ERCP and EUS

Linda S. LeeEditor

ERCP and EUS

A Case-Based Approach

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Videos to this book can be accessed at http://link.springer.com/book/10.1007/978-1-4939-2320-5.

ISBN 978-1-4939-2319-9 ISBN 978-1-4939-2320-5 (eBook)DOI 10.1007/978-1-4939-2320-5

Library of Congress Control Number: 2015938809

Springer New York Heidelberg Dordrecht London© Springer Science+Business Media New York 2015This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

Springer Science+Business Media LLC New York is part of Springer Science+Business Media (www.springer.com)

EditorLinda S. LeeDirector, Endoscopic Education and Women’s Health in Gastroenterology Brigham and Women’s HospitalGastroenterology, Hepatology, and EndoscopyAssistant Professor of MedicineHarvard Medical SchoolBoston, MAUSA

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Preface

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic to a mainly therapeutic procedure over the past 40 years. Endo-scopic ultrasound (EUS) with magnetic resonance cholangiopancreatography (MRCP) have largely replaced the diagnostic capabilities of ERCP with their decreased morbidity and comparable accuracy for a variety of pancreaticobil-iary disorders. This is reflected by the overall decrease in utilization of ERCP over the recent decades. EUS has begun a similar foray into therapeutics al-though it remains a mainstay for diagnosis and staging of luminal as well as extraluminal cancers and other lesions. With the inexorable trend towards minimally invasive procedures, EUS offers a complementary approach to ERCP especially with surgically altered anatomy and inaccessible ampullae or biliary and pancreatic ducts.

This practical case-based textbook guides the reader through scenarios involving the use of ERCP and EUS. Both parts of the book begin with chap-ters providing an overview of the key aspects of training and technique in ERCP and EUS. Historically endoscopic training has resembled an appren-ticeship. Recently, attention has been focused on the assessment of compe-tency. This is critical not only during training, but also amongst practicing gastroenterologists, especially with the development of new techniques. The ongoing evolution of endoscopic techniques requires novel ways to train and evaluate endoscopists, which remain in their infancy.

In the ERCP section, special attention is paid to understanding the indi-cations and complications of the procedure and importantly, the steps to minimize complications. While true for all endoscopic procedures, ensuring appropriate indication for an ERCP is the most critical step to preventing complications and thereby protecting the patient as well as the physician. The signature indications for ERCP including biliary stones, biliary strictures, and cholangitis have not changed although innovations including EUS evaluation of the biliary system, balloon sphincteroplasty, single-operator choledochos-copy, and fully covered metal stents have modified our approach to these situations. For pancreatic diseases, development of endoscopic cystgastros-tomy and necrosectomy have transformed the paradigm for managing pseu-docysts and walled-off pancreatic necrosis and demand intimate knowledge of both ERCP and EUS techniques. The changing landscape of diseases with the appreciation of autoimmune pancreatitis, autoimmune cholangiopathy, intraductal papillary mucinous neoplasm, and postsurgical patients require

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not only understanding of these entities, but also insight into the appropriate equipment necessary to fully evaluate and manage these patients.

In the EUS section, the wide variety of accessories and equipment as well as basic cytopathology for the endosonographer is reviewed. The endosonog-rapher must be comfortable with the radial and linear echoendoscopes as well as the high-frequency ultrasound probes and available needles in order to select the appropriate tools for a given procedure. The cornerstone of EUS still involves staging of luminal cancers and evaluating subepithelial lesions. However, EUS has evolved beyond this to play a critical role in the evalu-ation of benign and malignant pancreaticobiliary diseases as well as lung cancer. The therapeutic role of EUS remains in its adolescence, and currently focuses on celiac plexus neurolysis and endoscopic cystgastrostomy and necrosectomy with recent enthusiasm for EUS-guided biliary and pancreatic access. Improved accessories and devices are required to advance the realm of therapeutic EUS.

Through the use of cases and videos, this textbook provides physicians and trainees who practice or refer patients for ERCP and EUS a clear and practical resource about these procedures. The leading authorities around the world who have contributed to this endeavor provide not only an overview of the standard of care but also their expert opinions, tips, and tricks.

