Preface - bücher.de · 2019-01-02 · increase safety and reduce the time required for surgery....

Preface

Seven years after the initial publication of our book we now presentthe second edition. This new edition employs the same provenconcept as before. However, its content fully reflects the rapidadvances that have characterized the development of gastroentero-logical endoscopy in recent years. This development is not solely theresult of technical progress but has also been driven by an increasinginterest in endoscopy of the gastrointestinal tract. It is evident thatthe number of endoscopic centers has continuously increased inrecent years. We note with some satisfaction that this developmenthas embraced every continent. The major endoscopic journals re-port both increasing subscriptions and increasing submissions ofscientific papers. The major emerging economic powers in Asia,such as China and India, have apparently decisively influencedthis development. We also note that scientific papers in the fieldof endoscopy no longer come exclusively from university hospitals,but increasingly from municipal hospitals and private practices aswell.

This newly acquired knowledge extends to all aspects of gastro-enterological endoscopy that are relevant to the patient: patientpreparation prior to examination, premedication, screening of pre-malignant and malignant lesions, endoscopic diagnosis, and ther-apy.

Completely new technology and methods have been introduced.Not only has the endoscopist's field of endeavor expanded continu-ously as a result of this development, it has also undergone signifi-cant change.

The magic acronym NOTES has evoked fascination. It refers totransluminal invasive procedures in which the endoscope is ad-vanced through the wall of the organ of approach (stomach, vagina,etc.) to reach the target organ in the abdominal or retroperitonealspace in order to remove the appendix, gallbladder, kidney, etc.Surgical teams that include gastroenterologists now see a com-pletely new field of endeavor unfolding for the intrepid gastroen-terological endoscopist.

Colorectal carcinoma is by far the most impressive example ofthe impact of health care policies on the field of endoscopy. Wherecolonoscopy is the established method of screening for colon cancer,as in the United States and many European countries, endoscopistsare veritably flooded with screenees. Might this not mean that otherequally important tasks of the physician are being neglected as aresult? Obviously new biomarkers for colon cancer with high sen-sitivity and specificity are needed to filter out unsuitable candidatesso that only those cases where a genuine suspicion exists are sent tocolonoscopy.

Naturally, colonoscopy and the removal of adenomas are indis-pensable established methods of colon cancer screening. However,not every intervention detects precancerous lesions or small malig-nancies, permitting timely endoscopic or surgical removal. Obvi-ously improvements to endoscopic methodology or completely newmethods are required to reduce the number of interval carcinomasto near zero.

Recent findings that flat and dimpled adenomas and certainserrated polyps in the colon entail a higher risk of malignant degen-eration are important. Here there is some good news. Clear im-provements in the detection of changes in the epithelial surface ofthe gastrointestinal tract have resulted from enlarging the endo-

scopic image, using dyes, autofluorescence, high-definition endos-copy, and also by manipulating the wavelength of the applied lightby means of narrow-band imaging (NBI) and Fujinon intelligentcolor enhancement (FICE). More precise evaluation of the substratealso permits endoscopic classification of changes as premalignant ormalignant lesions; the Paris–Japan and Kudo classifications areconvincing examples of such a system. But this is not all. With theaid of confocal laser microscopy it is possible to obtain images of thedeeper layer of the intestinal mucosa beneath the epithelial surface.This modality can visualize high-grade dysplasia in ulcerative colitisthat might go undetected with white light microscopy. Have we notcome very close to many older endoscopists’ dream of practicable“endoscopic histology”?

The endoscopic submucosal dissection (ESD) developed by ourJapanese friends represents a great advance in both diagnosis andtherapy. In contrast to endoscopic mucosal resection (EMR), ESDallows better en bloc resection of the tumor-bearing area of the wall,more precise histopathological diagnostic studies, and a deeperresection. In the first edition of our book we had described endo-scopic mucosal resection as a revolutionary advance. Now thiselegant method risks being supplanted by endoscopic submucosaldissection. This will hold true especially if the modification sug-gested by the American Apollo group, namely first marking theaffected area of the wall laterally with electrocautery and liftingthe wall by inflating a balloon in the submucosa, does indeedincrease safety and reduce the time required for surgery.

New imaging modalities such as high-resolution–high-magnifi-cation endoscopy, autofluorescence, spectra modulation, etc., andnew therapeutic technology were applied in the colon. This noveltechnology was also applied in other fields such as esophagus,stomach, and bilio-pancreatic area. Particularly Barrett's esophaguswas favored to apply and evaluate all novel technology but progressin diagnostic and therapeutic possibilities was also made in thebilio-pancreatic field.

A true novelty in this second edition of the atlas is the in depthdescription of investigational possibilities for small intestinal dis-eases with capsule endoscopy and mono- and double balloon en-doscopy. The last endoscopic frontier has now been tackled, allow-ing investigation of the entire intestinal tract, whenever clinicallyindicated.

In parallel with the amazing endoscopic evolution was the fur-ther development of diagnostic and particularly therapeutic endo-sonography. Something which was unthinkable in the past is nowentering the arena of routine procedures in an optimally equippedand skilled endoscopic unit.

The key contributions of the gastroenterologal endoscopist todigestive oncology are hardly at risk of being usurped by otherdisciplines. The situation is different in the case of classic chemo-therapy or the application of biologicals by gastroenterologists inadvanced gastrointestinal tumors. This is common practice in cer-tain European countries. Indeed, the use of biologicals is hardly newto gastroenterologists used to treating patients with chronic inflam-matory bowel disease.

This book addresses all endoscopists throughout the world aswell as colleagues from related fields. It is especially intended forour fellows, for gastroenterologists in private practice and those

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aus: Classen, Gastroenterological Endoscopy (ISBN 9783131258526) © 2010 Georg Thieme Verlag KG

practicing in tertiary referral centers, who work closely with sur-geons, pathologists, radiologists, and oncologists, as well as for allthose who are involved in research and participate in clinical studieswherever possible. We are well aware of the great economic differ-ences between the various regions and countries of the world, andwe explicitly encourage our colleagues in the developing countries.Our express thanks go to those manufacturers of endoscopes andadd-on devices who help to establish gastroenterological and endo-scopic training centers for training physicians and assistants in thedeveloping countries.

This edition has seen a change in the group of editors. JacquesBergman, Alexander Meining, D Nageshwar Reddy, Michael Wal-lace, and Hisao Tajiri have been brought on board as associateeditors in an effort to involve younger endoscopists with solidscientific and clinical reputations, who have already acquired expe-rience and demonstrated sound critical judgment in both researchand practice. These colleagues have also played a crucial role indesigning the book and will be responsible for the coming editions.We felt it important that they already become familiar with theresponsibilities of editors. It is essential for a textbook to keepabreast of the latest developments. New aspects and changingemphasis make it important to enlist younger authors as well.This approach has paid off. However, the majority of our authors

had already contributed to the first edition. We know of few gastro-enterological book projects with such a broad international group ofcontributing authors. The editors would like to thank all the authorsfor their understanding for our urgent wishes and for their out-standing cooperation.

The high quality of text and image material the editors strived forwas nearly invariably achieved. We thank the enthusiastic donors(especially from Japan) for their excellent image material.

We present readers throughout the world with a book that doesjustice to the advances in medical science and to the developmentand importance of gastroenterological endoscopy. Gastroenterolo-gists throughout the world will receive the information they requirefor planning an endoscopy department, for their endoscopic work inboth private practice and the hospital, and for detecting and treatingeven rare pathology in the gastrointestinal tract and major digestiveglands.

Our special thanks go to the staff of Thieme Publishers, especiallyDr. Wachinger and Dr. Bergman. Ms. Rachel Swift not only didjustice to her name, but won the editors’ boundless admiration forher knowledge, patience, and kindness. Dr. Hauff was a generouspublisher who agreed to give the book an excellent layout.

The editors

Preface

VI


4 Evidence-Based EndoscopyJohn M. Inadomi and Ma Somsouk

Background

Evidence-based medicine provides a framework for using the med-ical literature to solve clinical problems and provide better patientcare [1]. While many practitioners are skeptical about the value ofthis approach, which they perceive as being “cookbook” and dis-missive of clinical judgment, the value of practicing evidence-basedmedicine is as much about understanding how little evidence isavailable to support our daily decision-making as it is about guidingpractice based on results of quality clinical studies. “EBM” stands forevidence-based medicine—but it is meant to complement experi-ence-based medical practice, not replace it.

This chapter will provide the foundation for understanding theprinciples of evidence-based medicine, using practical examplesfromendoscopy to illustrate the application of EBM.Wewill identifythe critical components necessary to validate studies of therapy,diagnosis, harm, and prognosis. Armed with these tools, it is hopedthat the reader will understand which aspects of his or her practiceare based on firm evidence, which are based on guidelines or stand-ards that may not be derived from solid evidence, and which aresimply dogma based on experience. As my mentor Dr. MarvinSleisenger is fond of saying, “It’s not what we don’t know that willkill us but rather what we think we know that is wrong.”

Each of the following sections will focus on a different type ofclinical problem, opening with a clinical scenario to frame thequestion, followed by the accepted components of a study thatwould provide valid evidence, and closing with recommendationsabout how to incorporate study results into clinical practice. Thebasis of these concepts has been presented previously by the Evi-dence-Based Medicine Working Group and published in a series ofarticles in JAMA entitled “Users’ Guides to the Medical Literature.”These comprehensive resources are listed as references, and inter-ested readers can peruse details of the concepts of evidence-basedmedicine through these publications [1–7].

The template for discussing evidence-based methods includesthree universal questions, each of which has subtopics, that ask:firstly, are the results of the study valid? Secondly, what are theresults? And thirdly, will the results help me in caring for mypatients? Since the second and third questions are irrelevant if thefirst question is not answered affirmatively, emphasis is placed ondetermining whether the study methods are valid. The whole es-sence of a valid study design boils down to a simple goal: reducebias. What is bias? In technical terms, it is “the consistent, repeateddivergence of the sample statistic from the population parameter inthe same direction.” In plain English, it is the presence of somethingthat causes the study to provide an answer that is not correct. Mostoften, it results from the presence of confounders, which are meas-ured or unmeasured factors that are associated with both the pre-dictor or exposure under scrutiny and the outcome. Instead of goingthrough the mathematical or statistical derivations of bias, we willexplore these ideas through various examples in this chapter.

Studies of Therapy

■ Clinical Scenario

You are consulted by your hospitalist to evaluate a patient withcoffee-ground emesis and melena. Upper endoscopy revealed alarge duodenal ulcer with a visible vessel that was not activelybleeding. Initial treatment was complicated by active bleeding,but you achieved hemostasis with epinephrine injection, thermo-coagulation, and continuous infusion of a proton-pump inhibitor.Unfortunately, rebleeding occurred within 24h. You feel that youhave given it your best shot and feel wary about repeating anendoscopy. You question whether or not repeated endoscopy iswarranted after initial endoscopy, or whether you should refer thepatient for surgery.

■ Are the Results Valid?

The issues that need to be addressed in order to determine whethera study of therapy is valid are shown in Table 4.1 and consist of: 1,randomization; 2, blinding; 3, concealed allocation; 4, completefollow-up; 5, intention-to-treat analysis; and 6, co-interventions[5].

Randomization refers to the process of randomly assigning pa-tients to one group versus another. If this were done by deliberateassignment, it could result in unequal distribution of patients, withconfounders in the study groups based on investigator bias. Forexample, assignment of patients with peptic ulcer hemorrhagecould be biased if the investigators preferentially assigned patientswithout stigmata of recent hemorrhage to a new endoscopic ther-apy while assigning patients with stigmata to medical therapy. Inthis case, the confounder would be stigmata of hemorrhage, whichcould drive the outcome of recurrent hemorrhage more heavilythan the intervention.While itwould be possible tomanually assignpatients in equal numbers to each armof a trial and thus reduce bias,the advantage of randomization is that it can adjust for unknown

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Table 4.1 Studies of therapy

Are the results of the study valid?1. Randomization2. Blinding3. Concealed allocation4. Complete follow-up5. Intention-to-treat analysis6. Co-interventions

What were the results?1. Magnitude of the treatment effect2. Precision of the treatment effect

Will the results help me in caring for my patients?1. Application of the study to my patients2. Clinically important outcomes3. Treatment benefits versus harms and costs

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confounders as easily as known confounders, while manual assign-ment can only adjust for the latter. A nice example of this occurredwith studies of ulcer hemorrhage, where prior to our knowledge ofHelicobacter pyloriwe could not have specified enrollment based onthis important etiologic factor; however, randomizationwould haveensured equal distribution of patients with and without H. pyloriinto competing arms of any trial.

Blinding. Study investigators may treat patients or assess themdifferently if they know that they are on a new medication versus astandard medication or placebo. Patients themselves may reportdifferent outcomes if they know whether they are on an activetherapy or placebo. For these reasons, it is essential to blind thepatients and investigators or study observers responsible for assess-ing outcomes.

Concealed allocation and baseline differences. Despite random-ization, it is possible that study groups may differ in importantprognostic factors at baseline. This tends to occur more commonlyin small trials, where there is an increased risk of imbalance be-tween study groups in the number of patients with different poten-tial confounders. More importantly, group differences may occur atthe time of enrollment prior to randomization, in the absence ofconcealed allocation. This term refers to the blinding of the personresponsible for enrolling patients to the sequence of group assign-ment. If an investigator is enrolling patients into a study comparinga new intervention versus standard therapy, theremay be consciousor subconscious efforts to enroll healthier patients if it is known thatthe strategy to which they would be randomized is the new inter-vention, while excluding other potentially “sicker” candidates fromenrollment on the basis of subjective exclusion criteria. Typically,the first table in a study of therapy will list baseline characteristicsand identify significant differences between study groups to ensurethat baseline differences are minimized. If significant differencesremain, it is still possible to adjust for the differences statistically,but the power to detect significant outcomes may be reduced.

Complete follow-up. If a substantial proportion of patients en-rolled in a trial are not followed to its conclusion, the possibility ofbiased ascertainment of end points may occur. Patients whose out-come is unknown could have dropped out because they were doingso well they did not feel the need to return; conversely, they mighthave been unable to attend for follow-up because they were too illor had in the meantime died. A general rule of thumb is that if thedropout rate is less than 10%, the conclusions are not likely tochange with complete ascertainment of end points from the lostpatients. If dropout is greater, a sensitivity analysis can be per-formed in which a “bad” outcome is assigned to all patients ran-domly assigned to the intervention or strategy being tested who donot have complete follow-up, while a “good” outcome is assigned toall patients randomly assigned to the comparator or placebo armwho do not have complete follow-up. If the conclusions of the studydo not change, the lack of complete follow-up is unlikely to interferewith the study’s conclusions; however, if the conclusions do change,an iterative analysis can be performed to find the threshold propor-tion of dropouts in each group who must have a “bad” or “good”outcome in order for the conclusions to change. In this way, thereader can be provided with a confidence interval depicting therange of potential outcomes.

Intention to treat. Patients should be analyzed by the interventionor strategy to which they were initially randomized, regardless ofwhether they were managed by that strategy. While this may ap-pear overly harsh, the reasons for this requirement should be appa-rent from the following example. The studies that compared endo-scopic treatment to surgical therapy for the management of bleed-ing esophageal varices examined endoscopic sclerotherapy andportocaval shunting [8]. Most patients randomly assigned to endo-scopic therapy received this within hours of enrollment; however,many patients randomly assigned to surgical therapy never re-

ceived the shunt, because they either exsanguinated before surgeryor became too unstable to undergo the procedure. For this reason,the patients who actually received shunt surgery were “healthier”than those who were randomized to endoscopic therapy, since thesickest patients in the surgical arm had died or could not undergosurgery. Thus, despite randomization, the patients who actuallyreceived the therapy towhich theywere randomizedwere differentwith regard to the overall morbidity and risk ofmortality. If the datafrom this study were subjected to a per-protocol analysis, the con-clusionswould bebiased to find better outcomes in the surgical arm.

Per-protocol analysis, in which patients are analyzed by theactual management received, may be considered the “best-casescenario” for that strategy. It may be useful to report a per-protocolanalysis, as it provides an estimate of what could be achieved, butdue to the bias illustrated above it should not be considered theprimary outcome.

Co-interventions. It is important to reduce differences inmanage-ment between study groups so that any difference in outcome canbe ascribed to the intervention under investigation, not differencesin other factors (termed “co-interventions”). Double-blinding as-sists in this process, but it is possible that certain interventions, suchas surgical procedures, do not allow complete blinding. Carefuladherence to study protocols to reduce co-interventions will there-fore be necessary.

If the study methods are deemed valid after each of the stepsmentioned above has been confirmed, then it is appropriate toassess the results and determine the potential impact on the clinicalcare of patients [2].

■ What Are the Results?

Magnitude of treatment effect. To assess the results of a study oftherapy, one needs to determine themagnitude and precision of thetreatment effect. In general, the results of a study of therapy reportthe proportion of patients who achieve the primary end point in theintervention group in comparison with the control or standardtherapy group. In this case, there will be a comparison of propor-tions between these groups and some determination of the statis-tical and clinical importance of the differences. The differences canbe described as the absolute risk reduction, which is simply thedifference between rates. Alternatively, one may report the relativerisk reduction, which is the percentage reduction in risk betweenstrategies [(baseline risk– intervention risk) / baseline risk]. The rel-ative risk reduction can be somewhat misleading, as it may appearto magnify the actual reduction in risk. For example, assume abaseline risk of pancreatitis after endoscopic retrograde cholangio-pancreatography (ERCP) of 2%. A new therapy that results in a 1%risk of post-ERCP pancreatitis nets an absolute risk reduction of 1%;however, the results can also be stated as a 50% relative risk reduc-tion [(2% – 1%) / 2%].

Precision of treatment effect.Onemust remember that a study canonly identify a “point estimate” of the treatment effect, since only asample of the entire population at risk for the outcome has beenassessed in a clinical trial. If the study were to be repeated multipletimes, the results might differ, and this variation in results reflectsthe precision. The confidence interval is used to describe the varia-tion in study results that could be expected with repeated studies.By convention, a 95% confidence interval is used to report the rangeof values within which the risk reduction is expected to fall 95% ofthe time if such a study is repeated over and over again. In general,the larger the sample size of the study, the narrower the range of theconfidence interval. Thus, when assessing the “power” of a study,which is the ability to detect a significant difference in treatmentoutcomes between competing strategies, the confidence interval isuseful to determine whether the study is large enough to provide a

4 Evidence-Based Endoscopy

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I


13 Wireless Video Capsule EndoscopyDavid Cave

Introduction

Video capsule endoscopy (VCE) became a clinical reality in 2001,with Food and Drug Administration (FDA) approval of the M2Acapsule (Given Imaging, Inc., Yoqneam, Israel) on the basis of a studycomparing push enteroscopy with the capsule in patients withobscure gastrointestinal bleeding [1]. For clinicians interested indisorders of the small intestine, the arrival of capsule endoscopywas timely. Conventional endoscopic technology was severely lim-ited; push enteroscopy allowed examination of up to 100 cm distalto the ligament of Treitz; ileoscopy allowed examination of thedistal ileum; intraoperative enteroscopy was and still is the “goldstandard” for small-bowel examination, but is far fromperfect and isinvasive [2]. The indications and limitations of VCE are now quitewell understood around the world. In 2007, the FDA approved theEndoCapsule (Olympus America, Inc., Center Valley, Pennsylvania,USA) [3]. Capsules developed in China and the MiRo capsule fromKorea have also been demonstrated [4], but are not yet clinicallyavailable inWestern countries.With the concurrent development ofother novel enteroscopic devices—double-balloon enteroscopes [5](Fujinon Inc.,Wayne, New Jersey, USA), single-balloon enteroscopes[6] (Olympus America), and spiral overtubes [7] (Endo-Ease Discov-ery SB; Spirus Medical, Inc., Stoughton, Massachusetts, USA) fordiagnosis and/or therapy—interest in the small intestine has under-gone a renaissance. This chapter reviews the technology of VCE, theindications for the procedure, and its complications and provides aperspective on it in relation to other enteroscopic techniques.

