Sridhar Diagnostic and Therapeutic Procedures in Gastroenterology

An Illustrated Guide
1. Auflage 2011
ISBN: 978-1-59745-044-7
Verlag: Humana Press
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 383 Seiten

Diagnostic and Therapeutic Procedures in Gastroenterology: An Illustrated Guide is a comprehensive volume describing procedures for the gastrointestinal tract in a simple way. Artistic illustrations are provided to educate the physician about procedures, and to provide not only clear descriptions of the changes in the anatomy and physiology, but also to provide advice on medical management of the post-procedure patient. Clear, detailed, artist-rendered illustrations of the anatomy are included as well as appropriate, radiological images. Chapters describe in detail the indications, contraindications, anatomical alterations, and physiological alterations that result from various operations and procedures. Comparisons between alternative operations, complications, medical management issues, and costs are also discussed. Diagnostic and Therapeutic Procedures in Gastroenterology: An Illustrated Guide is a unique volume, written primarily for primary care physicians and general internists. It is also suitable for medical students, residents, nurses and nurse practitioners, nutritionists, dietitians and various subspecialists, who take care of patients with gastrointestinal disorders.

Autoren/Hrsg.

Sridhar, Subbaramiah

Inhaltsverzeichnis

1;Diagnostic and Therapeutic Procedures in Gastroenterology;3
1.1;Dedication;5
1.2;Foreword;7
1.3;Preface;9
1.4;Contents;11
1.5;Contributors;13
1.6;1: Esophageal Strictures and Endoscopic Management;17
1.6.1;Introduction;17
1.6.2;Etiology of Esophageal Strictures;18
1.6.3;Diagnostic Work-up;18
1.6.4;Indications for Endoscopic Esophageal Dilation;19
1.6.5;Patient Preparation for Esophageal Dilation;19
1.6.6;Endoscopic Dilation Techniques;20
1.6.7;Complications of Esophageal Dilation;24
1.6.8;Alternative Management;24
1.6.9;Summary of Key Points;24
1.6.10;References;24
1.7;2: Endoscopic Management of Barrett’s Esophagus;26
1.7.1;Introduction;26
1.7.2;Endoscopy in Barrett’s Esophagus;27
1.7.3;Endoscopic Surveillance;28
1.7.3.1;BE Without Dysplasia;28
1.7.3.2;BE with LGD;28
1.7.3.3;BE with HGD;29
1.7.4;Advanced Endoscopic Imaging of Barrett’s Esophagus;29
1.7.4.1;High-Resolution/High-Definition/Magnification Endoscopy;30
1.7.4.2;Chromoendoscopy;30
1.7.4.3;Narrow Band Imaging;31
1.7.4.4;Autofluorescence Imaging;32
1.7.4.5;Confocal Laser Endomicroscopy;34
1.7.5;Endoscopic Therapy in Barrett’s Esophagus;35
1.7.5.1;Patient Group to Be Treated;35
1.7.5.1.1;Patients with LGD;35
1.7.5.1.2;Patients with HGD;35
1.7.5.2;Pre-endoscopic Therapy Work-up;37
1.7.5.2.1;Role of EUS;37
1.7.5.2.2;Diagnostic EMR;37
1.7.5.3;Eradication Therapies for BE;38
1.7.5.4;Photodynamic Therapy;39
1.7.5.5;Radiofrequency Ablation;39
1.7.5.6;Cryotherapy;40
1.7.5.7;Limitations of Ablative Therapies;41
1.7.5.8;Complications of Ablative Therapies;41
1.7.5.9;Endoscopic Mucosal Resection or Mucosectomy;42
1.7.5.9.1;Therapeutic EMR;42
1.7.5.10;Post-endoscopic Therapy BE Surveillance;44
1.7.6;References;44