I am deeply grateful to all those who contributed to this book in the midst of their incredibly busy careers and lives. I believe this work will help improve the quality of care provided to patients potentially needing ERCP and EUS, and sincerely hope it serves as a guide to those involved in the care of these patients.

Preface

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Contents

Part I Overview of ERCP

1 Training in Endoscopic Retrograde Cholangiopancreatography ........................................................... 3Alexander Lee and Linda S. Lee

2 Indications for ERCP .................................................................... 19Joseph K. Kim and David L. Carr-Locke

3 Overview of ERCP Complications: Prevention and Management ............................................................................ 37Nalini M. Guda and Martin L. Freeman

4 ERCP from Soup to Nuts: Evaluation, Preparation, Execution, and Follow-Up ............................................................. 57John Baillie

Part II Biliary Cases

5 Biliary Stones .................................................................................. 79Hemanth K. Gavini and John T. Cunningham

6 Biliary Infections ............................................................................ 95Sundeep Lakhtakia and Shyam Varadarajulu

7 Diagnosing Biliary Strictures and Indeterminate Biliary Strictures ............................................................................ 111Mansour A. Parsi and John J. Vargo

8 Management of Biliary Strictures and Bile Duct Injury ...................................................................... 131Guido Costamagna, Ivo Boškoski, Pietro Familiari and Andrea Tringali

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9 Other Benign Biliary Strictures: Sclerosing Cholangitis, Autoimmune Cholangitis, Post-Liver Transplant .................... 147Charles C. Gabbert, Jennifer Chennat and Adam Slivka

10 Choledochal Cysts: Evaluation and Management .................... 165James Stayner and Douglas G. Adler

Part III Pancreatic Cases

11 Acute Biliary Pancreatitis: Image, Intervene, or Observe? ................................................................................... 181Faris M. Murad and Steve Edmundowicz

12 Endoscopic Management of Complications in Acute Pancreatitis ........................................................................ 195Wasif M. Abidi and Christopher C. Thompson

13 ERCP in Chronic Pancreatitis .................................................... 215Amit Maydeo, Suryaprakash R. Bhandari and Mukta R. Bapat

14 Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry ............................ 227Ji Young Bang and Gregory A. Coté

15 ERCP in Other Pancreatic Disorders ......................................... 243Surinder Singh Rana and Robert H. Hawes

Part IV Special Considerations

16 Bleeding from the Papilla ............................................................ 263Simon K. Lo

17 ERCP in Post-Surgical Patients .................................................. 277Jemilat O. Badamas and Patrick I. Okolo

18 Ampullectomy ............................................................................... 291Andrew C. Storm and Christopher C. Thompson

19 ERCP in Pregnancy ..................................................................... 305Bahar Madani and Paul R. Tarnasky

20 Pediatric Endoscopic Retrograde Cholangiopancreatography ......................................................... 325Quin Y. Liu and Douglas S. Fishman

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Part V EUS – Overview

21 Training in Endoscopic Ultrasound ............................................ 343Rahul Pannala and Douglas O. Faigel

22 Equipment and Approach ........................................................... 357Ali A. Siddiqui, Anna Strongin, Andrew Kistler and Mohamad A. Eloubeidi

23 Techniques of Endoscopic Ultrasound-Guided Fine Needle Aspiration ......................................................................... 371Abdurrahman Kadayifci and William R. Brugge

24 Essential Cytopathology Concepts for the Endosonographer ......................................................................... 387Akeesha A. Shah, Susanne K. Jeffus and Edward B. Stelow

Part VI Diagnostic EUS in Luminal Disorders

25 Esophageal Cancer....................................................................... 409Lauren G. Khanna and Charles J. Lightdale

26 Gastric Cancer and Thickened Gastric Wall............................. 423Rei Suzuki, Takuto Hikichi, Atsushi Irisawa, Obara Katsutoshi, Hiromasa Ohira and Manoop. S. Bhutani

27 Rectal Cancer and Anal Sphincter Disorders ............................ 439Ferga C. Gleeson and Michael J. Levy

28 Subepithelial Lesions ................................................................... 457Christopher S. Huang and John R. Saltzman