Technology

The PillCam SB, EndoCapsule, and MiRo capsule are similar in size,shape, weight, and imaging capabilities. The MiRo capsule useselectrical field propagation to transmit images (Table 13.1). Boththe PillCam and EndoCapsule are single-ended imaging devices thatare able to take two images per second for a total of about 55000images over the life of the silver oxide battery. The images createdby the VCE are transmitted to a portable hard drive worn on the

patient’s belt, via eight sensor arrays adherent to the abdominalskin. After an 8-h period, the recorder is transferred from the patientto a workstation, and the images are processed into a video. Theimage quality of the two FDA-approved devices is excellent, butsubjectively different. The slightly larger field of view of the PillCamSB has yet to be shown to be clinically useful. The images aremagnified 1 : 8, allowing resolution of individual villi (Fig. 13.1).Since there is clear succus entericus in the lumen for much of thelength of the small bowel, conditions are met for immersion endo-scopy. The villi are often seen to be “floating,” analogous to seaweedon a submerged rock. There is considerable variation in the normalcharacteristics of the villi. In at least 75% of studies, the entire lengthof the intestine is visualized. In the remaining 25%, transit of thecapsule is incomplete after 8h, but fewer than 1% of capsules areretained for a long period. Transient retention usually occurs at theileocecal valve.

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Table 13.1 Comparison of video capsules

EndoCapsule PillCam SB MiRo

Length 26 26 24

Diameter 11 11 10.8

Weight 3.8 3.45 3.3

Frame rate 2 fps 2 fps 2fps

Image sensor CCD CMOS CMOS

Field of view 145 156 150

Illumination 6 white LEDs 6 white LEDs 6 white LEDs

Antennas 8 body leads 8 body leads Electrical fieldpropagation

Real-time viewing VE-1 viewer Yes No

Documentation DVD CD ?

CCD, charge-coupled device; CD, compact disk; CMOS, complementary metal oxide semi-conductor; DVD, digital video disk; fps, frames per second; LED, light-emitting diode.

a b

Fig. 13.1a Normal villi.b Edematous villi.

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Relatively recently, the PillCam ESO (Given Imaging, Inc., Yoq-neam, Israel) has been approved by the FDA [8,9] for screeningpatients for Barrett’s esophagus and detecting esophageal varices.The device is the same size as the other capsules described above,but is double-ended and is used to take seven frames per second ateach end. It has now been upgraded to take nine frames per second.Optimal imaging is obtained by placing the patient in the left lateralposition. After rinsing out the mouth, the patient swallows thecapsule with 15mL of water, followed every 30 s by 15mL of wateringested from a large-tipped syringe [10]. This position eliminatesgravity andminimizes bubbles, and esophageal motility is such thatthat several minutes of imaging of the esophageal mucosa arepossible. The battery life is only 30min, but excellent views of thegastric mucosa and proximal small bowel can also be obtained.Images front the front and back are reviewed in parallel, and asthe length of the capsule is known, it becomes possible to measurethe length of abnormalities. However, at current pricing levels thedevice is not cost-effective and it has not caught on in the clinicalarena. One study has reported sensitivity, specificity, and positiveand negative predictive values for Barrett’s esophagus in compar-ison with esophagogastroduodenoscopy (EGD) as 97%, 100%, 100%,and 98%, respectively. However, a second study including 96 pa-tients only showed a sensitivity of 67% and a specificity of 84%[9,11].This capsule has also been approved for detection of varices. In

this context, it has potential value in very ill patients with decom-pensated liver disease who are reluctant to undergo endoscopy, tocheck whether they have esophageal varices [12].A colon capsule has been developed and is undergoing trials in

Europe [13]. This is larger, 30mm long, and is again double-ended.Unfortunately, the withdrawal of the prokinetic agent tegaserod(Novartis), has put the trials in the USA on hold pending the avail-ability of a new small-bowel prokinetic agent.The Agile patency capsule (Given Imaging, Inc., Yoqneam, Israel)

has undergone development to the point that it is now a useful tool.

It consists of a plastic film encasing a lactose–bariummixture and asmall transponder [14,15]. At each end of it there is a dissolvableplug, which starts to disintegrate after about 36h of contact withdigestive juice. The concept is that this type of device can be usefulwhen there is a suspected stricture that cannot be demonstrated byother means. The capsule is swallowed, and 30h later the abdomenis scanned with a device to detect the transponder, or using a plainabdominal film. If the capsule is not detected or is in the colon, thereis sufficient lumen for the video capsule to pass. The video capsulemay still not complete its passage through the small bowel beforethe battery runs out. This device is particularly useful in patientsknown to have Crohn’s disease, inwhom there is a capsule retentionrisk of up to 13%. In patients without Crohn’s disease or those inwhom it is only suspected, the retention rate is 1% or less. Thedevice was originally designed with a single plug, which dissolvederratically and was associated with a few cases of obstruction.Preparation of the patient remains controversial. Many small

studies have beenperformed, but all have the fundamental problemof not being able to objectively measure what constitutes goodpreparation. Furthermore, it is not clear whether there is an in-creased diagnostic yield if the preparation is better; preparationmay wash away small amounts of blood and thereby reduce thediagnostic value of the procedure [16].The use of simethicone as a bubble-reducing agent is also con-

troversial, as are prokinetics. There is some evidence that placingthe bed-ridden patient in the right lateral decubitus position re-duces gastric transit time, but this has not been confirmed in am-bulatory patients. Clinically, the most commonly used preparationsare nothing by mouth for 12h before the procedure or 2 L of apolyethylene glycol solution the night before the procedure. Thepresent author does not routinely use preparation, except in pa-tients in whom there is evidence of reduced motility.The PillCam SB is approved for use in children down to the age of

10, but anecdotally it has been used in children as young as 2 years ofage without mishap. Children who are unable to swallow the cap-sule need to have the capsule placed endoscopically under generalanesthesia (Fig. 13.2).

Limitations

The technology is not perfect. In the majority of patients, 75% of thefull length of the small bowel may be visualized, but the mucosalsurface is incompletely seen. The duodenal sweep is usually poorlyimaged, and the ampulla of Vater is seen about 5% of the time(Fig. 13.3). This is for two reasons—firstly, the lumen is not dis-tended, so that it is not possible to see deeply between the plicae;and secondly, the capsule has been shown to tumble. This wasdemonstrated in the FDA trial for the Olympus capsule, in which aPillCam SB and EndoCapsule were swallowed by the same patient40min apart [3]. In some of the patients, the second capsule caughtup with the first and imaged the leading capsule in a variety ofpostures, including tumbling and with the lens hood buried in themucosa. This possibility was alluded to in an early paper in whichbeads were attached in a dog’s intestinal mucosa. Subsequent studywith VCE did not detect all the beads [17].Interpretation is a major issue. The American Society for Gastro-

intestinal Endoscopy has recommended credentialing guidelines,which should be regarded asminimalist. There is the problem of thelearning curve, particularly learning the range of normal variation.There is considerable confusion in interpreting abnormalities asso-ciated with intraluminal bubbles and what constitutes a submu-cosal mass. Thirdly, there is disagreement, even between experts, asto when a red spot becomes an angiectasia; the level of disagree-ment may be as high as 25% [3]. The capsule is also not the perfecttool for detecting small-bowel polyps or tumors, but is still better

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13 Wireless Video Capsule Endoscopy

Fig. 13.2 Capsuleplacement device.

Fig. 13.3 Ampulla ofVater.

IV


23 Laparoscopic, Natural Orifice, and Laparoscopy-Assisted Surgery: New Paradigms in MinimallyInvasive TherapyRobert H. Hawes, Stefan von Delius, D. Nageshwar Reddy, and Hubertus Feußner

Introduction

Robert H. Hawes

The development of laparoscopic cholecystectomy has had a sig-nificant influence on the practice of surgery, as well as on surgeons’mindset, making them more aware of new ways of operating lessinvasively. Endoscopists—both physicians and surgeons—have al-ways taken a less invasive approach, as therapeutic endoscopyprimarily developed as an alternative to more invasive surgicalprocedures. As a result, the introduction of natural orifice surgeryby Kalloo et al. in 2000 [1,2] created excitement in both disciplines.For surgeons, natural orifice transluminal endoscopic surgery(NOTES) offers new opportunities for less invasive procedures,while for endoscopists it has the potential to allow transluminaltherapy and also promises to accelerate the development of devicesfacilitating a whole range of new endoluminal procedures.

Since the first description of NOTES, there has been considerablespeculation—and indeed concern—about how it will develop. Thechaos in the early days of laparoscopic cholecystectomy is still vividin our memories. Although natural orifice surgery is considered tohave great potential, guidance anddirection in its implementation isneeded in order to ensure that patients are protected and that itdevelops in a responsible way. Toward this end, the Society ofAmerican Gastrointestinal Endoscopic Surgeons (SAGES) and theAmerican Society for Gastrointestinal Endoscopy (ASGE) estab-lished a joint committee to support basic research, promote educa-tion, and create a registry for humanNOTES procedures. In addition,an organization called the Natural Orifice Surgery Consortium forAssessment and Research (NOSCAR) was formed, with its member-ship drawn from teams of laparoscopy and flexible-endoscopy ex-perts from around the world. The joint ASGE/SAGES committee, incooperation with the NOSCAR group, was charged with settingstandards for conduct in the field of NOTES—such as insisting thatall human NOTES procedures be conducted under the guidance andoversight of institutional review boards—and establishing guide-lines for practice when appropriate. Groups with organizationalstructures and goals similar to those of NOSCAR have also emergedin Europe, Asia, and South America. This paradigm of cooperationbetween societies to provide leadership in the development of newtechniques will surely be one of the most powerful legacies ofnatural orifice surgery.

It is very important to viewnatural orifice surgery as amovementtoward less invasive therapies, rather than as a series of new surgicalprocedures. It has already had a significant influence and will un-doubtedly continue to have an impact on therapeutic endoscopy formany years to come:● It has brought endoscopists and laparoscopic surgeons togeth-

er—each with their own unique perspectives. Together, they willaccelerate innovation in endoscopy.

● It has brought representatives of medical-device manufacturerstogether—including companies that had previously concentrated

on innovative devices only in their own markets. Now, compa-nies specializing in laparoscopic devices, flexible endoscopes,and accessories for flexible endoscopes are exploring opportu-nities outside their own markets and are leveraging their know-ledge and experience in order to solve the unique problems facedin natural orifice surgery.

● The improved relationship between surgeons and endoscopists,combined with innovative technologies from industry, willgreatly accelerate the development of intraluminal therapiesfor obesity management, reflux disease, full-thickness resectionof intramural tumors, and endoscopic submucosal dissection.

These direct effects of theNOTESmovementwill create a legacy thatgoeswell beyond the new generation ofminimally invasive surgicalprocedures. To appreciate the real impact of NOTES, these develop-ments should be seen as awhole,without focusing exclusively on anannouncement of the NOTES equivalent of laparoscopic cholecys-tectomy, for example. There is no question that procedures willeventually be performed using natural orifices as access points.Medical historianswill look back and document the broad influencethat the introduction of natural orifice surgery had on therapeuticendoscopy.

This trend toward procedures with access via natural orifices hastremendous implications for future practice and maywell stimulatethe development of a “comprehensive digestivist”—an individualtrained in minimally invasive gastrointestinal therapy, regardless ofwhether it involves a laparoscope or a flexible endoscope, and onewho is equally comfortable with intraluminal, transluminal, andtransabdominal access. While the future may see the developmentof combinedmedical/surgical specialists in gastrointestinal therapy,this will take time. At present, speculation is continuing onwhetheritwill be surgeons or gastroenterologistswhowill take the leadwithNOTES. Initially, teams combining endoscopists and surgeons werethe driving force in basic NOTES research. Even now, most researchis being conducted with close cooperation between gastroenterol-ogy and surgery. However, the first NOTES procedures in humanshave been carried out with laparoscopic assistance. Access has beenprimarily transvaginal, with dissection and organ removal via anatural orifice but with traction, insufflation, clipping (of the cysticduct and artery)—and in the case of transgastric access, closure—ac-complished with laparoscopic access. Surgeons have clearly takenthe lead in these developments and in the end it is likely that naturalorifice surgery will be performed, with few exceptions, by surgeonswho either already possess or have acquired skills in flexible endo-scopy. This development has several important implications for thepractice of natural orifice surgery.

Firstly, surgeons are developing a greater appreciation of ther-apeutic endoscopy. As they acquire the skills in flexible endoscopyneeded to perform natural orifice surgery, they will probably alsotake advantage of the opportunities developing for intraluminaltherapies such as antireflux procedures, obesity therapies, full-thickness resection, and mucosal resection.

245

23


■ Transgastric Tubal Occlusion

A similar transgastric approach can be used for tubal occlusion(Fig. 23.6). A transvaginal uterine elevator is used to assist theprocedure [38]. The procedure is done using a single-channel9-mm gastroscope. Resolution clips are doubly applied over thefallopian tubes, which are divided in between using a needle-knife.Alternatively, an Endoloop can be used to occlude the tubes. Meth-ylene blue is injected at the end of the procedure to confirm tubalocclusion on the table.

The hybrid technique. Hybrid procedures involve performingNOTES with laparoscopic assistance [56]. While some groups havelimited the assisting laparoscopic port to an independent visual-ization port [57] in the form of a needlescope to monitor the pneu-moperitoneum, others have used it as a retraction port [58] or evenas a working port [59]. The hybrid technique provides better visualinformation independently of the endoscope that is being used tocarry out the procedure. During dissectionwith the working instru-ments, the endoscopic image is constantly inmotion and even shiftsaway from the operative field. The laparoscopic image, however, isstable and the operated field can always be kept at the center of it. Inparticular, this ensures the safety of the initial puncture and incisionand greatly facilitates advanced NOTES procedures, as it provides awide field of vision and sufficient illumination. The hybrid techni-que is also a useful bridge to performing “pure” NOTES procedures.

Natural orifice (transvaginal or transanal) extraction of a lapa-roscopically dissected specimen has also been described as a mod-ification of hybrid NOTES [60]. The dual-lumen or rendezvous tech-nique [61,62] is another variant of hybrid NOTES. The transgastricand transvaginal routes are used simultaneously here to provide thesame advantages of the hybrid techniquewhile avoiding an externalscar.

■ Transvaginal Cholecystectomy

The transgastric route for cholecystectomy requires the scope to bepositioned in a retroflexed position. The resulting difficulties inworking with a retroflexed scope can be avoided by using a moredirect transvaginal route. The other advantage of this route is that itis easy to close the colpotomy using manual suturing under vision[63]. The richness of the vaginal flora in comparisonwith the gastricflora is a cause for concern. From the gynecological point of view,other potential disadvantages of this route include the formation ofadhesions, spread of preexisting endometriosis, infertility, and dys-pareunia [64].

The patient receives preoperative antibiotics, which are contin-ued for 48h postoperatively. The vagina is disinfected with povido-ne–iodine. The patient is placed in a lithotomy position, with thesurgeon positioned between her legs. The cholecystectomy is usu-ally assisted with a needlescope placed transabdominally to guidethe initial puncture and to monitor the pneumoperitoneum. Somesurgeons have also used the laparoscopic port for organ retractionand clip placement [65]. A triangular area between the uterosacralligaments, which is avascular and without innervation, is chosen forport placement [38] (Fig. 23.7). An incision is sited on the posteriorvaginal cul-de-sac [66]. A double-channel endoscope is introducedinto the peritoneum after adequate pneumoperitoneum has beenachieved (Fig. 23.8). The dissection is commenced in the Calot tri-angle, separating the peritoneum off the cystic duct. The combina-tion of grasping and cutting with the endoscopic instruments andthe deflection movements of the tip of the endoscope are used toaccomplish the dissection (Fig. 23.9). Once sufficiently skeletonized,the cystic duct and artery are clipped and divided with endoscopicscissors. The gallbladder is then dissected from the liver and placedin a retrieval bag. The gallbladder bed is checked for hemostasis. Thespecimen is then removed transvaginally. The colpotomy is closedwith absorbable sutures transvaginally.

A recent systematic review shows that the NOTES operationperformed most often to date in humans is transvaginal cholecys-

250

23 Laparoscopic, Natural Orifice, and Laparoscopy-Assisted Surgery: New Paradigms in Minimally Invasive Therapy

Fig. 23.5 Transgastric appendectomy.a, b Division of the mesoappendix with electro-cautery.c Division of the appendix with loop cautery afterligation of the base with an Endoloop.d Extraction of the divided appendix.

IV


43 Gastric DiseasesKristien M.A.J. Tytgat and Guido N.J. Tytgat

Normal Stomach—Anatomical Variants—Mucosal Prolapse and Tearing

■ Normal Stomach

Normal stomachs have a variety of shapes. Some are long andvertical, others are transverse. At endoscopy, the stomach is gentlyinflatedwith air so that the entiremucosal surface can be inspected.Observations are made of the color of the mucosa, the degree ofluster, and whether blood vessels can be seen in a not overlydistended stomach. The rugae or folds are inspected for caliber,regularity, and pliability, and whether they flatten and disappearas the stomach is inflated. The entire gastric surface is inspected forlesions, including erosions, ulcers, nodules, polyps, tumors, tears,etc.

The stomach has three compartments: the antrum, gastric body(corpus), and fundus. The fundus is the dome-shaped area immedi-

ately above the gastric body and abutting the diaphragm. The foldsor rugae begin in the upper part of the stomach, and run distallytoward the antrum (Fig. 43.1 a). Folds or rugae are normally soft andpliable. Usually, they will almost completely flatten with distensionof the stomach. Four vertical fairly straight parallel folds run alongthe lesser curve toward the angle.

The antrum is usually smooth and free of folds. Gastric peristalsisbegins in the mid-gastric body, and progresses down to the antrum(Fig. 43.1b). The pylorus is usually open. When the contractionwave reaches it, the pylorus closes. This is probably important formixing and grinding of food, and to allow only liquid and smallparticles to pass into the duodenum. Peristaltic contractions nor-mally occur at a frequency of three perminute. It is useful towatch acontraction wave move from the gastric body to the antrum, todetermine whether there is a lack of symmetry or whether thereis an area that is less pliable. The pylorus opening is normally roundor oval (Fig. 43.1 c). Occasionally, a fold traverses the opening. Pas-sage of the instrument into the bulb usually occurs after gentle

511

a b

dc

Fig. 43.1a The normal fold pattern in the gastric body.b A circular concentric peristaltic wave on its wayto the pylorus.c The normal antrum, with a normal pyloricopening.d Retroflexed view of the cardia and upper part ofthe stomach.

43


pressure is exerted with the well-centered tip of an end-viewingendoscope into the pyloric channel. This maneuver may occasion-ally have to be repeated several times, because of displacement ofthe flexible tip as a consequence of antral motor activity.

When the endoscope is retroflexed, detailed observation of thelesser curvature, cardia, and fundus is possible. The retroflexedendoscope can be pulled up close to the cardia and upper fundus(Fig. 43.1d).

Visualization of the antrum and pylorus is occasionally not im-mediately apparent after introduction of the endoscope, especiallywhen there is acute angulation of the antrum and gastric body.Problems with orientation also occur when there is cascade forma-tion, inwhich the upper part of the stomach appears to be separatedfrom the distal part by a tissue bridge. With some maneuvering ofthe endoscope, it is usually possible to advance the instrument alongthe lesser curve into the distal stomach and antrum.

There are several organs adjacent to the stomach that can causeextrinsic compression on the gastric lumen. Impression by thespleen is usually seen in the posterior greater curvature area.

Normally, the gastric lining has a uniform salmon color. Withcareful inspection, one can observe the areae gastricae, and withhigh magnification the pit pattern. The pit pattern is different in theantrum (with a sulcus or grooved pit pattern) in comparison withthe gastric body (with a foveolar or round pit pattern) (Fig. 43.2).The areae gastricae are irregular or absent in patients with atrophicgastritis or with intestinal metaplasia, and enlarged in patients withacid hypersecretion. Blood vessels are normally not seen in ahealthystomach.

