drainage of Pancreatic Fluid Collections 218
Introduction 218
Diagnostic Work-up 219
Indications 219
Patient Preparation for Pseudocyst Drainage 220
Procedure 220
Transpapillary Pseudocyst Drainage 220
Transmural Pseudocyst Drainage 220
Cystoscopy-Guided Debridement 222
Post-procedural Care 224
Complications and Management 224
Alternative Procedures 224
Cost Effectiveness 225
References 225
14: Endoscopic Management of Pancreatic Pseudocysts 227
Introduction 227
Incidence and Etiology of Pseudocysts 227
Pathogenesis and Classification 228
Clinical Presentation and Diagnosis 231
History, Physical Examination, and Laboratory Evaluations: Narrowing the Differential 231
Imaging Studies and Possible Fluid Sampling 233
Conventional Abdominal Ultrasound 233
CT, MRI, and ERCP 233
EUS and Possible Fine Needle Aspiration with Fluid Analysis 234
Treatment of Pancreatic Pseudocysts 235
Preprocedural Assessment 235
Surgical Drainage 236
Percutaneous Drainage 237
Endoscopic Drainage 237
Efficacy and Cost-Effectiveness of Endoscopic Management 238
Technique of Cystgastrostomy/Duodenostomy 239
Transpapillary Drainage 241
Complications and Their Avoidance 242
References 244
15: EUS-Guided Drainage of Pelvic Abscesses 247
Introduction 247
Transvaginal/Transrectal Ultrasound-Guided Drainage 248
CT Guided Drainage 248
Surgery 248
Why Endoscopic Ultrasound Drainage? 249
Procedural Technique 249
Technical Outcomes 251
Limitations 252
References 252
16: Technique of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) 254
Introduction 254
Indications 255
Contraindications 255
Pre-evaluation 255
Preparation 256
Position 256
Equipment 256
The Echoendoscope 256
Prior Radial EUS 257
The Needle 259
Suction Syringes 260
Technique 261
Identification/Selection of the Target Lesion 262
Alignment of the Lesion in the Projected Path of the Needle 264
Stabilizing the Transducer 264
Apposition of the Transducer 264
Color Doppler Evaluation 264
Needle Puncture 265
Sampling the Targeted Lesion with or without Suction 268
Withdrawal of the Needle 269
Transfer of the Sampled Tissue or Fluid for Cytopathology 269
Complications 270
Perforation 270
Acute Pancreatitis 275
Bleeding 275
Infection 276
References 276
17: The Role of Endoscopic Ultrasound in Pain Management 278
Introduction 278
Pathophysiology 278
EUS-Guided Celiac Plexus Block and Neurolysis 279
Techniques for Performing EUS-Guided CPN and CPB 280
Superior Hypogastric Plexus Neurolysis 286
Ganglion Impar Neurolysis 290
References 294
18: Colonoscopic Polypectomy 296
Introduction 296
Indications 297
Contraindications 298
Procedure Site 299
Procedure Description 300
Polyp Retrieval 303
Complications 306
Post-procedure Care 307
Results 308
Alternatives 308
Cost 308
References 309
19: Acute Colonic Bleeding 311
Introduction 311
Epidemiology 312
Resuscitation and Initial Evaluation 312
Approach to the Patient with Severe Hematochezia–Clinical Algorithm 314
Diagnostic Evaluations 314
Colonoscopy 315
Bowel Preparation 316
CURE Hemostasis Group Results with an Urgent Endoscopic Approach to Severe Hematochezia 317
Alternate Procedures 317
Traditional Management of Severe Hematochezia in Adults 317
Emergency Abdominal Angiography 319
Red Cell Scanning 320
Results of Traditional Approach to Severe Hematochezia 321
Specific Colonic Lesions 321
Diverticular Hemorrhage 321
Internal Hemorrhoids 323
Ischemic Colitis 324
Solitary Rectal Ulcer Syndrome 325
Delayed Post-polypectomy Hemorrhage 325
Colonic Angiomas 327
Cost Assessment 328
References 328
20: Complications and Their Risk Factors in Gastrointestinal Endoscopy 331
Introduction 331
Complications Related to Preparation for Endoscopy 332
Upper Endoscopy 332
Colonoscopy 332
Complications Related to Sedation and Anesthesia 333
Cardiovascular Complications 334
Infection 335
Perforation 336
Upper Endoscopy 336
Colonoscopy 337
Post-polypectomy Syndrome 337
Bleeding 338
Upper Endoscopy 338
Colonoscopy 338
Aspiration 338
Vasovagal Reactions 340
Splenic Injury 340
Entrapment of the Endoscope 340
Complications of Percutaneous Endoscopic Gastrostomy 340
Fistula 340
Buried Bumper Syndrome 341
Stoma Leak or Enlargement 341
Wound/Tube Infection 341
Tube Dislodgement 342
Pneumoperitoneum 342
Hemorrhage 342
Endoscopic Retrograde Cholangiopancreatography 342
Pancreatitis 342
Infection 343
Hemorrhage 343
Perforation 344
Cardiopulmonary Complications 344
Mortality 344
Miscellaneous Complications 344
Endoscopic Ultrasound 344
Perforation 345
Bleeding 345
Infection 345
Pancreatitis 345
Miscellaneous 346
Advanced Therapeutic Techniques 346
Endoscopic Mucosal Resection 346
Radiofrequency Ablation 346
Endoscopy in Pregnant or Lactating Women 347
References 348
21: Documentation and Description of Endoscopic Procedures 351
Introduction 351
Photodocumentation of Endoscopic Procedures 352
Upper Gastrointestinal Endoscopy 352
Colonoscopy 357
Accurate Description of Endoscopic Findings 362
Terminology 363
Location of the Lesion 363
Description of Lesions 363
References 366
22: Ultrasound-Guided/Assisted Percutaneous Liver Biopsy 367
Introduction 367
Indications 368
Contraindications 369
Procedure Technique: Percutaneous Ultrasound-Assisted Liver Biopsy 370
Biopsy with a Jamshidi-Menghini Needle Kit 370
Alternate Devices 375
Liver Biopsy Gun 376
Complications 376
Costs 377
References 378
Index 379