Part VII Diagnostic EUS in Extraluminal Disorders

29 Endosonography of the Mediastinum ........................................ 481Kondal R. Kyanam Kabir Baig and Michael B. Wallace

30 EUS in Pancreatic Tumors .......................................................... 495Michael Sai Lai Sey, John DeWitt and Mohammad Al-Haddad

31 EUS in Pancreatic Cysts .............................................................. 515Linda S. Lee

32 EUS in Acute Pancreatitis, Chronic Pancreatitis, and Autoimmune Pancreatitis..................................................... 531J. Enrique Dominguez-Muñoz, Jose Lariño-Noia and Julio Iglesias Garcia

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Part VIII EUS in Therapeutics

33 Endoscopic Ultrasound-Guided Fine-Needle Injection ............ 551Jason B. Samarasena, Jason Yan-Lin Huang, Muhammad F. Dawwas and Kenneth J. Chang

34 EUS-Guided Bilio-Pancreatic Drainage..................................... 575Marc Giovannini, Erwan Bories and Felix Tellez

Index ...................................................................................................... 589

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Contributors

Wasif M. Abidi Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA

Douglas G. Adler Department of Gastroenterology and Hepatology, School of Medicine, Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA

Mohammad Al-Haddad Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, IN, USA

Jemilat O. Badamas Division of Gastroenterology, Department of Medi-cine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

John Baillie Virginia Commonwealth University, Medical Center, Rich-mond, VA, USA

Ji Young Bang Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA

Mukta R. Bapat Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India

Suryaprakash R. Bhandari Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India

Manoop. S. Bhutani Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Erwan Bories 1Endoscopic Unit, Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France

Ivo Boškoski Digestive Endoscopy Unit, Catholic University of Rome, Gemelli Hospital, Rome, Italy

William R. Brugge Department of Medicine/Gastroenterology, Massachu-setts General Hospital, Boston, MA, USA

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David L. Carr-Locke Mount Sinai Beth Israel Medical Center, Division of Digestive Diseases, Icahn School of Medicine, New York, NY, USA

Kenneth J. Chang Division of Gastroenterology and Hepatology, Univer-sity of California Irvine, Orange, CA, USA

Jennifer Chennat Department of Medicine, University of Pittsburgh Medi-cal Center Presbyterian, Pittsburgh, PA, USA

Guido Costamagna Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Rome, Italy

Gregory A. Coté Department of Medicine, Division of Gastroenterology, Medical University of South Carolina, Charleston, SC, USA

John T. Cunningham Division of Gastroenterology, University of Arizona Health Sciences Center, Tucson, AZ, USA

Muhammad F. Dawwas Division of Gastroenterology and Hepatology, University of California Irvine, Orange, CA, USA

John DeWitt Division of Gastroenterology and Hepatology, Indiana Uni-versity Medical Center, Indianapolis, IN, USA

Steve Edmundowicz Washington University, St. Louis, MO, USA

Mohamad A. Eloubeidi Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL, USA

Douglas O. Faigel Department of Gastroenterology, Mayo Clinic, Scotts-dale, AZ, USA

Pietro Familiari Digestive Endoscopy Unit, Policlinico Universitario Agos-tino Gemelli, Rome, Italy

Douglas S. Fishman Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

Martin L. Freeman Division of Gastroenterology, Hepatology and Nutri-tion, University of Minnesota, Minneapolis, MN, USA

Department of Medicine, GI Division, University of Minnesota Medical Center - Fairview, Minneapolis, MN, USA

Charles C. Gabbert Division of Gastroenterology, Hepatology and Nutri-tion, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

xiiiContributors

Julio Iglesias Garcia Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain

Hemanth K. Gavini Division of Gastroenterology, University of Arizona Health Sciences Center, Tucson, AZ, USA

Marc Giovannini 1Endoscopic Unit, Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France

Ferga C. Gleeson Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA

Nalini M. Guda Gastroenterology, Aurora St. Lukes Medical Center, Mil-waukee, WI, USA

Robert H. Hawes University of Central Florida College of Medicine, Flor-ida Hospital Institute for Minimally Invasive Therapy, Center for Interven-tional Endoscopy, Florida Hospital, Orlando, FL, USA