■ Hiatal Hernia

The normal cardia fits snugly around the endoscopewhen viewed inretroflection. When there is a hiatal hernia, this snug apposition islost, and a pouch or cupolamay be seen entering the thorax throughthe hiatal ring (Figs. 43.3–43.5). A commonly used definition ofhiatal hernia is based on dislocation of the esophagogastric junctionabove the pinchcock of the diaphragmduring quiet breathing and inthe absence of retching or vomiting. Three landmarks are helpful inindentifying the esophagogastric junction: the proximal extent ofthe gastric folds, the distal extent of the esophageal palisade vessels,and the pinch of the lower esophageal sphincter. A ring-like nar-rowing, causing dysphagiawhen the diameter is less than 13mm, atthe level of the squamocolumnar mucosal junction is called aSchatzki ring (Fig. 43.6). A hiatal hernia is often combined withevidence of reflux esophagitis or esophageal columnar metaplasia.Mild inflammatory changes may also be seen around the proximalextent of the gastric folds in the hiatal sac. In rare circumstances,there is polypoid thickening of this fold—known as the “sentinelpolyp” (Fig. 43.7). Riding ulcers (Cameron ulcers) may develop as aconsequence of the constant to-and-fro movement of the gastricmucosa across the pinchcock of the diaphragm, causing mechanical

43 Gastric Diseases

512

a b

Fig. 43.2a The sulcular or grooved pit pattern.b The foveolar or round pit pattern, with a honey-comb-like subepithelial capillary network.

a

b c

d e

Fig. 43.3 The various forms of hiatal hernia.a Normal anatomy.b Axial sliding hiatal hernia.c Paraesophageal hiatal hernia.d Combined hiatal hernia.e Upside-down stomach.

VI


47 Colorectal DisordersWitold Bartnik, Jacek Pachlewski, and Jaroslaw Regula

Colorectal Polyps

Gastrointestinal tract polyps are typically limited protrusions thatform on the mucosal lining. The majority of colorectal polyps aresporadic and solitary. However, some are hereditary—particularlymultiple polyps—and give rise to polyposis syndromes. The clinicaldescription of polyps and their treatment includes several elements,including the shape (pedunculated, sessile, or flat), size (in centi-meters), location (the region of the colon or the distance from theanus on withdrawal of a colonoscope), the technique of polyp re-moval, and its endoscopic completeness. For a more detailed shapedescription, the Paris–Japanese classification, including depressedlesions, can be used (Table 47.1) [1].Three main groups of polyps can be distinguished histopatho-

logically: neoplastic, nonneoplastic, and submucosal (Table 47.2).Single, nonneoplastic polyps do not have malignant potential. Hy-perplastic polyps occur most frequently. Diminutive hyperplasticpolyps (< 5mm) located in the rectum have no clinical significance;however, it is important to distinguish them from adenomas byhistopathology. In contrast, large hyperplastic polyps may havemalignant potential. A hyperplastic polyposis syndrome is sus-pected when hyperplastic polyps are numerous (n >20), large(> 1 cm), and localized in the right colon.Among intestinal polyps, adenomas are themost important from

the clinical point of view [2]. Adenomas represent 70% of all polypsremoved during colonoscopy. Four types of adenoma can be distin-guished histopathologically: tubular, tubulovillous, villous, and“serrated” (Table 47.2). A common feature among adenomas isepithelial cell dysplasia, which involves cytological and architec-tural changes that unequivocally indicate a neoplastic abnormality.Dysplasia is divided into low-grade and high-grade types. Cells withhigh-grade dysplasiamaypenetrate through themuscularismucosainto the submucosal layer, resulting in invasive carcinoma.Colorectal adenomas can be diagnosed at any age, but there is a

clear increase in the incidence among adults over 30, and theincidence increases to about one-third in those over the age of 50.Colorectal adenomas are significant, as they are regarded as pre-cancerous lesions in the large bowel. The majority of adenomas areless than 1 cm in diameter, with low malignant potential. The po-tential is significantly increased in advanced adenomas that are1 cm or larger in diameter, contain a villous element (at least20%), or show high-grade dysplasia. It is estimated that develop-ment into a medium-sized adenoma takes roughly 5 years, whiledevelopment to invasive cancer takes about 10 years. In an asymp-tomatic population of adults over 50 years old, the incidence ofadvanced adenoma is about 5–10%, while that of invasive canceris about 1%. Advanced adenoma plus cancer is known as advancedneoplasia.The most frequent symptom of polyps is rectal bleeding. Less

frequently reported symptoms include mild anemia, tenesmus, orthe presence of mucus in the stool. The majority of polyps arecompletely asymptomatic, especially when small (< 1 cm in diame-ter). Polyps can be diagnosed with endoscopy or radiography. Thebarium enema has limited diagnostic value, particularly when per-formed without using the double-contrast method. Even in referralcenters, the sensitivity is not more than 60–70% for lesions 1 cm or

larger. Better results can be obtained with computed-tomographiccolonography; spiral computed tomography (CT) allows detectionof 90% of polyps 1 cm or larger, but it is not widely used for polypdiagnosis. Endoscopy is most commonly used to diagnose adenom-atous polyps and makes it possible to carry out treatment withendoscopic polypectomy simultaneously. Approximately two-thirds of adenomas lie within reach of flexible sigmoidoscopy,which is also used for screening purposes, especially in the UnitedKingdom. Small polyps (< 7mm) that are detected during flexiblesigmoidoscopy screening are biopsied to examine the histology.According to current opinion, when only hyperplastic polyps with-out adenomas are detected, the diagnostic process is completed; therisk of advanced proximal adenoma is estimated to be only 1–3%.However, when an adenoma is detected in the rectum or sigmoidcolon, independent of its diameter, the risk of advanced proximaladenoma increases to 5–7%, and a total colonoscopy is indicated.The sensitivity of total colonoscopy is over 90% for detecting polyps≥7mm. Characterization of the polyp type (neoplastic, nonneoplas-tic, type of adenoma, etc.) is based on the histopathologist’s assess-ment and currently cannot be predicted macroscopically with suf-ficient probability, even with modern visualization techniques.Detection of a colorectal polyp as a result of diagnostic work-up

or incidental discovery nearly always requires its removal. Pedun-

596

Table 47.1 The Paris–Japanese classification of the morphology of polypoidlesions [1]

Polyp type Description

ProtrudingIp PedunculatedIsp SemipedunculatedIs SessileSuperficialIIa Flat, elevationIIa + IIc Flat, elevation + depressionIIb Flat; no elevation or depressionDepressedIIc Mucosal depressionIIc + IIa Depression + elevated edges

Table 47.2 Classification of colorectal polyps

Mucosal polyps Submucosal polyps

Neoplastic Nonneoplastic

Adenomas: Hyperplastic Lymphoid collectionTubular Inflammatory Pneumatosis cystoides intestinalisTubulovillous Hamartomas: Colitis cystica profundaVillous Juvenile Lipoma“Serrated” Peutz–Jeghers Neuroendocrine (carcinoid)

HemangiomaLeiomyoma

VII


culated and semipedunculated polyps larger than 7mm should beremoved with a diathermic snare. Smaller polyps can be removedwith biopsy forceps or cold snaring, which is performed withoutactivating the diathermic current. Other techniques are also avail-able, including piecemeal polypectomy, endoscopic mucosal resec-tion (EMR), or endoscopic submucosal dissection (ESD). Only aminority of polyps (very large polyps with visible signs of malig-nancy)may require a laparotomy. Typical shapes and sizes of colonicpolyps, including pedunculated, semipedunculated, and flat polyps,as well as the value of image enhancement using the narrow-bandimaging technique (NBI), are illustrated in Figs. 47.1–47.5.

Colorectal Polyps

597

Fig. 47.1 The longstalk of a pedunculatedadenoma.

Fig. 47.2 A pedunculated adenoma undergoing endoscopic polypectomy.a The long stalk of the adenoma.

b Placing the snare.c Closing the snare while applying diathermy current.

a, b c

a b

c d

Fig. 47.3 Various flat adenomas.a A flat adenoma in the ascending colon, close tothe ileocecal valve.b A flat rectal adenoma.c A flat adenoma with an elevated portion.d A flat adenoma—underwater view.

47


Index

A

abdominal compression 142abdominal pain see painablation 339–340radiofrequency, gastroesophageal reflux disease357–358

see also argon plasma coagulation (APC); lasertherapy; photodynamic therapy (PDT)

abscessesin diverticular disease 609pelvic, drainage 479

acalculous cholecystitis 756–757achalasiapediatric patients 774–775, 776pneumatic dilation 326, 774–775

acid-suppression therapyBarrett’s esophagus 495gastroesophageal reflux disease 357,489–490

see also proton-pump inhibitors (PPIs)acquired immune deficiency syndrome (AIDS)753–761abdominal pain 755acalculous cholecystitis 756–757cholangiopathy 756, 757Cryptosporidium infection 749–750diarrhea 757–760diagnostic yield 758–759pathogens 757–758, 759pathophysiology 757, 758

dysphagia/odynophagia 753–755epidemiology 753gastric diseases 520–521, 755–756gastrointestinal bleeding 760pancreatitis 756peritoneal disease 735safety precautions for endoscopists 761see also human immunodeficiency virus (HIV)

Actinomyces infection, gastric 521, 522acute abdomen 737acute colonic pseudo-obstruction (ACPO) 426–427clinical features 426management 426–427

acute diarrhea see diarrheaacute gallstone pancreatitis (AGP) 385, 386,702–704pediatric patients 796

adenocarcinomasampullary 283, 573–574colorectal 604, 631see also colorectal cancer

esophageal 332, 503see also esophageal cancer

small bowel 555, 557–559, 603, 649duodenal 558–559, 603

adenomasampullary 290–291, 292, 573–574colonic 299, 596–602hereditary syndromes 602–604see also specific syndromes

see also colorectal polypsfamilial adenomatous polyposis 535,602–603

gastric 535–536, 537hepatic 730minor papilla 575small bowel 557–558villous 535see also polyps

adenomatous polyposis coli (APC) gene mutation602, 603see also familial adenomatous polyposis (FAP)

adhesions, postoperative 728, 736–737adjustable silicone gastric band (ASGB)band erosion 191–192see also laparoscopic adjustable silicone gastricbanding (LASGB)

adnexitis 734advanced imaging techniques 21–34aims of 21see also specific techniques

adverse events see complicationsAeromonas 743agenesis, pancreatic 701, 702Agile patency capsule 128air insufflation 138airway evaluation 59–60airway management 63, 64Alagille syndrome 794–795alanine aminotransferase (ALT) 702alcohol disinfection 86alcohol-induced conditionscancer 731cirrhosis 727, 729, 732fatty liver 724, 725gastritis 525hepatitis 726, 727pancreatitis 704, 709, 715

allergic colitis 786–787, 788allergic esophagitis 497, 772, 773allergycontrast 671food 497

alpha loop 144–145amebiasis 629, 748–749American dilators 324American Society of Anesthesiology (ASA) score 16,17, 59, 60

5-aminolevulinic acid (ALA) 8, 284, 285, 286, 350porfimer sodium vs. 350

ampulla of Vater 128, 571anatomic variations 571–572inflammation 572–573periampullary diverticula 157, 571, 673periampullary fistula 574tumors 573–574adenocarcinomas 283, 573–574adenomas 290–291, 292, 573

see also papilla of Vaterampullectomy 378, 574see also endoscopic papillotomy (EPT)

„Amsterdam“ stent 403, 404, 407amyloidosissmall bowel 567stomach 530

anal canalanatomy 142cancer 665–666colonoscope insertion 142fissures 648, 653, 663hemorrhoids see hemorrhoidsrectal prolapse 664–665warts 665see also rectum

anal intraepithelial neoplasia (AIN) 666–667anemiaceliac disease and 567hemolytic 791

lower intestinal bleeding and 641, 646, 650, 661small bowel tumors and 555, 556

anemic halos 566anesthesiageneral see general anesthesiatopical 61see also sedation

aneuploidy 681aneurysm, aortic 591angiectasia/angiodysplasiacolonic 565, 645–646, 652argon plasma coagulation 293–294, 652

gastric 531pharmacotherapy 651small-intestinal see small bowel

angioedema, hereditary, stomach 529angiographycomputed-tomographic 645visceral 645see also percutaneous transhepatic cholangiog-raphy (PTC)

animals, live 96, 98Anisakis worms 521, 522Ann Arbor classification system 547annular pancreas 700–701anorectal diseases 659–667bleeding in 648treatment 653

see also anal canal; rectum; specific diseasesantibiotic prophylaxis 58–59acute variceal bleeding 581endoscopic papillotomy 372endoscopic retrograde cholangiopancreatogra-phy 670–671, 687

pediatric patients 769antibiotic therapy, diarrhea 744anticoagulation therapy 70–71colonoscopic polypectomy and 305

antiplatelet therapy 71colonoscopic polypectomy and 305

antireflux surgery, Barrett’s esophagus 495antispasmodicscolonoscopy 136endoscopic retrograde cholangiopancreatogra-phy (ERCP) 153

antrum 110, 111, 511see also stomach

anus see anal canalaortic aneurysm 591aortic stenosis 566aortoenteric fistulas 591aphthous ulcerationAIDS patients 754Behçet disease 614Crohn’s disease 619, 622, 625, 635, 771

appendectomytransgastric 249–250

appendicitis 737argon plasma coagulation (APC) 274, 287–296, 651clinical applications/outcomes 289–296ampullary adenomas 290–291, 292Barrett’s esophagus 289–290colorectal cancer 293, 294, 340colorectal polyps 291, 293, 303esophageal cancer 290gastric cancer 290hemostasis 274, 293–295small bowel adenomas 290–291stent manipulation 295–296, 410, 411

806


tissue ablation 289–293Zenker diverticulum 295

clinical techniques 288–289probes 287, 288technology 287tissue effects 287–288

arteria lusoria 501arteriovenous malformation (AVM) 564–565Ascaris lumbricoides 687ascending colonanatomy 147colonoscope insertion 147–148see also colon

ascitescirrhosis 728, 729fluid sampling 207peritoneal disease and 425–426, 735–736of unknown cause 736

Aspergillus 628aspiration, recurrent 770aspirincolonoscopic polypectomy and 305colorectal cancer prevention 606gastric ulcers and 533, 534–535gastritis and 524

atrophic gastritis 515, 517, 518–519autofluorescence imaging (AFI) 24, 332Barrett’s esophagus 494

autoimmune enteritis 783autoimmune gastritis 215, 519, 523–524autoimmune pancreatitis 572–573, 715

B

Bacillus cereus 742bacterial infections 745–748colonic 607–608, 628, 745–748rectal 659–660see also infections; specific bacteria

bag-mask ventilation 63, 64balloon-assisted enteroscopy 119–123, 124,642–643duodenal papilla 10, 387, 671single-balloon method 121–122, 643, 654see also double-balloon enteroscopy (DBE)

balloon dilationachalasia 326, 774–775papillary 10bile duct stones 387, 688

pediatric patients 774–775percutaneous transhepatic papillary balloon di-lation (PTPBD) 444, 446

balloon dilators 324–325balloon-occluded retrograde transvenous obliter-ation (BRTO) 586, 587

balloon tamponadeesophageal variceal bleeding 583gastric variceal bleeding 586

band erosion, bariatric surgery complication 186,191–192

band ligationDieulafoy lesion 531, 532Endoloops 278–279esophageal varices 276–278, 500, 581, 582–583pediatric patients 779

gastric varices 278–279hemorrhoids 663–664

Bannayan –Riley–Ruvalcaba syndrome 789bariatric surgery 113, 179, 346, 551–552complications 185–193, 551–552early postoperative period 186–187endoscopic findings 186–187endoscopic therapeutic interventions186–193

late postoperative period/follow-up 187indications for endoscopy following 184

normal endoscopic findings 184–185procedures 182–184see also specific procedures

barium enemacolorectal polyps/cancer 596, 605Crohn’s disease 560, 634diverticula 609ischemic colitis 606small bowel 645

barium esophagraphy 323, 327, 501Barrett’s esophagus 109–110, 493–495biopsy 206, 212, 214–215diagnosis 493video capsule endoscopy 131

dysplasia 284–286, 494endomicroscopy 26–28epidemiology 493histopathology 206, 214–215neoplasia inendoscopic mucosal resection (EMR) 215,334–335, 495

laser therapy 283–286screening/surveillance 493–494therapy 289, 495acid-suppression 495argon plasma coagulation 289–290photodynamic 284–286, 289, 351–353, 495radiofrequency ablation 495

baskets, trapped 454, 455batteries, ingestion of 436, 438, 771, 780Behçet disease 614benzodiazepine 61bezoars 438, 528, 550, 551bile ductAIDS cholangiopathy 757biopsy 206–207, 386cysts see choledochal cystsdrainage 9, 169–170, 176endoscopic ultrasonography-guided 479–481see also biliary stenting

endoscopic papillotomy see endoscopic papil-lotomy (EPT)

leaks 369, 370, 416–417, 677–678obstruction see biliary obstructionpaucity 793, 794–795postoperative lesions 386, 415, 416stenoses 386–387stent placement see biliary stentingstones see choledocholithiasisstrictures 369, 370benign 415–418, 678–679chronic pancreatitis and 415–416, 418,714–715

malignant 386, 413–415, 680–682see also cholangiocarcinoma

pediatric patients 793, 794, 795, 796postoperative 386, 415, 416, 678–679see also specific strictures

tumors 368, 370diagnosis 164see also cholangiocarcinoma

biliary obstructionin chronic pancreatitis 714–715pediatric patients 793, 794, 795, 796see also bile duct, strictures

biliary reflux gastritis 517, 518, 527biliary stenting 9, 169, 173, 176, 386antireflux stents 420benign strictures 415–418biliary leaks 416–417, 678biliary stones 417–418, 454–455, 676–677cholecystitis 418chronic pancreatitis and 415–416, 714–715postoperative 386, 415, 416primary sclerosing cholangitis 415, 683

bioabsorbable stents 420

complications 175future developments 419–420indications 167, 413–418malignant strictures 413–415, 682, 687–688management ofmalfunctioning stents 295–296,408–412

plastic stents 403–405, 406–407, 408–409,714–715

pregnant patients 67self-expanding metal stents 405–406, 407–408,409–412

technique 406–408biliary tractendoscopic retrograde cholangiopancreatogra-phy see endoscopic retrograde cholangio-pancreatography (ERCP)

endoscopic ultrasonography see endoscopic ul-trasonography (EUS)

laser therapy 286malignancy 680–682diagnosis 680–681imaging techniques 680metastatic 680stenting 413–415, 682, 687–688tissue sampling 386, 681–682

parasites 368, 369, 687see also bile duct; gallbladder; liver; percutane-ous transhepatic cholangiographic drainage(PTCD); percutaneous transhepatic cholan-giography (PTC); percutaneous transhepaticcholangioscopy (PTCS)

biliopancreatic diversion (BPD) 183–184, 185biliopancreatic diversion with duodenal switch(BPD-DS) 184, 185

biliopleural fistula 175biliovenous fistula 175Billroth I gastrectomy 550Billroth II gastrectomy 550endoscopic papillotomy and 377, 380, 384endoscopic retrograde cholangiopancreatogra-phy and 157, 158, 671

postgastrectomy neoplasms 550–551bioendoscopy 212biopsybile duct 206–207, 386colon 206, 212, 219–222colitis 219–220colorectal polyps 221inflammatory bowel disease 620, 628

duodenum 206, 217–219celiac disease 218

esophagus 206, 212, 231–215Barrett’s esophagus 206, 212, 214–215esophagitis 212, 213–214gastroesophageal reflux disease 213–214

forceps 203, 204, 211biliary malignancy 386, 681hot 303, 319

guidelines, for inflammatory diseases of gastro-intestinal tract 212

ileum 220laparoscopic 268liver see liver biopsypancreatic duct 206–207stomach 206, 215–219gastric cancer 217, 542gastric polyps 539, 540gastric ulcers 535gastritis 212, 215–216, 519, 521

strip 334see also histopathology; tissue sampling

bipolar probe coagulation 273, 274bleeding see hemorrhageblood transfusion, esophageal variceal hemorrhage580

blue rubber bleb nevus syndrome 786, 787, 800

Index

807


blunt abdominal trauma 737body fluid sampling 207bone marrow transplantation 562botulinum toxin injectionanal fissure 663pancreas divisum 697pediatric achalasia 775sphincter of Oddi dysfunction 686

bougie dilators 323, 324–325bougienage see esophageal dilationbovine spongiform encephalopathy (BSE) 84Bozzini, Philipp 2Brace Bar 345brain–hand coordination, assessment 100breach of duty 50breast cancer, hepatic metastases 734Brunner gland hypertrophy 111, 112brush cytology 203esophagus 206malignant biliary strictures 386, 681

Buschke–Loewenstein tumors 665N-butyl-2-cyanoacrylate injection 278, 583–584

C

Cameron ulcers 512, 514Campylobactercolitis 607, 746HIV-associated diarrhea 757, 758

cancerhistory of endoscopic treatment 331–332see also specific treatments

staging see stagingsee also tumor(s); specific types of cancer

Candida infectioncolonic 628esophageal 490in AIDS patients 753, 754

cannulating devices 152–153catheters 152guide wires 152–153sphincterotomes 152–153

cannulationminor papilla 154–157, 371, 696selective 154

capsule endoscopy see video capsule endoscopy(VCE)

capsule endoscopy Crohn’s disease activity index(CECDAI) 634

carbon dioxide insufflation 138colonoscopic polypectomy 303

carcinoembryonic antigen (CEA) 240, 605carcinoid tumorscolorectal 613–614gastric 538–540small bowel 559, 649video capsule endoscopy 131

carcinoma in situ 574, 666carcinosarcoma, esophageal 504cardia 109, 110, 511, 512see also stomach

Caroli disease 685catheters 152caustic injuries see chemical-induced injuriescecumanatomy 147cancer 604see also colorectal cancer

colonoscope insertion 147–148see also colon

celiac disease 567biopsy 218endomicroscopy 29pediatric patients 776, 778small bowel tumors and 558, 559video capsule endoscopy 131

celiac plexus neurolysis (CPN), endoscopic ultra-sonography-guided 473–474

chemical dissolutioncholedocholithiasis 676pancreatolithiasis 712

chemical-induced injuriescolonic 611, 630esophageal 492, 779–780, 781gastric 527pediatric patients 779–780, 781

chemotherapy, colorectal cancer 604–605cherry-red spots 500, 577chest pain, pediatric patients 770children see pediatric endoscopyChlamydia trachomatiscolitis 607proctitis 659–660, 745

chlorine dioxide 87cholangiocarcinoma 680–682biliary stenting 413–415, 682choledochal cysts and 685diagnosis 164, 680–681peroral cholangioscopy 163, 164

molecular markers 240, 681–682nonresectable, photodynamic therapy 167,169–170, 286, 354–355

primary sclerosing cholangitis and 683staging 680, 682tissue sampling 681–682

cholangiographyintraoperative 677percutaneous transhepatic see percutaneoustranshepatic cholangiography (PTC)

see also endoscopic retrograde cholangiopan-creatography (ERCP)

cholangioscopes 168cholangioscopypercutaneous transhepatic see percutaneoustranshepatic cholangiography (PTC)

peroral see peroral cholangioscopycholangitis 175acute obstructive 368, 369, 381AIDS-related 756, 757endoscopic papillotomy and 381, 385see also primary sclerosing cholangitis (PSC)

cholecystectomylaparoscopic 245, 246, 385postcholecystectomy syndrome 686postoperative biliary strictures 386, 415, 416,678–679

transcolonic 251, 253transvaginal 250–251, 252

cholecystitis 248, 418, 481, 679acalculous 756–757

cholecystoduodenal fistula 574cholecystostomyendoscopic ultrasonography-guided 248, 481,679

laparoscopic see laparoscopic cholecystotomy(LCT)

percutaneous 248choledochal cysts 386, 684–685cholangiocarcinoma and 685classification 684clinical presentation 685pediatric patients 792–793treatment 685

choledochocele 368, 386, 571–572, 684, 685choledochoduodenostomy 378endoscopic ultrasonography-guided 480

choledocholithiasis 673–679diagnosis 673–674computed tomography 673–674endoscopic retrograde cholangiopancreatog-raphy 673

endoscopic ultrasonography 238–239,673–674

magnetic resonance cholangiopancreatogra-phy 674, 702

transabdominal ultrasonography (TUS) 673,674

management 674–679chemical dissolution 676endoscopic papillary balloon dilation 387, 688endoscopic papillotomy/sphincterotomy367–370, 385, 674–675, 688

endoscopic retrograde cholangiopancreatog-raphy and 677

lithotripsy see lithotripsypercutaneous transhepatic cholangioscopy171, 172–173

peroral cholangioscopy 165, 443, 444stent placement 417–418, 454–455, 676–677see also cholecystectomy

pediatric patients 791–792risk stratification 674

choledochoscopes 161–162, 164cholelithiasis 672–673, 679acute gallstone pancreatitis 385, 386, 702–704pediatric patients 796

management 673transabdominal ultrasonography (TUS)672–673, 679

see also choledocholithiasischolestasis, neonatal 793–795chromocolonoscopy, magnifying seemagnifyingchromocolonoscopy

chromoendoscopy 21–22digital 22–23inflammatory bowel disease 632–633methylene blue, bile duct lesions 164–165polyps 300, 301–302

chronic diarrhea see diarrheacirrhosis 59, 499, 578, 726–729ascites 728, 729gallbladder in 724, 725, 728hepatocellular carcinoma and 729, 733laparoscopic classification 727liver biopsy 729metastatic tumors in 729portal hypertension 728–729varicesesophageal see esophageal varicesgastric see gastric varices

clamshell polyps 314–315cleaningarea, endoscopy suite 80endoscopes/endoscopic accessories see reproc-essing of endoscopes/endoscopic accessories

clips 343–344hemostasis see hemoclipspolypectomy 304, 305in lesion location 316

Clostridium botulinum toxin injection see botuli-num toxin injection

Clostridium difficile 742AIDS-related diarrhea 758colitis 606–607, 628, 629, 747–748

Clostridium perfringens 742Coag-Grasper 315coagulationargon plasma see argon plasma coagulation(APC)

coaptive 273–274, 299probes 273–274see also hemostasis

coaptive coagulation 299cobblestoning 560, 561, 608, 622, 624coin ingestion 433, 435, 780colectomy, inflammatory bowel disease 626, 630,632

Index

808


colitisacute self-limited 627allergic 786–787, 788biopsy 219–220chemical-induced 611, 630collagenous 219–220, 610drug-induced 611, 629, 647hemorrhage 647infectious 606–609, 627–628, 629, 647bacterial 607–608, 628, 745–748fungal 628inflammatory bowel disease vs. 627–628, 629,743–744

parasitic 607, 628, 629viral 609, 628, 629, 745, 759see also diarrhea

ischemic 606, 629, 646–647lymphocytic 219, 220, 610–611microscopic 30, 610–611pediatric 786–787, 788pseudomembranous 606–607, 629, 747–748ulcerative see ulcerative colitisvideo capsule endoscopy 130

colitis cystica profunda (CCP) 613collagenous colitis 219–220, 610collagenous gastritis 530colonangiectasia/angiodysplasia 565, 645–646, 652argon plasma coagulation 293–94, 652

ascending see ascending colonbiopsy see biopsycarcinoma see colorectal cancerdecompression 426–429descending see descending colondiverticula 143, 145, 609–610, 629hemorrhage 610, 645, 646, 652

drug-induced injury 611, 629dysplasia 221in inflammatory bowel disease see inflam-matory bowel disease (IBD)

endometriosis 614endoscopic ultrasonography 233foreign bodies 438–440hemorrhage 645–647angiodysplasias 645–646, 652during colonoscopic polypectomy 315diverticula 610, 645, 646, 652inflammatory lesions 606, 647, 652neoplastic lesions 647, 653postpolypectomy 319, 647, 653see also lower intestinal bleeding disorders

histopathology 219–222inflammatory conditions 219–221neoplastic conditions 221–222

inflammation of see colitismelanosis 611–612metastases to 614obstruction 398–400functional 426–427mechanical 427–429

perforations, colonoscopic polypectomies and318

polyps see colorectal polypssigmoid see sigmoid colonstent placement 398–400tattooing of 201, 317, 601tissue sampling 206transverse see transverse colontuberculosis 608tumors 613–614adenomas see adenomascarcinoids 613–614lipomas 613see also colorectal cancer

ulcers see colonic ulcerscolonic ulcers

chemical-induced 611cytomegalovirus-associated 609drug-induced 611stercoral 613tuberculosis-associated 608see also colitis; ulcerative colitis

colonoscope(s) 136–138, 303, 313insertion technique see colonoscopymagnifying 137–138pediatric 784variable-stiffness 137

colonoscopic polypectomy 299–320, 598–602accessories 302–305argon plasma coagulator 303carbon dioxide 303clips 304, 305, 316colonoscopes 303, 313detachable loop 303–304electrosurgical units 299, 302gastroscope for better tip deflection 313heater probe and BICAP 303hot biopsy forceps 303injector needles 303snares 305, 313third-eye retroscope 313–314

anticoagulation therapy and 305checklist of practice points 320chromoendoscopy and 300, 301coaptive coagulation 299combined laparoscopic–endoscopic procedures257, 315

complications 148, 318–319, 789hot forceps biopsy 319intraprocedural hemorrhage 315perforation 148, 318postpolypectomy coagulation syndrome 148,318–319

postpolypectomy hemorrhage 148, 319, 647,653

currents 299, 302follow-up interval 315heat sealing of blood vessels 299location of lesions 316–317clips 316endoscopic follow-up 316endoscopic landmarks 316healing of polypectomy site 316intraoperative colonoscopy 316–317invalidity of shaft measurement 316marker injections 201, 317

narrow-band imaging 300–302, 597–598patient preparation 305pediatric patients 784–785, 789piecemeal 311–312, 598, 599prepolypectomy laboratory testing 305principles of 299problems 312–315

„blind spots“ 313–314clamshell polyps 314–315intraprocedural bleeding 315polyp position 312polyp size 314–315polyps too difficult to remove 315–316positional changes and abdominal pressure313

retroversion 315when to remove polyps 313

results 319–320safety measures 308–312air aspiration 311malignant polyps 310piecemeal polypectomy 311–312snare handle marking 308–309snare tip 311stopping at line 311submucosal injection 309, 310, 600

tenting of polyp away from base 311tumor tracking 311volume of injected fluid 309–310

technique 305–308endoscopic submucosal dissection (ESD) 306,307

pedunculated polyps 306polyp base treatment after removal 306, 308polyp position 305sessile polyps 306small polyps 305snare catheter placement 305

see also polypectomycolonoscopy 133–149AIDS-related diarrhea 758antispasmodics 136bowel preparation 134–135, 617, 783–784clinical training 92–93colonoscopes insertion technique 141–148abdominal compression 142anus 142ascending colon 147–148cecum 147–148descending colon and splenic flexure 145–146instrument handling 141–142patient position 142rectum 142–143sigmoid colon 143–145terminal ileum 147–148transverse colon and hepatic flexure 146–147

colonoscope withdrawal, examination techni-que during 148, 149

complications 148, 620, 789contraindications 134elderly patients 69equipment 136–139, 784accessories 139carbon dioxide vs. air insufflation 138see also colonoscope(s)

history 6imaging during 139–141fluoroscopy 139impact of 140–141magnetic endoscope imaging 140–141

indications 133–134intestinal decompression 426–429intraoperative 316–317intraprocedural quality indicators 18lower intestinal bleeding 642, 653patient preparation 134–135, 617pediatric patients see pediatric endoscopypregnant patients 67sedation 135tissue sampling techniques 206, 207total, achievability 148see alsomagnifying chromocolonoscopy

colorectal cancer 604–606chemoprevention 606chemotherapy 604–605development of 200, 604diagnosis 604pit pattern see pit pattern classification

endomicroscopy 29, 30endoscopic mucosal resection (EMR) 333–334endoscopic submucosal dissection (ESD) 333–334epidemiology 604hemorrhage 647, 653hereditary nonpolyposis 603–604histopathology 221–222inflammatory bowel disease and 630laparoscopic–endoscopic procedures 254, 257laser therapy 283, 284magnifying chromocolonoscopy 197–201obstructivedecompression 427–428stent placement 398–400, 427

Index

809


colorectal cancerpediatric patients 788–789photodynamic therapy 354preoperative tattooing 201screening 29, 605elderly patients 69pediatric patients 788–789

staging 604, 605submucosal invasion 197, 200symptoms 604vascular pattern diagnosis 197–198

colorectal polyps 299–300, 596–602biopsy 221clamshell 314–315classification 314–315flat 315–316, 597hemorrhage 647, 653hereditary syndromes 602–604see also specific syndromes

malignant 310–311, 788–789see also colorectal cancer

narrow-band imaging 300–302, 597–598, 633pediatric patients 784–785, 788–789pedunculated 299–300, 306, 597removal see colonoscopic polypectomysessile 299–300, 306symptoms 596

combined laparoscopic–endoscopic procedures seelaparoscopic–endoscopic procedures (LEPs)

common bile duct see bile ductcompactEASIE simulator 97, 98–100complete portal tract (CPT) number, liver biopsy261, 267–268

complicationsbariatric surgery see bariatric surgerycolonoscopic polypectomy see colonoscopicpolypectomy

colonoscopy 148, 620pediatric 789

Crohn’s disease 627endoscopic band ligation 582endoscopic mucosal resection 339endoscopic papillotomy see endoscopic papil-lotomy (EPT)

endoscopic retrograde cholangiopancreatogra-phy see endoscopic retrograde cholangio-pancreatography (ERCP)

endoscopic submucosal dissection 337, 339endoscopic ultrasonography (EUS) 230EUS-guided cholecystostomy 481EUS-guided choledochoduodenostomy 480EUS-guided drainage of pancreatic fluid col-lections 478–479

EUS-guided hepaticogastrostomy 479EUS-guided pancreatic duct drainage478–479, 482

esophageal dilation 324, 327–328esophagogastroduodenoscopy 115intragastric balloon treatment 181laparoscopic cholecystotomy 677–678lithotripsy 454–455percutaneous endoscopic gastrostomy 467, 469,470, 782

percutaneous liver biopsy 263percutaneous transhepatic cholangiographicdrainage 175

percutaneous transhepatic cholangiography 175percutaneous transhepatic cholangioscopy 175peroral cholangioscopy 164photodynamic therapy see photodynamic ther-apy (PDT)

sclerotherapy 582sedation, risk factors for 58–59stentingbiliary 175esophageal 395–396

gastroduodenal/colonic 399pancreatic 709

video capsule endoscopy (VCE) 129compression, abdominal 142computed-tomographic angiography (CTA) 645computed tomography (CT)choledocholithiasis 673–674colorectal cancer 605esophageal tumors 501pancreasin autoimmune pancreatitis 716normal 719

computer-based documentation 79condylomata acuminata 665, 760, 761confocal laser endomicroscopy see endomicro-scopy

congenital esophageal stenosis 799consent see informed consentconstipation, post-bariatric surgery 187continuous quality improvement 19see also quality assurance

contrast agentsendomicroscopy 26endoscopic retrograde cholangiopancreatogra-phy 153

endoscopic ultrasonography 240contrast allergy 671corrosive esophagitis 492Cotton–Huibregtse stent 403, 404Cotton–Leung stent 403, 404Courvoisier sign 724, 725, 728Cowden syndrome 789Creutzfeldt–Jakob disease 84, 86Crohn’s disease 560, 561balloon-assisted enteroscopy 121, 122, 634–635biopsy 620capsule endoscopy Crohn’s disease activity index(CECDAI) 634

cobblestone mucosa 560, 561, 608, 622, 624colonoscopy 620bowel preparation 617complications 620

colorectal cancer risk 630complications 627differential diagnosis 627–630, 743endoscopic characteristics 622, 623–625endoscopic evaluation of disease activity618–619

endoscopic ultrasonography 636granulomatous gastritis 526–527hemorrhage 647, 652histopathology 216–217, 220medications for mucosal healing 619–620pediatric patients 770, 771, 776, 782–783,787–788

perianal fistulas 636perioperative endoscopy 635postoperative recurrence 626small bowel adenocarcinoma and 558ulceration 560, 561, 618–619, 623–624, 625–626aphthous 619, 622, 625, 635, 771

upper endoscopy 625–626video capsule endoscopy 130, 131, 634, 635,782–783

see also inflammatory bowel disease (IBD)Cruveilhier–Baumgarten syndrome 728–729Cryptosporidium infection 743, 749–750AIDS patients 759

cuffitis 626Curling’s ulcer 528Curtis–Fitz–Hugh syndrome 736Curtiss, Lawrence E. 4Cushing’s ulcer 528cyanoacrylate glue injection 278, 583–585cyclooxygenase inhibition 589, 606

see also aspirin; nonsteroidal anti-inflammatorydrugs (NSAIDs)

cystic fibrosis 796–797, 798cystscholedochal see choledochal cystscolitis cystica profunda 613duplication, small bowel 563hepatic 729–730parovarian 734

Cytoimplant 474cytokeratins 212, 213cytology, brush see brush cytologycytomegalovirus (CMV) infectionAIDS patients 754, 755, 759colonic 609, 629, 745esophageal 490, 754gastric 522, 755rectal 660, 759

D

decompression 425–429colonic 426–429gastric 425–426, 459indications 425, 426small-intestinal 425–426

Demling, Ludwig 10Demling–Classen papillotome 372, 373demonstrations, live, obtaining informed consentfor 53

descending colonanatomy 145colonoscope insertion 145–146see also colon

Desormeaux, Antonin 2detergents 85diagnostic testsevidence-based evaluation 39–41see also specific conditions

diaphragmatic hernias 497–498hiatal see hiatal hernias

diarrhea 742acute infectiousbacterial 745–748clinical history 742diagnostic testing 742–743differential diagnosis 627–629, 743–744parasitic 748–750physical examination 742treatment 744viral 745see also colitis, infectious

chronicAIDS-related see acquired immune deficiencysyndrome (AIDS)

pediatric patients 776, 778, 787–788post-bariatric surgery 187

diazepam 61didanosine 756Dieulafoy lesion 276, 531, 590, 646band ligation 531, 532hemostasis 531, 590, 652argon plasma coagulation 295

digital chromoendoscopy 22–23dilated gastrojejunostomy, gastric bypass surgerycomplication 190

dilationesophageal see esophageal dilationminor papilla 698–699pancreas divisum 419, 698–699see also balloon dilation

direct percutaneous endoscopic jejunostomy(DPEJ) 426, 459, 466–467, 469complications 467, 469, 470contraindications 460

Index

810


elderly patients 69discharge, patient, as postprocedural quality indi-cator 17, 18

disconnected pancreatic duct syndrome 714disinfectants 86–87disinfectionarea, endoscopy suite 80definition 83endoscopes/endoscopic accessories see reproc-essing of endoscopes/endoscopic accessories

dissection see endoscopic submucosal dissection(ESD)

dissolution, chemical see chemical dissolutiondiverticulacolonic see colonduodenum 571esophageal see esophageal diverticulagastric 514juxtapapillary 379–380Meckel’s 563, 649, 652pediatric 769–770periampullary 157, 571, 673small bowel 563, 649Zenker see Zenker diverticulum

diverticulitis 606, 609–610documentation, computer-based 79Dormia basket, trapped 454, 455double-balloon enteroscope 119, 120insertion 120

double-balloon enteroscopy (DBE) 119–121, 123,642–643duodenal papilla 387, 671inflammatory bowel disease 121, 634–635intestinal bleeding 643, 654intraoperative endoscopy vs. 120

droperidol 61, 62drug-eluting stents 420drug-induced conditionscolopathy 611esophagitis 491–492gastric ulceration 533, 534–535gastritis 216, 524–525small bowel ulceration 122, 130, 561, 649–650

drugs, sedative 60–63see also sedation

duodenal cancer 557adenocarcinoma 558–559, 603histopathology 218laparoscopic–endoscopic procedures 254,256–257

laser therapy 283duodenal ulcers 115Helicobacter pylori and 216hemorrhage 642pediatric patients 779

see also peptic ulcersduodenitis 216, 217–218duodenoscopes 108, 152endoscopic papillotomy 372–373history of 7see also esophagogastroduodenoscopy (EGD)

duodenumanatomynonpathological alterations 111–113normal 111

biopsy see biopsydiverticula 571erosions, hemorrhage and 589gastrinoma 560histopathology 217–219inflammatory conditions 217–218neoplastic conditions 218

polyps, argon plasma coagulation 290–291stent placement 397–398, 399tissue sampling 206tumors 557

see also duodenal cancerulcers see duodenal ulcerssee also esophagogastroduodenoscopy (EGD);small bowel

duplication cysts, small bowel 563dysphagiaAIDS patients 753–755esophageal tumors and 501lusoria 501malignant 282palliative laser therapy 282–283

pediatric patients 770–775peptic strictures and 496photodynamic therapy complication 352

dysplasiaBarrett’s esophagus 284–286, 494colonic 221in inflammatory bowel disease see inflam-matory bowel disease (IBD)

dysplasia-associated lymphoid mass (DALM), in-flammatory bowel disease 630–632

E

EagleClaw 345–346, 364early gastric cancer (EGC) 332–333EASIE (Erlangen Active Simulator for InterventionalEndoscopy) 98team-training method 100–101