Takuto Hikichi Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

Christopher S. Huang Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

Atsushi Irisawa Department of Gastroenterology, Fukushima Medical Uni-versity Aizu Medical Center, Aizuwakamatsu, Japan

Susanne K. Jeffus Department of Pathology, University of Arkansas for Medical Science, Little Rock, AR, USA

Kondal R. Kyanam Kabir Baig Mayo Clinic College of Medicine, Jack-sonville, FL, USA

Abdurrahman Kadayifci Department of Medicine/Gastroenterology, Gaziantep University Hospital, Gaziantep, Turkey

Department of Medicine/Gastroenterology, Massachusetts General Hospital, Boston, MA, USA

Obara Katsutoshi Division of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

Lauren G. Khanna Division of Digestive and Liver Disease, Columbia University Medical Center, New York, NY, USA

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Joseph K. Kim Mount Sinai Beth Israel Medical Center, Division of Diges-tive Diseases, Icahn School of Medicine, New York, NY, USA

Andrew Kistler Thomas Jefferson University Hospital, Philadelphia, PA, USA

Michael Sai Lai Sey Division of Gastroenterology and Hepatology, London Health Sciences Centre-Victoria Hospital, University of Western Ontario, London, ON, Canada

Sundeep Lakhtakia Asian Institute of Gastroenterology, Hyderabad, AP, India

Jose Lariño-Noia Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain

Alexander Lee Department of Gastroenterology, Hepatology and Endos-copy, Brigham and Women’s Hospital, Boston, MA, USA

Linda S. Lee Department of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Michael J. Levy Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA

Charles J. Lightdale Division of Digestive and Liver Disease, Columbia University Medical Center, New York, NY, USA

Quin Y. Liu Division of Gastroenterology, Hepatology, and Nutrition, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Los Angeles, CA, USA

Simon K. Lo Department of Medicine, Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Bahar Madani Methodist Dallas Medical Center, Dallas, Texas, USA

Amit Maydeo Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India

J. Enrique Dominguez Muñoz Department of Gastroenterology and Hepa-tology, University Hospital of Santiago de Compostela, Santiago de Compos-tela, La Coruña, Spain

Faris M. Murad Washington University, St. Louis, MO, USA

Hiromasa Ohira Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan

xvContributors

Patrick I. Okolo Department of Gastroenterology and Hepatology, Depart-ment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Rahul Pannala Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA

Mansour A. Parsi Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology/A31, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

Surinder Singh Rana Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

John R. Saltzman Department of Endoscopy, Brigham and Women’s Hos-pital, Boston, MA, USA

Jason B. Samarasena Division of Gastroenterology and Hepatology, Uni-versity of California Irvine, Orange, CA, USA

Akeesha A. Shah Department of Pathology, University of Virginia Health Sciences, Charlottesville, VA, USA

Ali A. Siddiqui Thomas Jefferson University Hospital, Philadelphia, PA, USA

Adam Slivka Department of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA

James Stayner Department of Gastroenterology and Hepatology, School of Medicine, Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA

Edward B. Stelow Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA

Andrew C. Storm Division of Gastroenterology, Hepatology and Endos-copy, Brigham and Women’s Hospital, Boston, MA, USA

Anna Strongin Thomas Jefferson University Hospital, Philadelphia, PA, USA

Rei Suzuki Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan

Paul R. Tarnasky Methodist Dallas Medical Center, Dallas, TX, USA

xvi Contributors

Felix Tellez 1Endoscopic Unit, Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France

Christopher C. Thompson Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Andrea Tringali Digestive Endoscopy Unit, Policlinico Universitario Agos-tino Gemelli, Rome, Italy

Shyam Varadarajulu Center for Interventional Endoscopy, Florida Hospi-tal, Orlando, FL, USA

John J. Vargo Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland, USA

Michael B. Wallace Mayo Clinic College of Medicine, Jacksonville, FL, USA

Jason Yan-Lin Huang Department of Gastroenterology, University of Cali-fornia Irvine Medical Center/The Royal Brisbane and Women’s Hospital, Orange, CA, USA