EASIE-R 98, 99Echinococcus 687ectasiasvenous 564see also angiectasia/angiodysplasia

ectopic pancreas 540, 541edemagastritis 515postoperative 549

education see trainingelastic scattering spectroscopy 23–24elastographyendoscopic ultrasonography 240–241magnetic resonance 727–728transient 727, 728

elderly patientsendoscopy 69–71sedation 60

electrocoagulation see coagulationelectrohydraulic lithotripsy (EHL) 168, 449–450,453–454, 455, 675

electrolysis 87Elgiloy self-expanding metal stent 405emergency situations, informed consent and 49emphysematous gastritis 521, 523Encephalitozoon intestinalis 759EndoCapsule 127EndoCinch 344–345, 360–361, 364endocytoscopy 25endoglin 565Endoloops 278–279endometriosis, colonic 614endomicroscopy 25–31, 138clinical data 26–31Barrett’s esophagus 26–28celiac disease 29colorectal cancer 29, 30gastric cancer 28–29gastritis 28–29microscopic colitis 30ulcerative colitis 28–29

contrast agents 26future of 30–31principles 26

endoscope reprocessing see reprocessing of endo-scopes/endoscopic accessories

endoscopically placed gastrojejunostomy 459, 466

endoscopic injection sclerotherapy (EIS) 272–273,277–278, 501, 581–582complications 582hemorrhoids 664needles 581nonvariceal hemorrhage 272–273pediatric patients 779sclerosants 272–273, 277, 581treatment schedule 581–582variceal hemorrhage 277–278, 581–582band ligation and 278band ligation vs. 277–278esophageal wall changes 581intravariceal 581paraintravariceal 581–582

endoscopic mucosal resection (EMR) 9, 331complications 339history of 331–332indications 332–334Barrett’s esophagus 215, 334–336, 495colonic cancer 333–334esophageal cancer 332, 334–336, 504gastric cancer 332–333, 542–544, 545

lesion diagnosis and 332, 333techniques 334–336strip biopsy 334using transparent plastic cap see endoscopicmucosal resection using a transparentplastic cap (EMR-C)

treatment principles 334endoscopic mucosal resection using a transparentplastic cap (EMR-C) 331technique 334, 335

endoscopic papillary balloon dilation (EPBD), bileduct stones 387, 688

endoscopic papillotomy (EPT) 10, 367–387alternatives to 387, 688ampullectomy 378biliary duct 367–370, 375–378, 384, 385–387choledocholithiasis 367–368, 385, 674–675,688

Billroth II gastrectomy and 380, 384complications 380–384long-term 383–384prevention 382risk factors 381–382short-term 380–383

fistulotomy 378history of 367indications 367–371bile ducts 367–370main duodenal papilla 367minor papilla 367pancreas 370–371

instruments 372–374juxtapapillary diverticula and 379–380methods 375–380minor papilla 367, 379, 383, 699–700needle-knife papillotomy 376–378, 382pancreas divisum 371, 697, 699–700pancreatic duct 367, 382–383, 384, 710transpancreatic sphincter precutting ap-proach 378–379

pancreatitis therapy 370–371, 385, 386, 703–704patient admission 372patient preparation 372precut papillotomy 375–376, 675rendezvous technique 380results 384–387in individual indications 384–387technical success 384

sedation 372sphincter of Oddi dysfunction 367, 385–386,575, 686

wire-guided 373–374

Index

811


endoscopic resection with hypertonic saline–epi-nephrine (ERHSE) 331

endoscopic retrograde cholangiopancreatography(ERCP) 151–158, 670–671antibiotic prophylaxis 670–671, 687, 769balloon-assisted enteroscopy and 123, 124, 671biliary malignancy 680–681challenging scenarios 157, 158, 671Billroth II gastrectomy 157, 158, 671papillary distortion 157periampullary diverticula 157

choledocholithiasis 673, 674, 677cholelithiasis 672–673complications 157–158, 798pancreatitis 158, 381–382, 798

contrast allergy prophylaxis 671elderly patients 69–71equipment 152–153cannulating devices 152–153contrast agents 153endoscopes 152

facilities 151future directions 158gallbladder 679drainage 248

history of 6, 7, 151indications 151, 367, 670intraprocedural quality indicators 18laparoscopic cholecystectomyand 385, 677–678normal cholangiogram 671–672pancreas divisum 697–698pancreatitis 702, 703–705pediatric patients see pediatric endoscopypregnant patients 67–68primary sclerosing cholangitis 636, 683technique 153–157, 790minor papilla cannulation 154–157oropharyngeal intubation 154patient position 153patient preparation 153, 670, 790sedation 153, 670, 790

tissue sampling methods 206–207, 386training 93–94using ex vivo porcine tissuemodels 97, 98–99,100

using live animals 98endoscopic sphincterotomy (ES, EST) 10sphincter of Oddi dysfunction 367, 385–386,575, 686

see also endoscopic papillotomy (EPT)endoscopic submucosal dissection (ESD) 9,306–307, 316, 331, 340complications 337, 339history of 331indications 306, 332–334colon cancer 333–334esophageal cancer 332gastric cancer 332–333

knives 336, 337lesion diagnosis and 332, 333patient preparation 336–337postoperative care 337technique 306, 336–337, 338hook knife 339

treatment principles 334endoscopic tattooing 201, 317, 601endoscopic ultrasonography (EUS) 225–241benign lesions 238–240biliary tract 231–233, 238–239, 670–671choledocholithiasis 238–239, 673, 674cholelithiasis 672–673, 679indications 670malignancy 680–681

colorectum 233complications 230contrast agents 240

Crohn’s disease 636elastography 240–241elderly patients 70equipment 225–227EUS-guided puncture techniques 227–229fine-needle 229–230, 240

facilities 80future directions 240–241gallbladder 233, 248, 679gastrointestinal tumor staging 233–235indications 229, 670inflammatory bowel disease 636lymph nodes 231mediastinum 231NOTES (natural orifice transluminal endoscopicsurgery) and 483

pancreatic tract 231–233pancreatic tumors 234, 236–238pancreatitis 239–240patient preparation 230, 670pediatric patients 798–801prerequisites for 229–230principles of 225, 227sedation 230stomach 230, 231submucosal lesions 235–236therapeutic 473–483celiac plexus neurolysis 473–474drainage of biliary system 248, 479–481drainage of pancreatic duct 481–482drainage of pancreatic fluid collections475–479

equipment 473future indications 483implantation of radiopaque markers 475, 476pancreatic cancer treatment 474–475vascular interventions 483

training 241treatment room 80upper gastrointestinal tract 230–231, 232

endoscopic ultrasonography–fine-needle aspira-tion (EUS–FNA) 204–205, 207cholangiocarcinoma 681

endoscopic ultrasonography–fine-needle injection(EUS–FNI) 473pancreatic cancer treatment 474–475

endoscopic ultrasonography–fine-needle puncture(EUS–FNP) 229–230, 240

endoscopic variceal ligation (EVL) 276–277, 500,581, 582–583

endoscopy-assisted laparoscopic wedge resection255stomach 256see also laparoscopic–endoscopic procedures(LEPs)

endoscopy-assisted transluminal resection255–256stomach 255–256see also laparoscopic–endoscopic procedures(LEPs)

endoscopy report, as postprocedural quality indi-cator 17–18

endoscopy suite 75–80cleaning/disinfection area 80examination room 78–80equipment 78–80size 78

laser treatment room 80location 76–77management of 20number of rooms 77–78planning guidelines 75, 76, 77preparation/recovery room 80radiography room 78, 80routes/pathways 75–76staffing 80

ultrasonography room 80Entamoeba histolytica infection 607, 748–749enteral nutrition 459gastric see percutaneous endoscopic gastro-stomy (PEG)

jejunal 459, 466see also direct percutaneous endoscopic jeju-nostomy (DPEJ)

enterochromaffin-like (ECL) cellhyperplasia, autoimmune gastritis 524see also carcinoid tumors

enteroclysis 645Enterocytozoon bieneusi 759enteroendocrine tumorsgastric 538–540see also carcinoid tumors

enterogastric reflux gastritis 517, 518, 527enterohemorrhagic Escherichia coli (EHEC)746–747

enteroinvasive Escherichia coli (EIEC) 746enteropathygluten see celiac diseasehuman immunodeficiency virus 759–760

enteroscopy 119–124balloon-assisted see balloon-assisted entero-scopy

deep, video capsule endoscopy and 131, 132history 8inflammatory bowel disease 634–635intraoperative see intraoperative enteroscopypediatric patients 782–783push 119, 634, 642rope-way 119sonde 119tissue sampling techniques 206, 207see also small bowel; video capsule endoscopy(VCE)

enterotomy 123–124Enteryx 358–359eosinophilic esophagitis 497, 772, 773eosinophilic gastritis 530epinephrine injection, nonvariceal hemorrhage272

epiphrenic diverticula 499ERCP see endoscopic retrograde cholangiopan-creatography (ERCP)

Erlangen Active Simulator for Interventional En-doscopy see EASIE (Erlangen Active Simulator forInterventional Endoscopy)

Erlanger Endo-Trainer 98, 99erosionsduodenal 589esophageal 488–490gastric 515, 516, 529–530, 589

erythematous gastritis 515, 516Escherichia coli 84AIDS-associated diarrhea 757, 758colitis 607–608, 746–747

esophageal cancer 332, 503–504, 731–732adenocarcinomas 332, 503endoscopic mucosal resection 332, 334–336,504

fistula, stent placement 396–397histopathology 214–215laparoscopic–endoscopic procedures 254, 256laser therapy 283–286malignant dysphagia 282palliative laser therapy 282–283

metastasis 732photodynamic therapy 284–286, 351–353squamous cell carcinoma 332, 503staging 503endoscopic ultrasonography 233–235

esophageal dilation 8, 323–328complications 324, 327–328contraindications 323

Index

812


dilator types 324–325history of 323indications 323patient preparation 324pediatric patients 774–775physiology 325predilation evaluation 323techniques 325–327caustic/corrosive strictures 326–327dilation of Schatzki rings 326, 496malignant strictures 327peptic strictures 326, 496–497pneumatic dilation for achalasia 326, 774–775refractory/high-grade strictures 327self-bougienage 327

esophageal diverticula 498–499epiphrenic 499intramural pseudodiverticula 499traction 499Zenker diverticulum see Zenker diverticulum

esophageal tumorsbenign 501–503fibrovascular polyps 503gastrointestinal stromal tumors 502granular cell tumors 502hemangiomas 502inflammatory fibroid polyps 503lipomas 502squamous papillomas 501–502

malignant see esophageal canceresophageal varices 499–501anatomy 577cherry-red spots 500, 577classification 577detection, video capsule endoscopy 131epidemiology 499grading 499–500hemorrhage 499–500, 579management 580–583see also hemostasis

pediatric patients 779natural history 579prophylactic treatment 500–501see also varices

esophagitis 589, 590AIDS-related 491, 753–754biopsy 212, 213–214Candida 490, 753, 754corrosive 492cytomegalovirus 490–491, 754eosinophilic 497, 772, 773hemorrhage, pediatric patients 779herpes simplex 490, 754infectious 490–491pediatric patients 770–775pill-induced 491–492radiation-induced 492–493reflux 488–490

esophagogastric junction (EGJ) 109, 110esophagogastroduodenoscopy (EGD) 106–116AIDS-related diarrhea 758clinical training 92–93complications 115contraindications 114Crohn’s disease 625–626elderly patients 69indications 114–115intestinal bleeding 642intraprocedural quality indicators 17pediatric patients 769–780caustic/foreign body ingestion 779–780chronic diarrhea/malabsorption 776, 778complications 782dysphagia/odynophagia 770–775indications 770

percutaneous endoscopic gastrostomy 780,782

unexplained vomiting and abdominal pain775–776, 777–778

upper gastrointestinal hemorrhage 778–779postprocedural care 109pregnant patients 67procedure 106–109advancement/maneuvering of endoscope108–109

documentation 115–116insertion of endoscope 107–108patient preparation 107sedation 106

tissue sampling techniques 206, 207see also duodenoscopes; gastroscopes; uppergastrointestinal tract

esophagusachalasia see achalasiaanatomygastroesophageal junction 488lower esophageal sphincter 488nonpathological alterations 111–114normal 109–110, 488squamocolumnar junction 488

atresia 772, 773, 774biopsy see biopsycancer see esophageal cancercaustic injuries 492pediatric patients 779–780

dilation see esophageal dilationdiverticula see esophageal diverticulahistopathology 213–215inflammatory conditions 213–214neoplastic conditions 214–215

infections 490–491medication-induced injuries 491–492mucosal diseases 488–496Barrett’s esophagus see Barrett’s esophagusesophagitis see esophagitisheterotopic gastric mucosa 495Mallory–Weiss tears 276, 495–496, 514–515,589

obstruction, food bolus 431, 433radiation damage 492–493rings 497Schatzki see Schatzki ring

stenosiscongenital 799dissection-induced 339resection-induced 339

stenting 393–397biodegradable stents 396complications 395–396efficacy 395self-expanding metal stents 393–396self-expanding plastic stents 393, 396, 397stent placement 393, 395, 396in treatment of benign disease 397in treatment of malignant esophageal fistula396–397

see also stent(s)stricturesdilation see esophageal dilationpediatric patients 772, 773, 774–775peptic 326, 496–497

tissue sampling techniques 206trauma, nonendoscopic tube 495tumors see esophageal tumorsulcers 589AIDS patients 491, 754hemorrhage 589–590

vascular diseases 499–501arteria lusoria 501varices see esophageal varices

see also esophagogastroduodenoscopy (EGD)

EsophyX 361, 363ethanolamine 272, 277EUS see endoscopic ultrasonography (EUS)evidence-based endoscopy 37–45studies of diagnosis 39–41studies of harm 42–43studies of prognosis 43–45studies of therapy 37–39

Evolution stent 394, 395extracorporeal shock-wave lithotripsy (ESWL)biliary stones 451–452, 454, 676, 677pancreatic stones 418, 711–712

extragonadal germ cell tumor 549extramedullary hematopoiesis 530–531exudative gastritis 515, 516EZ Clip 343

F

falciform ligament 723–724familial adenomatous polyposis (FAP) 602–603adenomas 535, 602–603argon plasma coagulation 290–291, 292attenuated 603fundic gland polyps 536, 539, 603pediatric patients 788

Fasciola hepatica 369, 687fatty liver 724–725fentanyl 61, 62pediatric patients 768

fiberscopes 106, 108history 4–6

fibrin sealant injection 273fibrosarcoma 548FibroScan 727, 728fibroscopy see esophagogastroduodenoscopy(EGD)

fibrovascular polyps, esophageal 503fiducials, endoscopic ultrasonography-guided im-plantation 475, 476

fine-needle aspiration (FNA)biliary malignancy 681endoscopic ultrasonography-guided see endo-scopic ultrasonography–fine-needle aspira-tion (EUS–FNA)

needle devices 203, 205fine-needle aspiration biopsy (FNAB), liver264–265

fissures, anal 648, 653, 663fistulasaortoenteric 591biliopleural 175biliovenous 175gastrogastric, bariatric surgery complication 186malignant esophageal, stent placement396–397

pancreatic duct 714periampullary 574perianal, Crohn’s disease 636trachesophageal 770, 771

fistulotomy 378, 574flexible sigmoidoscopy see sigmoidoscopy, flexiblefluence 350fluid sampling 207flumazenil 61, 63pediatric patients 768

fluorescence spectroscopy 23fluoroscopyduring colonoscopy 139pregnant patients and 67–68

fluorouracil (5-FU), colorectal cancer 604, 605focal nodular hyperplasia 730–731folinic acid 604, 605food allergy 497food impaction 431, 433, 434forceps, biopsy see biopsy

Index

813


foreign body removal 8, 431–440batteries 436, 438, 780bezoars 438, 780, 781clinical approach 431coins 433, 435, 780colonic 438–440food bolus impaction 434historical aspects 8, 9impacted food bolus 431, 433magnets 436, 438pediatric patients 780, 781rectal 438–440sharp objects 435–436, 437, 780, 781surgically-assisted 440unusual objects 438, 439

FREDDY laser system 450–451, 454see also laser lithotripsy (LL)

fundoplicationtransoral incisionless 361, 363see also gastroesophageal reflux disease (GERD)

fundus 110, 111, 511see also stomach

fungal infectionscandidal see Candida infectiongastric 521, 522histoplasmosis 647

future developments 8endomicroscopy 30–31endoscopic retrograde cholangiopancreatogra-phy 158

endoscopic treatment of gastroesophageal refluxdisease 364–365

endoscopic ultrasonography 240–241NOTES (natural orifice transluminal endoscopicsurgery) 253

peroral cholangioscopy 165photodynamic therapy 355quality assurance 20suturing 346training 102

G

gallbladder 724, 725cancer 679, 680, 734in cirrhosis 724, 725, 728Courvoisier sign 724, 725, 728drainage 248endoscopic retrograde cholangiopancreatogra-phy 248, 679

endoscopic ultrasonography 233, 248, 679inflammation 248, 418, 481, 679polyps 679stones see cholelithiasissee also biliary tract

gallstones see cholelithiasisgamma loop, transverse 145, 147Gardner’s syndrome 558gastrectomyBillroth I 550Billroth II see Billroth II gastrectomy

gastric antral valve ectasia (GAVE) 217, 531–533,590argon plasma coagulation 274, 293, 294,532–533

gastric banding 182, 183, 184, 185see also laparoscopic adjustable silicone gastricbanding (LASGB)

gastric bypass (GBP) 182–183complications 185, 187staple-line dehiscence and gastrogastric fis-tula 190–191

Roux-en Y see Roux-en Y gastric bypass (RYGB)see also bariatric surgery

gastric cancer 541–549

advanced 544–547biopsy 217, 542classification 542, 544–546, 547differential diagnosis 546early 332–333, 353, 354, 542–544, 545endomicroscopy 28–29endoscopic mucosal resection (EMR) 332–333,542–544, 545

Helicobacter pylori and 28, 541, 547hemorrhage 590–591histopathology 217laparoscopic–endoscopic procedures 254, 256linitis plastica 544, 546lymph-node stations 546lymphoma 217, 547–548, 591AIDS-related 756

metastasis 547, 732metastatic gastric disease 549photodynamic therapy 353, 354risk factors 544sarcoma 548, 549signs and symptoms 545staging 544, 547endoscopic ultrasonography 234, 235

stent placement 397gastric decompression 425–426gastric diverticula 514gastric malakoplakia 523gastric outlet obstruction, stent placement 397gastric perforationendoscopic mucosal resection and 339endoscopic submucosal dissection and 339

gastric polyps 535–541biopsy 539, 540carcinoids 538–539epithelial lesions 535–540adenomatous polyps 535–536, 537fundic gland polyps 536, 539hyperplastic polyps 536, 537

management algorithm 540subepithelial lesions 540–541gastrointestinal stromal tumors 540, 541leiomyomas 540, 541

gastric ulcers 533–535biopsy 535differential diagnosis 535drug-induced 533, 534–535healing 534Helicobacter pylori-associated 534hemorrhagehemostasis 272, 275see also hemostasis

pediatric patients 778–779malignant 535malignant cycle 542, 543stress-induced 528subtypes 533–534see also peptic ulcers

gastric variceal obturation (GVO) 583–585gastric varicesanatomy 577classification 278, 577, 578hemorrhage 580treatment 583–586see also hemostasis

isolated 577, 578, 579natural history 580pediatric patients 779treatment 278–279see also varices

gastric xanthelasma 517gastric zone 577gastrinoma 526, 560gastritis 515–531AIDS patients 520–521, 755, 756alcohol-induced 525

atrophic 515, 517, 518–519autoimmune 215, 519, 523–524biopsy 212, 215–216, 519, 521caustic injury-induced 527, 528classification 215, 520collagenous 530drug-induced 216, 524–525emphysematous 521, 523endomicroscopy 28–29enterogastric reflux 517, 518, 527erosive 515, 516, 529–530, 589erythematous-exudative 515, 516granulomatous 526–527hemorrhagic 517, 518, 589Henoch–Schönlein 529hyperplastic 517, 518, 526hypertrophic hypersecretory 526, 527hypertrophic hyposecretory 526idiopathic 529–531infectious 520–523cytomegalovirus-associated 520–521, 522,755

Helicobacter pylori-associated 28, 216, 519,520, 522

lymphocytic 520mechanical trauma-induced 528metaplasia 519, 520nosological causes 519pediatric patients 776, 779phlegmonous 521, 523radiation-induced 527–528staging/grading 515–519endoscopic aspects 515–518histological aspects 215–216, 518–519

stress-induced 528varioliform 529–530

gastrocamera 4–6gastroesophageal junction (GEJ) 488gastroesophageal prolapse 514, 515gastroesophageal reflux disease (GERD) 357acid-suppression therapy 357, 489–490biopsy 213–214endoscopic treatment 357–365aims 357future developments 364–365indications 357injection/implantation 357, 358–359plication/suturing devices 344–346, 357,359–364

radiofrequency ablation 357–358esophagitis 488–490, 589, 590grading systems 489

histopathology 213–214pediatric patients 770, 771–772, 775

gastrogastric fistula, bariatric surgery complication186, 190–191

gastrointestinal bleeding see hemorrhagegastrointestinal leak, bariatric surgery complica-tion 186

gastrointestinal stromal tumors (GISTs)endoscopic ultrasonography 235–236esophageal 502gastric 540, 541hemorrhage 591immunohistochemistry 207, 236small-intestinal 557, 558

gastrojejunostomydilated, gastric bypass surgery complication 190endoscopically placed 459, 466

gastroparesis, decompression 425–426gastropathy 215portal hypertensive 533

gastroplasty 183, 184transoral 364see also vertical banded gastroplasty (VBG)

gastroscopes 106, 107

Index

814


in colonoscopic polypectomy 313history 3–6fibreglass gastroscope 4–6Japanese contributions 4, 6semiflexible gastroscope 3–4

pediatric 106, 108technical characteristics 108therapeutic 106, 107, 108transnasal 106, 108video 106, 107, 108see also esophagogastroduodenoscopy (EGD)

gastroscopy see esophagogastroduodenoscopy(EGD)

gastrostomy see percutaneous endoscopic gastro-stomy (PEG)

Gatekeeper reflux repair system 359Geenen stent 403, 404general anesthesia 57equipment, procedure room requirements 79pediatric patients 768–769

genital warts 665, 760, 761germ cell tumor, extragonadal 549giant-cell arteritis 561giant condyloma 665giardiasis 743, 748AIDS patients 758gastric 521

Global Rating Scale (GRS) 19–20glucagon 136, 153glutaraldehydecolitis 630as disinfectant 86

gluten enteropathy see celiac diseaseglyceryl trinitrate (GTN) 663gonococcal infection, perihepatitis 736gonorrheal proctitis 659g-Prox 346graft-versus-host disease (GVHD) 220, 530,562–563, 614pediatric patients 776, 777

granular cell tumors 502granulomasCrohn’s disease 624eosinophilic 530suture 550tuberculous 608, 747

granulomatous gastritis 526–527guidelinesclinical training 92–93endoscopy suite planning 75, 76, 77reprocessing of endoscopes/endoscopic acces-sories 85–86

guide wires 152–153

H

hamartomatous polyposis syndromes 603, 604see also specific syndromes

harm, studies of, evidence-based evaluation 42–43heater probe coagulation 273–274colonoscopic polypectomy 303hemoclips vs. 275

Helicobacter heilmannii 520Helicobacter pylori infectionAIDS patients 755duodenitis 217–218gastric cancer and 28, 541, 547gastritis 28, 216, 519, 520, 522pediatric patients 775, 776

peptic ulcers and 534, 589Heller myotomy 253hemangiomasesophageal 502hepatic 730small-intestinal 564, 565

hematopoiesis, extramedullary 530–531

hemobilia 175, 591hemochromatosis 726, 728hemoclips 274–275, 651thermocoagulation vs. 275

hemolytic anemia 791hemolytic–uremic syndrome 786hemophilic patients 72hemorrhageAIDS-related 760anal fissures 648, 653bariatric surgery complication 186–187colonic see colonDieulafoy lesion see Dieulafoy lesionduodenal ulcers/erosions 589, 642pediatric patients 779

endoscopic papillotomy complication 380–381endoscopic signs 275–276endoscopic submucosal dissection complication339

endoscopic ultrasonography and 483esophageal ulcers 589–590esophagitis, pediatric patients 779gastric antral valve ectasia 590gastric tumors 590–591gastric ulcer 272, 275gastritis 517, 518, 589hemorrhoids 648, 653inflammatory bowel disease 627, 647, 652Mallory–Weiss tears 276, 495–496, 515, 589managementpreendoscopy 587–588see also hemostasis

pediatric patients 778–779, 786, 787peptic ulcers see peptic ulcersportal hypertensive gastropathy 533rectal see rectal bleedingsmall bowel 555, 556, 565–566, 648–650,653–654pediatric patients 782

varicesesophageal see esophageal varicesgastric see gastric variceshemostasis see hemostasisprediction of first bleed 578–579

video capsule endoscopy indications 129–130see also lower intestinal bleeding disorders;upper gastrointestinal tract, bleeding disor-ders

hemorrhagic gastritis 517, 518, 589hemorrhoids 663–664external 663hemorrhage 648, 653, 786internal 663classification 663, 664

pediatric patients 786treatment 663–664

hemostasishistorical aspects 9–10laser photocoagulation 282nonvariceal hemorrhage 272–276argon plasma coagulation 274, 293–295, 303bipolar probe 273, 274combination treatment 275diluted epinephrine 272fibrin sealant 273heater probe 273–274hemoclips 274–275, 651injection therapy 272–273limitations of endoscopic therapy 276sclerosants 272–273thermal methods 273–274, 275thrombin 273

radiologic angiotherapy 651surgical options 651variceal hemorrhage 276–278, 500–501

band ligation 276–278, 500–501, 581,582–583

combination treatment 278, 501, 581detachable snares 279Endoloops 278–279endoscopic injection sclerotherapy see endo-scopic injection sclerotherapy (EIS)

pediatric patients 779pharmacologic treatment 581tissue adhesives 278, 583–586

see also hemorrhage; lower intestinal bleedingdisorders, therapy; specific lesions

hemosuccus pancreaticus 591Henning, Norbert 3, 11Henoch–Schönlein purpura 529, 562, 776, 777heparin therapy 71–72hepatic cysts 729–730hepatic flexure 146colonoscope insertion 142, 146–147

hepaticogastrostomy, endoscopic ultrasonogra-phy-guided 479–480

hepatic venous pressure gradient (HVPG) 499, 578hepatitis 725–726acute viral 725–726chronic 726see also cirrhosis

hepatocellular carcinoma (HCC) 729, 733–734hepatopancreatic ampulla see ampulla of Vaterhereditary angioedema, stomach 529hereditary hemorrhagic telangiectasia (HHT) 531,564, 565, 646, 647

hereditary nonpolyposis colorectal cancer (HNPCC)603–604

hereditary polyposis syndromes 602–604see also specific syndromes

hernias, hiatal see hiatal herniasherpes simplex virus (HSV)colitis 609esophagitis 490in AIDS patients 754

proctitis 660, 745heterotopic gastric mucosa, esophagus 495Hetzel–Dent classification 489hiatal hernias 110, 497–498, 512–514combined 512, 514paraesophageal 498, 512, 514Schatzki ring 512, 513sliding 498, 512, 513upside-down stomach 512, 514

high-definition endoscopy 21, 22Hippocrates 48Hirschowitz, Basil 4, 106Histoacryl injection 278, 583–584histopathology 211–222colon see colondiagnostic yield 211–212duodenum see duodenumesophagus see esophagusileum see ileumimmunohistochemistry 212–213stomach see stomachtumor resection and 332see also biopsy; tissue sampling

histoplasmosis 647history of endoscopy 2–11colonoscopy 6endoscopic retrograde cholangiopancreatogra-phy 6, 7

endoscopic ultrasonography 10enteroscopy 8gastroscopy 2–6fibreglass endoscopes 4–6Japanese contributions 4, 6semiflexible gastroscope 3–4

laparoscopy 11percutaneous transhepatic cholangiography 6, 8

Index

815


history of endoscopyphotodynamic therapy 8pioneers 2–3therapeutic endoscopy 8–10cancer treatment 331–332

history of quality assurance 15–16history-taking 58–59acute infectious diarrhea 742lower intestinal bleeding disorders 641

Hodgkin’s lymphoma 734hook knife 337technique 339

Hopkins, Harold H. 4hot biopsy forceps 303, 319human immunodeficiency virus (HIV)enteropathy 759–760esophagitis 491lower gastrointestinal bleeding and 647, 652Mycobacterium avium complex (MAC) infection561

small bowel tumors and 559, 560see also acquired immune deficiency syndrome(AIDS)

human papilloma virus (HPV) 665, 666hydatid disease 687hyoscine 136, 153hyper-IgM syndrome 788hyperplasia, focal nodular 730–731hyperplastic gastritis 517, 518, 526hypertrophic hypersecretory gastritis 526, 527hypertrophic hyposecretory gastritis 526

I

idiopathic esophageal ulceration (IEU), AIDS pa-tients 754

ileal pouch–anal anastomosis (IPAA) 626ileocecal valve 147–148erythema 629tuberculosis 608

ileumanatomy 147biopsy 220colonoscope insertion 147–148histopathology 219–221inflammatory conditions 219–221neoplastic conditions 221

tumors 557carcinoid 559

see also small bowelimaging, advanced see advanced imaging techni-ques

immunodeficiencygastritis and 530see also acquired immune deficiency syndrome(AIDS); human immunodeficiency virus (HIV)

immunohistochemistry 212–213immunoproliferative small-intestinal disease (IP-SID) 559–560

impacted food 431, 433, 434incompetent patients, informed consent and 50India ink 201, 317indication for endoscopy, as preprocedural qualityindicator 16

indigo carmine dye spraying, colonoscopy 137,148,149

indocyanine green 317infants see pediatric endoscopyinfectionsantibiotic prophylaxis see antibiotic prophylaxisbacterial see bacterial infectionscolonic see colitis, infectiousendoscopy-related 83–85mechanism 83–84outbreak management 88

esophageal 490–491

fungal see fungal infectionsgastric see gastritis, infectiousrectal 609, 659–660, 745small bowel 560–561viral see viral infectionssee also specific infectious diseases e. g. diarrhea;specific pathogens

inflammatory bowel disease (IBD) 617–637biopsy 620, 628chromoendoscopy 632–633colonoscopy 147, 620bowel preparation 617complications 620

colorectal cancer risk 630complications 627differential diagnosis 627–630, 743–744infectious colitis vs. 627–628, 629, 743–744

dysplasia in 221, 630–632endoscopic detection 632–633endoscopic features 632endoscopic surveillance 630–632

endoscopic characteristics 620–625endoscopic evaluation of disease activity617–620

endoscopic ultrasonography 636enteroscopy 122, 634–635double-balloon 634–635push 634

hemorrhage 627, 647, 652histopathology 220–221medications for mucosal healing 619–620neoplasia in, endoscopic detection 632–633pediatric patients 787–788perioperative endoscopy 635primary sclerosing cholangitis and 636strictures 627surgery for 626upper endoscopy 625–626video capsule endoscopy 130, 131, 634, 635see also Crohn’s disease; ulcerative colitis

inflammatory diseases of gastrointestinal tractbiopsy guidelines 212see also specific inflammatory diseases

inflammatory fibroid polypsesophageal 503gastric 530

inflammatory polyps 602in ulcerative colitis 620, 623

information technology (IT), quality assurance and18–19

informed consent 48–54concept 48declarations protecting patients’ rights 48–49endoscopic retrograde cholangiopancreatogra-phy 153

exceptions 49historical perspectives 48incompetent patients 50Jehovah’s Witnesses 50medicolegal issues 50–51mentally impaired adults 49–50nonphysician endoscopy and 53–54obtaining 51–54for endoscopy-based research 53for live endoscopy demonstrations 53personnel responsible for 52for teaching/learning 52–53

open-access endoscopy 52pediatric patients 50as preprocedural quality indicator 16withdrawal 50

informed refusal 50injection sclerotherapy see endoscopic injectionsclerotherapy (EIS)

insufflationair 138

carbon dioxide see carbon dioxide insufflationinsulated-tip (IT) knife 336, 337intensity-modulated radiotherapy (IMRT) 666intermediate filaments 213intestinal decompression see decompressionintraductal ultrasonography (IDUS) 681intragastric balloon treatment 179–181balloons 179, 180complications 181contraindications 179–180indications 179–180results 180–181technique 180

intraoperative cholangiography 677intraoperative colonoscopy 316–317intraoperative enteroscopy 123–124, 643double-balloon enteroscopy vs. 120

intraprocedural quality indicators 17intubation, oropharyngealendoscopic retrograde cholangiopancreatogra-phy 154

esophagogastroduodenoscopy 107–108intussusception, stomal 550ischemiacolonic 606, 629, 646–647gastric 528–529mesenteric 562rectal 660, 661

isolated gastric varices (IGVs) 577, 578, 579isosorbide dinitrate (ISDN) 663Isospora belli 750

J

jaundice 53, 68, 572, 791Jehovah’s Witnesses, informed consent and 50jejunal percutaneous endoscopic gastrostomy(JPEG) 459, 466see also percutaneous endoscopic gastrostomy(PEG)

jejunitis, ulcerative 131jejunoileal bypass (JIB) 182jejunostomy 459see also direct percutaneous endoscopic jeju-nostomy (DPEJ)

jejunumangiectasia 564diverticula 563enteral feeding and 459, 466see also direct percutaneous endoscopic jeju-nostomy (DPEJ)

telangiectasia, argon plasma coagulation 295tumors 557, 558ulceration 550, 551varices 566see also small bowel

juvenile polyposis syndrome 603, 604, 786, 788juvenile polyps 536, 538, 602, 604juxtapapillary diverticula 379–380

K

Kapany, Norinder S. 4Kaposi’s sarcoma 548, 549, 560, 760colonic 760esophageal 754, 755gastric 755–756

Kartagener syndrome 766Kelling, George 11ketamine 768Klebsiella oxytoca 629Klippel–Trenaunay syndrome 786, 787knives, endoscopic 336, 337Kussmaul, Adolf 2

Index

816


L

lactating patients 68–69laparoscopic adjustable silicone gastric banding(LASGB) 182, 183, 184, 185complications 185, 186band erosion 191–192stoma obstruction 188, 189

laparoscopic cholecystectomy 245, 246, 385laparoscopic cholecystotomy (LCT) 246–248,677–678complications 677–678effectiveness 248endoscopic retrograde cholangiopancreatogra-phy and 385, 677–678

patient selection 246technique 246–248

laparoscopic–endoscopic procedures (LEPs)253–257, 723anesthesia 254colon 254, 257, 316contraindications 254duodenum 254, 256–257equipment 254, 255esophagus 254, 256general principles 254indications 254patient positioning 254polypectomy 257, 316as „pseudo-NOTES“ 257results 256–257stomach 254, 256technical aspects 254–255variants 255–256

laparoscopic ultrasonography 240malignant hepatic lesions 733, 734

laparoscopyabdominal pain 736–737bariatric surgery 184blunt abdominal trauma 737history 11liver 723biopsy 268malignant lesions 731, 732–733, 734

peritoneal disorders 726, 734, 736laparoscopy-assisted endoscopic resection 255stomach 256see also laparoscopic–endoscopic procedures(LEPs)

laser lithotripsy (LL) 286, 450–451advantages 451choledocholithiasis 168, 286, 450–451disadvantages 451„FREDDY“ 450–451, 454pancreatolithiasis 286, 712results 454

laser therapy 281–286ampullary neoplasia 283colorectal cancer 283duodenal neoplasia 283early gastrointestinal cancer/precancer283–286

hemostasis 282malignant dysphagia 282–283physics 281principles of 281tissue interactions 281treatment room 80types of laser 281–282

leiomyomagastric 540, 541small-intestinal 236, 558

leiomyosarcomagastric 548, 549small-intestinal, metastasis 735

Leiter, Josef 3

lidocaine 61, 63linitis plastica 544, 546lipomascolonic 613esophageal 502gastric 540small-intestinal 559

LithCrush V 445–447lithotripsy 443–455alternatives 454–455complications 454electrohydraulic 168, 449–450, 453–454, 455,675

extracorporeal shock-wave lithotripsy see ex-tracorporeal shock-wave lithotripsy (ESWL)

indicationscholedocholithiasis 443, 675–676pancreatolithiasis 711–712

laser see laser lithotripsy (LL)mechanical seemechanical lithotripsy (ML)percutaneous cholangioscopic 171,172–173,174,176, 443–445

peroral cholangioscopic 165, 443direct 452–453

results 453–454shock-wave 449see also choledocholithiasis

live animals 96, 98live demonstrations, informed consent and 53liver 723–724benign focal lesions 729–731adenomas 730focal nodular hyperplasia 730–731hemangioma 730hepatic cysts 729–730peliosis hepatis 731sarcoidosis 731

cirrhosis see cirrhosisfatty infiltration 724–725inflammation of see hepatitislaparoscopy see laparoscopylymphatic vessels 723, 724occlusion 729

malignant focal lesions 731–734diagnostic accuracy 731gallbladder carcinoma 734hepatocellular carcinoma 729, 733–734lymphoma 734metastatic esophageal carcinoma 731–732metastatic gastric carcinoma 732metastatic pancreatic carcinoma 732–733

normal findings 723–724„potato“ 725–726transplantation 733–734

liver biopsy 261–268, 723in cirrhosis 729complete portal tract (CPT) number 261,267–268

indications 261laparoscopic 268percutaneous see percutaneous liver biopsy(PLB)

quality of 267–268transvenous (jugular) approach 265–267

liver flukes 369, 687loperamide 744lower esophageal sphincter (LES) 488lower intestinal bleeding disorders 641–654AIDS-related 760clinical course and prognosis 641definitions 641diagnostic approach 641–645endoscopy 642–644, 653–654exploratory laparotomy 645laboratory studies 642nuclear scintigraphy 644–645

patient history 641physical examination 641–642radiology 645

differential diagnosis 645–650angiodysplasias 645–646, 647, 648anorectal diseases 648colonic lesions 645–647Dieulafoy lesion 646diverticular disease 645, 649inflammatory lesions 647, 649–650ischemia 646–647radiation injury 646, 647rectal varices 646, 647small bowel lesions 648–650, 653–654tumors 647, 649

epidemiology 641outcome, impact of endoscopy 653–654pediatric patients 654, 786, 787therapy 650–653anorectal diseases 653diverticular disease 652endoscopy 650–651, 652–654inflammatory lesions 652initial resuscitation 650neoplastic lesions 653pediatric patients 654, 786pharmacotherapy 651radiologic angiotherapy 651surgery 651vascular diseases 652

see also hemorrhagelung cancer, hepatic metastases 734lupus erythematosus 562lymphangiectasia 783lymphangioma, gastric 236lymphatic vessels, liver see liverlymph node(s)endoscopic ultrasonography 231stations, gastric cancer 546see alsometastases

lymphocysts 729lymphocytic colitis 219, 220, 610–611lymphocytic gastritis 520lymphogranuloma venereum (LGV) 659, 660lymphomagastric 217, 547–548, 591AIDS-related 756

hepatic 734Hodgkin 734immunohistochemistry 212–213MALT seemucosa-associated lymphoid tissue(MALT) lymphoma

non-Hodgkin see non-Hodgkin lymphomaperitoneal 735small bowel 559–560

lymphomatous polyposis 213Lynch syndrome 603–604

M

magnetic endoscope imaging (MEI), during colo-noscopy 140–141

magnetic resonance cholangiopancreatography(MRCP)choledocholithiasis 674, 702pancreas divisum 693, 697pancreatitis 705pediatric patients 790primary sclerosing cholangitis 683, 684

magnets, ingestion of 436, 438magnification endoscopy 21magnifying chromocolonoscopy 197–201, 300,301–302inflammatory bowel disease 633

malabsorption 555, 567pediatric patients 776, 778

Index

817


malakoplakia, gastric 523malignant dysphagia 282palliative laser therapy 282–283

malignant melanoma seemelanomaMallampati classification 59, 60Mallory–Weiss tears 276, 495–496, 514–515, 589Maloney dilators 324malpractice 50–51claims, causes of 51

MALT lymphoma seemucosa-associated lymphoidtissue (MALT) lymphoma

manometryminor papilla 697, 698sphincter of Oddi see sphincter of Oddi man-ometry (SOM)

mastocytosis 218meat impaction, esophageal 431, 433mechanical lithotripsy (ML) 373, 374, 445–449,675, 676complications 454equipment 445–447indications 443results 453technique 447–449

Meckel’s diverticulum 563, 649, 652mediastinumendoscopic ultrasonography 231see also lymph node(s)

medication-induced conditions see drug-inducedconditions

medicolegal issues, informed consent 50–51Medigus SRS endoscopic stapling system 363, 364melanomaesophageal 504metastatic 560

melanosis coli 611–612Ménétrier’s disease 526Menghini technique, liver biopsy 262mentally impaired adults, informed consent and49–50

meperidine 61, 62mesenteric ischemia 562mesothelioma 734–735metaplasia, classification 519, 520metastasesbiliary tract 680endoscopic ultrasonography 233–234, 240esophageal carcinoma 731–732gastric cancer 547, 732histopathology and 217large bowel 614liver 729, 731–733, 734pancreatic cancer 413, 732–733peritoneum 735–736intestinal decompression 425–426

small bowel 560stomach 549

methylene blue chromoendoscopy, bile duct le-sions 164–165

methyl tert-butyl ether (MTBE) 676metronidazole 607, 610, 611microcarcinoid 524microlithiasis 370, 672microsatellite instability (MSI) 603, 604microscopic colitis 30, 610–611microscopy see endomicroscopymicrosporidial infection, AIDS patients 759midazolam 61pediatric patients 768

minilaparoscopy 11, 268, 735, 737minor papillacannulation 154–157, 371, 696dilation and stenting 698–699diseases 575endoscopic papillotomy/sphincterotomy 367,379, 383, 699–700

manometry 697, 698sphincteroplasty 698surgical sphincterotomy 698, 699

Mirizzi syndrome 679MiRo 127mitochondrial neurogastrointestinal encephalo-myopathy (MNGIE). 767

monitoring, patient see patient monitoringmorbid obesity see obesitymother–baby scope system 161, 207mucosa-associated lymphoid tissue (MALT) lym-phoma 213gastric 547–548small bowel 559

mucosal B ring see Schatzki ringMultiClips 344multimodal spectroscopy 24multiple endocrine neoplasia (MEN) 217Mycobacterium avium complex (MAC) infection561, 747, 759AIDS patients 756, 759

Mycobacterium tuberculosis see tuberculosismyoma, uterine 734myotomyHeller 253pediatric patients 775, 776

N

naloxone 61, 63pediatric patients 768

narrow-band imaging (NBI) 138, 139Barrett’s esophagus 494colonic polyps 300–302, 597–598, 633

nasobiliary tube 373, 374nasogastric tubesin decompression 425esophageal trauma 495

nasogastroscopy 106, 108Natural Orifice Surgery Consortium for Assessmentand Research (NOSCAR) 245, 248

natural orifice transluminal endoscopic surgery seeNOTES (natural orifice transluminal endoscopicsurgery)

nausea, post-bariatric surgery 187NDO Plicator 345, 361, 362needle-knife papillotomy 376–378, 382Neisseria gonorrhoeae, proctitis 659, 745neonatal cholestasis 793–795neostigmine 426, 427neurinoma, gastric 236neuroendocrine tumors see carcinoid tumorsNissen fundoplication 113, 114nitinol self-expanding metal stents 394, 405, 406nitrous oxide 60, 135Nitze, Max 2non-Hodgkin’s lymphomaAIDS patients 756liver 734peritoneum 735

nonphysician endoscopy, informed consent and53–54

nonselective beta-blockers, variceal hemorrhageprophylaxis 586–587

nonsteroidal anti-inflammatory drugs (NSAIDs)colitis and 611, 629, 647colorectal cancer chemoprevention 606gastritis and 524–525ulceration and 122, 130, 775, 776gastric 533, 534–535small bowel 122, 130, 561, 649–650

NOTES (natural orifice transluminal endoscopicsurgery) 245, 248–253, 723advantages 253disadvantages 253

future directions 253training 102transanal 251transcolonic 251, 253transesophageal 253transgastric appendectomy 249–250transgastric tubal occlusion 250, 251transvaginal cholecystectomy 250–251, 252see also laparoscopic–endoscopic procedures(LEPs)

NSAIDs see nonsteroidal anti-inflammatory drugs(NSAIDs)

nuclear scintigraphy 644–645number needed to treat (NNT) 39nursing staff 80involvement in quality assurance 18safety and satisfaction 18

O

obesity 179endoscopic treatments 179–182, 364intragastric balloon treatment see intragastricballoon treatment

prevalence 179surgery for see bariatric surgery

octreotide 651odynophagiaAIDS patients 753–755pediatric patients 770–775photodynamic therapy complication 352pill esophagitis 491

Ogilvie syndrome see acute colonic pseudo-ob-struction (ACPO)

older patients see elderly patientsONYX-015 474–475open-access endoscopy 52opioids 61, 62optical coherence tomography (OCT) 24–25Oriental cholangiohepatitis 685oropharyngeal intubation see intubation, orophar-yngeal

Osler–Weber–Rendu syndrome 531, 564, 565, 646,647

oximetry, pulse 17, 51, 63–64, 79

P

painabdominal 736–737AIDS patients 755pediatric patients 775–776, 777–778post-bariatric surgery 187

chest, pediatric patients 770on swallowing see odynophagia

palisade zone 577palliative therapybiliary malignancy 413–415, 682colorectal cancer 283, 284, 293esophageal cancer 290, 327malignant dysphagia 282–283

historical aspects 8pancreasdevelopmental anomalies 693–702agenesis 701, 702annular pancreas 700–701anomalous pancreatobiliary ductal junction701, 702

see also pancreas divisumectopic 540, 541endoscopic ultrasonography 231–233drainage of fluid collections/abscesses475–479

tumor diagnosis/staging 234, 236–238inflammation of see pancreatitis

Index

818


necrosis 705–706pseudocysts see pancreatic pseudocyststrauma 798tumorspediatric patients 799, 800see also pancreatic cancer

see also pancreatic ductpancreas divisum 379, 693–700, 796, 797associated abnormalities 700annular pancreas 700–701

clinical relevance 693, 695dorsal ductography 696magnetic resonance cholangiopancreatography693, 697

management 697–700botulinum toxin injection 697dilation and stenting 419, 698–699endoscopic papillotomy/sphincterotomy 371,697, 699–700

endoscopic retrograde cholangiopancreatog-raphy 697–698

sphincteroplasty 698surgical sphincterotomy 698

minor papilla cannulation 154–157, 371, 696pediatric patients 796, 797prenatal development 693, 694ventral pancreas 695

pancreatic cancer 716–719cystic neoplasms 716–719diagnosis/staging, endoscopic ultrasonography234, 236–238

invasive 559managementendoscopic ultrasonography-guided fine-needle injection 474–475

pancreatic stenting 419photodynamic therapy 354

metastasis 413, 732–733molecular markers 681–682mucin-producing neoplasms 716–718„obstructive“ pain 419

pancreatic ductbiopsy 206–207drainage, endoscopic ultrasonography-guided481–482

endoscopic papillotomy 367, 382–383transpancreatic sphincter precutting ap-proach 378–379

fistulas 714leaks 419, 705, 706, 714stenting 9, 387, 705, 706bioabsorbable stents 420chronic pancreatitis 371, 418–419, 707–709complications 709efficacy 707–709future developments 419–420indications 418–419management of malfunctioning stents408–409

obstructive pancreatic-type pain 419pancreas divisum 371, 419, 698–699pancreatic duct strictures 418, 707–709pancreatic stones 418placement technique 707plastic stents 403–405pseudocysts 419, 712–714„wing“ stent 420

stones see pancreatolithiasisstrictures 418, 707–709

pancreatic pseudocysts 712–714drainage 371, 419, 475–479, 712–714pediatric patients 798, 801

pancreatitisacute 370, 702–706biliary 385, 386, 702–704recurrent 704–705

unresolving 705–706AIDS patients 756autoimmune 572–573, 705, 716chronic 371, 386–387, 707–716biliary strictures and 415–416, 418, 714–715endoscopic ultrasonography-guided pancre-atic duct drainage 481–482

pancreatic ductal stones 709–712pancreatic pseudocysts/fistulas 712–714pancreatic strictures 707–709sphincter of Oddi dysfunction 715stent placement 371, 418–419, 707–709

endoscopic papillotomy 370–371, 385, 386–387,703–704

endoscopic retrograde cholangiopancreatogra-phy 702, 703–705

endoscopic ultrasound diagnosis 239–240idiopathic 705pancreas divisum and 695pediatric patients 796–798post-endoscopic papillotomy 380, 381–382post-endoscopic retrograde cholangiopancrea-tography 158, 381–382

pancreatobiliary ductal junction anomaly 701, 702pancreatolithiasis 371, 383, 709–712pediatric patients 797, 798stone removal 383, 418chemical dissolution 712endoscopic 710–711lithotripsy 711–712

panendoscope 4, 94papillamajor duodenal see papilla of Vaterminor duodenal seeminor papilla

papilla of Vaterballoon dilation 10, 387endoscopic sphincterotomy vs. 688

cannulation 154–157distortion 157double-balloon enteroscopy 387, 671inflammation 572–573, 686stenosis 383, 384, 686see also ampulla of Vater; endoscopic papillot-omy (EPT)

papillary stenosis 383, 384, 686papillectomy 378, 574papillitis 572–573, 686papilloma, esophageal 501–502, 770, 772papillotomes 10, 372–373papillotomy see endoscopic papillotomy (EPT)paraesophageal hiatal hernias 498, 512, 514parasitic infections 748–750biliary 368, 369, 687colitis and 607, 628, 629diarrhea and 748–750gastric 521, 522stool evaluation 743see also specific parasites

parovarian cyst 734patient assessment, preliminary, as preproceduralquality indicator 16–17

patient discharge, as postprocedural quality indi-cator 17, 18

patient monitoringintraprocedural 63–64as quality indicator 17

systems 79patient preparationcolonic stenting 400colonoscopic polypectomy 305colonoscopy 134–135, 617, 783–784endoscopic papillotomy 372endoscopic retrograde cholangiopancreatogra-phy 153, 670

endoscopic submucosal dissection 336–337endoscopic ultrasonography 230, 670

esophageal dilation 324esophagogastroduodenoscopy 107pediatric see pediatric endoscopypercutaneous endoscopic gastrostomy 460percutaneous liver biopsy 261–262percutaneous transhepatic cholangiography 168percutaneous transhepatic cholangioscopy 168room 80for sedation see sedationvideo capsule endoscopy 128, 784

patient resuscitation see resuscitationpatient satisfaction, as postprocedural quality in-dicator 18

patients’ rights 48–49see also informed consent

pause, team, as preprocedural quality indicator 17pediatric endoscopy 766–801colonoscopy 783–785bowel preparation 783–784chronic diarrhea 787–788colitis 786–787, 788complications 789contraindications 785equipment 784indications 785inflammatory bowel disease 787–788lower gastrointestinal tract hemorrhage 786,787

polypectomy 784–785screening/surveillance for polyposis and neo-plasia 788–789

technique 784contraindications 769endoscopic retrograde cholangiopancreatogra-phy 789–796biliary stricture/disruption 793, 794, 795, 796choledochal cysts 792–793choledocholithiasis 791–792complications 798contraindications 790equipment 790indications 790–791neonatal cholestasis 793–795pancreatic pseudocyst 798, 801pancreatic trauma 798pancreatitis 796–798patient preparation 790sedation 790sphincter of Oddi dysfunction 798technique 790

endoscopic ultrasonography (EUS) 798–801enteroscopy 782–783equipment 769gastroscopes 106, 108

indications 766, 770informed consent and 50ingested coin removal 433, 435see also foreign body removal

lower gastrointestinal bleeding 654, 786, 787patient preparation 766–769antibiotic prophylaxis 769dietary restrictions 767emotional preparation 766–767sedation 767–769

percutaneous endoscopic gastrostomy 780, 782upper gastrointestinal tract see esophagogas-troduodenoscopy (EGD)

peliosis hepatis 731pelvic abscesses, drainage 479peptic strictures 326, 496–497peptic ulcers 588Helicobacter pylori and 534, 589hemorrhage 275–276, 295, 588–589hemostasis 588–589

pediatric patients 775, 776see also duodenal ulcers; gastric ulcers

Index

819


peracetic acid 87percutaneous cholecystectomy 248percutaneous endoscopic colostomy (PEC) 427percutaneous endoscopic gastrostomy (PEG)459–471complications 467, 469, 470, 782contraindications 459–460elderly patients 69indications 459decompression 425–426, 459

patient preparation 460pediatric patients 780, 782postprocedural care 466procedure 460–466introducer-type (Russell) technique 463, 464,466

optimal site location 460–462pull-type (Ponsky–Gauderer) technique462–464, 465

push-type (Sacks–Vine) technique 463, 464replacement/removal 468, 471see also direct percutaneous endoscopic jeju-nostomy (DPEJ)

percutaneous endoscopic jejunostomy see directpercutaneous endoscopic jejunostomy (DPEJ)

percutaneous liver biopsy (PLB) 261–265aftercare 263complications 263contraindications 262fine-needle aspiration biopsy 264–265Menghini technique 262patient preparation 261–262plugged 264Tru-Cut needle biopsy 262–263ultrasound-guided 265

percutaneous transhepatic cholangiographicdrainage (PTCD) 167, 176complications 175indications 167results 173technique 168–169

percutaneous transhepatic cholangiography (PTC)167, 176complications 175contraindications 167equipment 167–168history of 6, 8indications 167, 677, 678, 680, 685patient preparation 168results 173technique 168

percutaneous transhepatic cholangioplasty 167,169–170, 173

percutaneous transhepatic cholangioscopy (PTCS)167, 176complications 175contraindications 167diagnostic 167, 174equipment 167–168indications 167patient preparation 168postprocedural care 171, 173results 174–175technique 170–171therapeutic 167, 174–175stone removal 171, 172, 174, 443–445

percutaneous transhepatic papillary balloon dila-tion (PTPBD) 444, 446

perforating zone 577perforation(s)colonoscopic polypectomy and 148, 318endoscopic papillotomy and 381gastricendoscopic mucosal resection and 339endoscopic submucosal dissection and 339

sharp foreign bodies and 435–436

periampullary diverticula 158, 571, 673perianal fistulas 636perihepatitis 736peripancreatic fluid collectionsdefinitions 476–477endoscopic ultrasonography-guided drainage475–479complications 478–479future developments 479indications for intervention 476–477procedure/technique 477–478results 479

peritoneal disorders 734–737adhesions 736–737infectious diseases 736laparoscopy 734mesothelioma 734–735metastatic disease 735–736intestinal decompression 425–426

pain syndromes 736–737see also ascites

peritonitis, tuberculous 736peroral cholangioscopy 161–165, 443, 444clinical applications 164–165diagnostic 164therapeutic 164–165, 443

complications 164direct 162, 452–453future directions 165instruments 161–162, 443, 444techniques 161–163, 443, 444

pethidine 61, 62Peutz–Jeghers syndrome 604polyps 602, 604, 783, 788gastric 535small-intestinal 123, 559, 604, 783, 789

phlebectasias 564phlegmonous gastritis 521, 523phosphosoda see sodium phosphatephotodynamic therapy (PDT) 349–355complications 352, 353, 354, 355photosensitivity 351, 353

contraindications 355equipment 349–350dosimetry 350light application systems 350, 351light sources 350photosensitizers 349–350

future directions 355history of 8, 349indications 351–355Barrett’s esophagus 284–286, 289, 351–353,495

colorectal cancer 354gastric carcinoma 353, 354nonresectable cholangiocarcinoma 167,169–170, 286, 354–355

pancreatic cancer 354principles of 349see also laser therapy

Photofrin (porfimer sodium) 8, 349–3505-aminolevulinic acid (ALA) vs. 350see also photodynamic therapy (PDT)

photographic record, as intraprocedural qualityindicator 17

phytobezoar 438, 528, 550, 551piecemeal polypectomy 311–312PillCam ESO 128PillCam SB 127, 128pill-induced conditions see drug-induced condi-tions

pioneers 2–3pit pattern classification 197, 198–199treatment policies and 199, 200–201type V 199–201

recent trends in endoscopic diagnosis199–200

subclassification 200plasmacytoma, gastric 549Plexiglas 359plication devices 357, 359–364Plicator 345, 361, 362ploidy 681plugged percutaneous liver biopsy 264pneumatic dilation see balloon dilationpneumatosis cystoides intestinalis 612point spectroscopy 23polidocanol 272, 273, 277, 295polyarteritis nodosa 561–562, 776PolyDiagnost 161, 162polyethylene glycol–electrolyte solution (PEG–ELS)134, 617

Polyflex stent 396, 397polymethylmethacrylate 359polypectomy 8–9, 299colonoscopic see colonoscopic polypectomyhistory of 331postpolypectomy coagulation syndrome 148,318–319

polyposishereditary syndromes 602–604lymphomatous 213see also specific syndromes

polypscolorectal see colorectal polypsesophageal 503gallbladder 679gastric see gastric polypshistopathology 211inflammatory see inflammatory polypsjuvenile 536, 538, 602, 604small-intestinal 559argon plasma coagulation 290–291

types 299–300see also adenomas

Ponsky–Gauderer gastrostomy 462–464, 465porfimer sodium see Photofrin (porfimer sodium)portal hypertension 577–578, 723, 727AIDS patients 760cirrhosis 728–729gastric antral valve ectasia and 590gastric varices and 580hepatocellular carcinoma 733rectal varices and 646, 647

portal hypertensive gastropathy 533postcholecystectomy syndrome 686postpolypectomy coagulation syndrome 148,318–319

postpolypectomy hemorrhage 148, 319postprocedural quality indicators 17–18potato liver 725–726pouchitis 626precut papillotomy 375–376, 675pregnant patientsendoscopy 67–68sedation 60

preparation, patient see patient preparationpreparation room 80preprocedural quality indicators 16–17primary sclerosing cholangitis (PSC) 386, 415, 636,682–684classification 682endoscopic retrograde cholangiopancreatogra-phy 636, 683

inflammatory bowel disease and 636magnetic resonance cholangiopancreatography(MRCP) 683, 684

pediatric patients 793, 794peroral cholangioscopy 164–165stent placement 415, 683

probiotics 607

Index

820


procedural sedation see sedationproctitis 659–662infectious 609, 659–660, 745ischemic 660, 661radiation 646, 647, 652, 660–662

proctocolitis 659, 660prognosis studies, evidence-based evaluation43–45

prolapsegastroesophageal 514, 515rectal 662, 663, 664–665

prolapse gastropathy 514, 515promethazine 62propofol 61, 62–63pediatric patients 768

proton-pump inhibitors (PPIs)gastric polyps and 536, 539peptic ulcer management 589

pseudocysts, pancreatic see pancreatic pseudocystspseudomembranous colitis 606–607, 628, 629,747–748

Pseudomonas aeruginosa 84, 743pseudomyxoma peritonei 735pseudopolyps see inflammatory polypsPTEN hamartoma tumor syndrome 789pulse oximetry 17, 51, 63–64, 79push-and-pull enteroscopy see double-balloon en-teroscopy (DBE)

push enteroscopy 119, 634, 642see also enteroscopy

pyloroplasty 113, 114, 550pylorusdouble/split 550examination 108stenosis 339

Q

quality assurance 15–20in endoscopy 16–20data use 19endoscope reprocessing see under reprocess-ing of endoscopes/endoscopic accessories

future directions 20impact on practice 20indicators of see quality indicatorsinformation technology and 18–19nursing involvement 18

history of 15–16quality indicators 16–18intraprocedural 17postprocedural 17–18preprocedural 16–17recording 18

quality of life 44QuickClip 343

R

radiation-induced conditionsenteritis 562esophagitis 492–493gastritis 527–528proctitis 295, 646, 647, 652, 660–662

radiofrequency ablationBarrett’s esophagus 495gastroesophageal reflux disease 357–358

radiographyfacilities 78, 80small bowel 645

radiotherapyendoscopic ultrasonography-guided implanta-tion of radiopaque markers 475, 476

intensity-modulated 666rectal cancer 604

Raman spectroscopy 24Rapid Exchange system 152rapid on-site evaluation (ROSE) 229ras gene mutations 681record, photographic, as intraprocedural qualityindicator 17

recovery room 80rectal bleeding 596, 648, 653, 666pediatric patients 786see also lower intestinal bleeding disorders;specific lesions

rectal cancerlaser therapy 283, 284radiotherapy 604see also colorectal cancer

rectal prolapse 662, 663, 664–665rectal varices 646, 647, 651treatment 652

rectumanatomy 142carcinoids 613–614colitis cystica profunda 613colonoscope insertion 142–143endoscopic ultrasonography 233foreign bodies 438–440hemorrhage see rectal bleedinginfections 609, 659–660, 745inflammation of see proctitismetastatic disease 614prolapse 662, 663, 664–665radiation damage 646, 647, 652, 660–662ulceration 630see also solitary rectal ulcer syndrome (SRUS)

varices see rectal variceswarts 665

reflux esophagitis 488–490grading systems 489

refusal, informed 50rendezvous technique 380, 481Rendu–Osler–Weber syndrome 531, 564, 565, 646,647

reprocessing of endoscopes/endoscopic accessories83–88automated procedures 85–86guidelines 85–86manual procedures 85, 86new agents/disinfectants 86–87quality assurance 87–88indicator organisms 84

Spaulding criteria 83research, obtaining informed consent for 53resection see endoscopic mucosal resection (EMR)Resolution Clip 344resuscitationequipment 79esophageal variceal hemorrhage 580lower intestinal bleeding disorders 650

retrograde jejunogastric intussusception 550retroscope, third-eye 313–314riding ulcers 512, 514rights, of patients 48–49see also informed consent

rope-way enteroscopy 119Roux-en Y gastric bypass (RYGB) 182–183, 185complications 185, 186band erosion 192stomal stenosis 189–190

endoscopic access to bypassed segments192–193

see also gastric bypass (GBP)Russell gastrostomy 463, 464, 466

S

Sacks–Vine gastrostomy 463, 464safety measuresAIDS and 761colonoscopic polypectomy see colonoscopicpolypectomy

safety pin ingestion 435–436safety sphincterotomes 372, 373Salmonella infectionAIDS-associated 757, 758, 761colonic 607, 746

Santorinicele 575, 694, 697, 699Santorini duct 693, 694pancreas divisum 694stenting 371

sarcoidosis 527hepatic 731

sarcomagastric 548, 549Kaposi’s see Kaposi’s sarcoma

Savary–Gilliard dilators 324Savary–Miller classification 489Schatzki ring 488, 496, 512, 513dilation 326, 496

Schindler, Rudolf 3, 4Schindler’s disease 526, 527schistosomiasis 749scintigraphy, nuclear 644–645sclerosants 272–273, 277, 581see also endoscopic injection sclerotherapy (EIS)

sclerotherapy see endoscopic injection sclerother-apy (EIS)

ScopeGuide 140screeningBarrett’s esophagus 493–494colorectal cancer see colorectal cancer

sedation 57–64colonoscopy 135complications, risk factors 58–59elderly patients 69endoscopic papillotomy 372endoscopic retrograde cholangiopancreatogra-phy 153, 670pediatric patients 790

endoscopic ultrasonography 230, 670esophagogastroduodenoscopy 106intraprocedural monitoring 63–64lactating patients 69levels of 57–58as intraprocedural quality indicator 17

patient preparation/assessment 58–60airway evaluation 59–60fasting instructions 58obtaining medical history 58–59physical examination 59special considerations 60

pediatric patients 767–769pharmacological options 60–63adjuvant agents 61, 62antagonists 61, 63benzodiazepines 61opioids 61, 62propofol 61, 62–63topical agents 61

procedures without 60see also general anesthesia

self-bougienage 327self-expanding metal stents (SEMS) 393biliary 405–406, 407–408, 409–412, 715colonic 398–400covered vs. uncovered 406duodenal 398, 399esophageal 393–396for malignant gastric outlet obstruction 397materials 394, 405

Index

821


self-expanding metal stents (SEMS)mesh type/design 405see also stent(s)

self-expanding plastic stents (SEPS), esophageal393, 396, 397

sentinel polyp 512, 513serositis 148, 318–319Serratia marcescens 84, 743sexually transmitted proctitis (STP) 659–660, 745sharp objects, ingestion of 435–436, 437, 780, 781Shigella 742, 743, 745AIDS-related diarrhea 757, 758colitis 745–746

shock-wave lithotripsy 449sigmoid colonanatomy 143colitis cystica profunda 613colonoscope insertion 143–145diverticulosis 143, 145, 629, 645, 646pneumatosis cystoides intestinalis 612volvulus 428–429see also colon

sigmoidoscopy, flexible 53–54, 60, 134colorectal polyp screening 596, 605pregnant patients 67pseudomembranous colitis 607

sildenafil, sphincter of Oddi dysfunction 686–687simulators see trainingsingle-balloon enteroscope 120, 121insertion 122

single-balloon enteroscopy 121–123, 124sliding hiatal hernia 498, 512, 513small bowelamyloid deposition 567angiectasia/angiodysplasia 122, 130, 563–564,565–566hemorrhage 648

biopsy 212, 217–219, 220bulges 557congenital lesions 555, 563decompression 425–426diverticula 563, 649duplication cysts 563hemorrhage 555, 556, 565–566, 648–650,653–654pediatric patients 782

malabsorption seemalabsorptionpolyps 559argon plasma coagulation 290–291see also Peutz–Jeghers syndrome

radiography 645tumors 219, 290–291, 555–560, 649adenoma/adenocarcinoma 557–559, 649argon plasma coagulation 290–291carcinoid 559, 649diagnosis 556–557, 558histopathology 219Kaposi sarcoma 560lipomas 559lymphoma 559–560metastatic disease 560stromal 557symptoms and signs 555–556types 557video capsule endoscopy 130–131, 556

ulcerative/erosive lesions 130, 555, 560–562,649–650Crohn’s disease 560, 561graft-versus-host disease 562–563infections 560–561medication-induced 122, 130, 561, 649–650mesenteric ischemia 562radiation injury 562vasculitis 561–562Zollinger–Ellison syndrome 560

vascular lesions 555, 563–566

angiectasia 122, 130, 563–564, 565–566varices 566

Whipple disease 218, 567see also duodenum; enteroscopy; ileum; jeju-num

small cell carcinoma, esophageal 504snaresdetachable 279, 303–304mini-snares 278–279polypectomy 203, 303–304, 305, 313see also colonoscopic polypectomy

rotatable 313variceal ligation 279

sodium phosphate 134–135, 617colonic injury 611

sodium tetradecyl sulfate (STD) 272Soehendra lithotriptor 447Soehendra–Tannenbaum stent 403, 404, 420solitary rectal ulcer syndrome (SRUS) 612–613,630, 648, 653, 662–663differential diagnosis 662pediatric patients 786treatment 662–663

sonde enteroscopy 119Spaulding classification 83spectroscopy 23–24elastic scattering 23–24fluorescence 23multimodal 24point 23Raman 24

sphincter of Oddi dysfunction (SOD) 367, 574–575,685–687botulinum toxin injection 686classification 575, 686pancreatitis and 705, 715pediatric patients 798sildenafil therapy 686–687sphincterotomy 367, 385–386, 575, 686

sphincter of Oddimanometry (SOM) 367, 574–575,685–686, 705pediatric patients 798

sphincteroplasty 698sphincterotomes 152–153, 372–373disposable 373safety 372, 373see also endoscopic papillotomy (EPT)

sphincterotomyendoscopic see endoscopic sphincterotomy (ES,EST)

surgical 367minor papilla 698, 699

Spiderman suturing device 345splenic artery embolization, partial, gastric varicealbleeding 586

splenic flexureanatomy 145, 146colonoscope insertion 144, 145–146

split pylorus 550sprue see celiac diseasesquamocolumnar junction (SCJ) 488squamous cell carcinomaanal canal 665, 666esophageal 332, 503see also esophageal cancer

squamous papilloma, esophageal 501–502, 770,772

staffendoscopy suite 80nursing see nursing staff

stagingcholangiocarcinoma 680, 682colorectal cancer 604, 605endoscopic ultrasonography and 229, 233–235,236–238

esophageal cancer see esophageal cancer

gastric cancer see gastric cancerpancreatic cancer 234, 236–238

staple-line disruption, bariatric surgery complica-tion 186, 190–191

stapling, Medigus SRS endoscopic system 363, 364stenosesaortic 566biliary 386–387dissection-induced 339esophageal see esophaguspapillary 383, 384, 686pyloric 339resection-induced 339stenting see stent(s)stomal 188–189see also strictures

stent(s)drug-eluting 420placementbiliary see biliary stentingfor colonic obstruction 398–400, 427complications see under complicationsesophageal see esophagusgastroduodenal 397–398, 399for malignant gastric outlet obstruction 397minor papilla 698–699pancreatic see pancreatic ductpregnant patients 67, 68

stercoral ulcers 613sterilizationdefinition 83see also reprocessing of endoscopes/endoscopicaccessories

stomachanatomynonpathological alterations 111–114normal 110–111, 511–512

antrum 110, 111, 511biopsy see biopsycancer see gastric cancercardia 109, 110, 511, 512decompression 425–426, 459diverticulum 514endoscopic ultrasonography 230, 231enteral nutrition and see percutaneous endo-scopic gastrostomy (PEG)

fundus 110, 111, 511gastric body 110, 111hernias see hiatal herniashistopathology 215–219inflammatory conditions 215–217neoplastic conditions 217

inflammation see gastritisischemia 528–529polyps see gastric polypspostoperative 113, 549–552thoracic 514tissue sampling 206ulcers see gastric ulcersupside-down 512, 514varices see gastric varicesvascular disorders 531–533angiodysplasia 531Dieulafoy lesion see Dieulafoy lesiongastric antral valve ectasia see gastric antralvalve ectasia (GAVE)

portal hypertensive gastropathy 533vasculitis 528–529

see also esophagogastroduodenoscopy (EGD)stomal intussusception 550stomal obstruction, bariatric surgery complication186, 188–190

stomal stenosis, bariatric surgery complication186, 188–190

stomal ulceration 550, 551stress-induced conditions, gastritis 528

Index

822


Stretta device 357–358stricturesbile duct see bile ductdilation see dilationesophageal see esophagusinflammatory bowel disease 627pancreatic duct 418, 707–709peptic 326, 496–497stenting see stent(s)ulcerative colitis 627see also stenoses

strip biopsy 334stromal tumors see gastrointestinal stromal tumors(GISTs)

Strongyloides infection 216, 561, 750studies, evidence-based evaluation of see evidence-based endoscopy

submucosal lesions, endoscopic ultrasonography235–236

sump syndrome 368, 369surgeryanatomic variations as result of 112–114antireflux, Barrett’s esophagus 495bariatric see bariatric surgeryinflammatory bowel disease 626postoperative stomach 113, 549–552see also specific surgical techniques

surveillanceBarrett’s esophagus 493–494colorectal polyps/cancer 29, 605elderly patients 69pediatric patients 788–789

ulcerative colitis 630–633, 632–633suture granuloma 550suturinganti-obesity techniques 364devices 343, 344–346future prospects 346

swallowingdifficulty see dysphagiapainful see odynophagia

Syntheon Antireflux Device 363syphilisgastric 521, 522rectal 660

T

tamponade, balloon see balloon tamponadetattooing, colonic 201, 317, 601team pause, as preprocedural quality indicator 17telangiectasia 564argon plasma coagulation 295hereditary hemorrhagic 531, 564, 565, 646, 647

temoporfin 354terminal ileum see ileumthalidomide 651therapeutic endoscopyevidence-based evaluation 37–39history 8–10see also specific endoscopic procedures

therapeutic privilege 49thermocoagulation 273–274, 650–651, 652hemoclips vs. 275

third-eye retroscope 313–314thoracic stomach 514threadworm 216thrombin injection 273, 585–586timeliness, as preprocedural quality indicator 16tissue ablation see ablationTissue Apposition System (TAS) 345tissue sampling 203–207devices 203–205techniques 206–207in colonoscopy 206

in endoscopic retrograde cholangiopancrea-tography 206–207, 386

in endoscopic ultrasonography–fine-needleaspiration 207

in enteroscopy 206in esophagogastroduodenoscopy 206

see also biopsy; histopathologytissue staining see chromoendoscopyTNFerade 474topical anesthesia 61torus pyloricus 98trachesophageal fistula 770, 771traction diverticula 499training 92–102colonoscopy 92–93courses 100–102comparison of teaching models 101–102live video 94studies of 100–101

endoscopic retrograde cholangiopancreatogra-phy 93–94

endoscopic ultrasonography 241esophagogastroduodenoscopy 92–93future prospects 102guidelines 92–93informed consent and 52–53instructors 102„learning pyramid“ 93, 94quality assurance 19simulators 94–100computer 95–96ex vivo porcine tissue 97, 98–100live animals 96, 98static 94–95

studies on 92–93transabdominal ultrasonographycholedocholithiasis 673, 674cholelithiasis 672–673, 679

transcolonic cholecystectomy 251, 253transgastric appendectomy 249–250transgastric tubal occlusion 250, 251transjugular intrahepatic portosystemic shunt(TIPS)esophageal variceal bleeding 583gastric variceal bleeding 586

transjugular liver biopsy (TJLB) 265–267transmural burn 148, 318–319transoral gastroplasty (TOGA) 364transoral incisionless fundoplication (TIF) 361, 363transplantationbone marrow 562liver 733–734see also graft-versus-host disease (GVHD)

transportal obliteration, gastric variceal bleeding586

transvaginal cholecystectomy 250–251, 252transverse colonanatomy 146colonoscope insertion 146–147see also colon

transverse gamma loop 145, 147Trapezoid RX 447traumablunt abdominal 737gastric 528nonendoscopic tube, esophageal 495pancreatic 798

Treponema pallidum, proctitis 660, 745trichobezoar 438, 528, 780, 781TriClip 344trimethadione 712Tru-Cut needle biopsy, liver 262–263truncal zone 577tubal occlusion, transgastric 250, 251tuberculosis 747, 748colonic 608, 747, 748

esophagitis 491gastric 521, 522hepatic 724, 736peritoneal 736small-intestinal 560–561, 747, 748

tumor(s)ampulla of Vater see ampulla of Vateranal 665–666bile duct see bile ductcarcinoid see carcinoid tumorscolonic 613–614see also colorectal cancer

duodenal 557see also duodenal cancer

esophageal see esophageal tumorsgallbladder 679, 680, 734granular cell 502pancreaspediatric patients 799, 800see also pancreatic cancer

resection, histopathology and 332small bowel see small bowelstaging see stagingstromal see gastrointestinal stromal tumors(GISTs)

see also specific tumorsTurner syndrome 564tutors 102see also training

U

ulcerationcolonic see colonic ulcersCrohn’s disease see Crohn’s diseaseduodenal see duodenal ulcersesophageal see esophagusgastric see gastric ulcerspeptic see peptic ulcersrectal see rectumsmall-bowel see small bowelstomal 550, 551

ulcerative colitisbiopsy 620chromoendoscopy 632–633colonoscopy 147, 617–618, 620bowel preparation 617complications 620

colorectal cancer risk 630differential diagnosis 627–630, 743–744endomicroscopy 29–30, 633endoscopic characteristics 620–622, 623, 744endoscopic evaluation of disease activity617–618

endoscopic ultrasonography 636hemorrhage 647histopathology 220–221, 744medications for mucosal healing 619–620pediatric patients 787–788pseudopolyps in 620, 623quiescent 620strictures 627surveillance procedures 630–633, 632–633see also inflammatory bowel disease (IBD)

ulcerative jejunitis 131ulcus jejuni pepticum 550, 551ultrasonography see endoscopic ultrasonography(EUS)

ultrasound-guided liver biopsy 265upper gastrointestinal tractanatomydifficult-to-examine locations 114nonpathological alterations 111–114normal 109–111surgically modified 112–114

Index

823


upper gastrointestinal tractbleeding disorders 577–591AIDS-related 760hemostasis see hemostasisnonvariceal 587–591pediatric patients 778–779variceal 577–587see also hemorrhage

endoscopyendoscopic ultrasonography 230–231, 232esophagogastroduodenoscopy see esophago-gastroduodenoscopy (EGD)

see also duodenum; esophagus; stomachupside-down stomach 512, 514uterine myoma 734

V

vancomycin 607varicescherry-red spots 500, 577esophageal see esophageal varicesgastric see gastric variceshemodynamics 577–578hemorrhagehemostasis see hemostasisprediction 578–579

prophylaxis 586–587primary 586–587secondary 587

rectal see rectal varicessmall bowel 566

varioliform gastritis 529–530vasculitissmall bowel 561–562stomach 528–529

venous ectasias 564ventral pancreas 695verrucous carcinoma, esophageal 504vertical banded gastroplasty (VBG) 183, 184complications 185, 186band erosion 192staple-line dehiscence and gastrogastric fis-tula 190

stomal stenosis 188–189video capsule endoscopy (VCE) 127–132, 643–644complications 129contraindications 129–131, 634enteroscopy and 8, 119, 131, 132history of 8indications 129–131, 556, 634Crohn’s disease 130, 131, 634, 635, 782–783gastrointestinal bleeding 129–130, 644, 653,654

interpretation 128limitations 128–129patient preparation 128, 783pediatric patients 782–783retained capsule removal 121technology 127–128

video integration systems 79in clinical training 94

viral infections 745anorectal 660, 745colonic 609, 628, 629, 745esophageal 490–491gastric 520–521, 522see also specific infections; specific viruses

visceral angiography 645volvulus, sigmoid 428–429vomitingpost-bariatric surgery 187

unexplained, pediatric patients 775–776,777–778

von Mikulicz-Radecki, Johannes 2

W

waiver, of informed consent 49walled-off pancreatic necroses (WOPNs) 476, 477,479

Wallflex stent 394, 395, 406warfarin therapy 71–72warts, genital 665, 760, 761watermelon stomach see gastric antral valve ectasia(GAVE)

Whipple’s disease 218, 567wire-guided polyvinyl dilators 325wireless video capsule endoscopy see video capsuleendoscopy (VCE)

X

xanthelasma, gastric 517xanthography 724, 725

Y

„yellow writing“ 724, 725Yersinia enterocolitica infection 607, 629, 746

Z

Zahn anomaly 724, 725Zenker diverticulum 115, 498–499argon plasma coagulation 295

Zollinger–Ellison syndrome 526, 560

Index

824


Preface - bücher.de · 2019-01-02 · increase safety and reduce the time required for surgery....

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