1.8;3: Gastrointestinal Tract Stenting;48
1.8.1;Introduction;48
1.8.2;Esophageal Stent Placement;48
1.8.2.1;Indications;48
1.8.2.2;Contraindications;49
1.8.2.3;Technique;50
1.8.2.4;Complications;52
1.8.2.5;Postoperative Care;53
1.8.2.6;Outcomes;53
1.8.3;Benign Disease;55
1.8.3.1;Available Devices;55
1.8.4;Enteral Stent Placement;56
1.8.4.1;Indications;56
1.8.4.2;Contraindications;57
1.8.4.3;Technique;57
1.8.4.4;Complications;59
1.8.4.5;Postoperative Care;60
1.8.4.6;Clinical Efficacy;60
1.8.4.7;Available Devices;60
1.8.4.8;Alternative Treatments;61
1.8.5;Colonic Stenting;61
1.8.5.1;Indications;61
1.8.5.2;Contraindications;62
1.8.5.3;Procedure;62
1.8.5.4;Complications;63
1.8.5.5;Postoperative Care;63
1.8.5.6;Clinical Data;64
1.8.5.7;Available Devices;64
1.8.5.8;Alternative Procedures;65
1.8.6;References;65
1.9;4: Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding;69
1.9.1;Introduction;69
1.9.2;Causes of UGIB;70
1.9.2.1;Initial Evaluation of Patients with UGI Bleeding;70
1.9.2.2;Anatomy of a Bleeding Ulcer;71
1.9.2.3;Timing of Endoscopy;71
1.9.2.4;ENDOSCOPIC THERAPY OF BLEEDING PEPTIC ULCERS;72
1.9.3;Patient Monitoring;72
1.9.4;Patient Position;73
1.9.4.1;Gastric Lavage;74
1.9.4.2;Endoscopic Treatment;74
1.9.5;Thermal Therapy;74
1.9.5.1;Electrothermocoagulation;74
1.9.5.2;The Technique;75
1.9.6;Nonelectrothermocoagulation;75
1.9.6.1;The Technique;76
1.9.7;Injection Therapy;76
1.9.7.1;Agents Used;76
1.9.7.2;Thrombin/Fibrin Glue;77
1.9.7.3;The Technique;77
1.9.8;Mechanical Clips;77
1.9.8.1;The Technique;79
1.9.9;Choice of Techniques;79
1.9.9.1;Forrest Class Ia and Ib (Actively Bleeding Ulcers);81
1.9.9.2;Forrest Class IIa (Ulcer with Nonbleeding Visible Vessel);81
1.9.9.3;Forrest Class IIb (Ulcer with Adherent Clot);81
1.9.9.4;Post-endoscopic Therapy;82
1.9.9.5;Mallory–Weiss Tears;83
1.9.9.6;Second-Look Endoscopy;83
1.9.10;Conclusions;83
1.9.11;References;84
1.10;5: Endoscopic Management of Varices and Variceal Hemorrhage;86
1.10.1;Introduction;86
1.10.2;Risk Assessment of Patients;87
1.10.2.1;Primary Prophylaxis;88
1.10.2.2;Secondary Prophylaxis;90
1.10.3;Initial Management of Acute Variceal Hemorrhage;90
1.10.4;Endoscopic Variceal Band Ligation;93
1.10.4.1;Technique;93
1.10.4.2;Injection Therapy;95
1.10.4.3;Technique;95
1.10.4.4;Intravariceal Injection;96
1.10.4.5;Paravariceal Injection;97
1.10.5;Combination of Band Ligation and Sclerotherapy;98
1.10.5.1;Argon Plasma Coagulation;98
1.10.5.2;Gastric Varices;98
1.10.5.3;Follow-up;101
1.10.6;References;101
1.11;6: Argon Plasma Coagulation;104
1.11.1;Introduction;104
1.11.2;Indications;104
1.11.2.1;Hemostasis;105
1.11.2.2;Ablation;105
1.11.3;Contraindications;106
1.11.4;Procedure Description;106
1.11.4.1;The Plasma Coagulator Device;106
1.11.4.2;The Circuit: Monopolar Versus Bipolar;106
1.11.4.3;Mechanics;107
1.11.4.4;First- and Second-Generation APCs;108
1.11.4.5;Technique;109
1.11.5;Complications;109
1.11.5.1;Minor Complications;109
1.11.5.2;Major Complications;110
1.11.6;Postoperative Care;110
1.11.7;Alternative Procedures;110
1.11.8;Costs;111
1.11.8.1;Summary of Key Points;111
1.11.9;References;112
1.12;7: Endoscopic Mucosal Resection;113
1.12.1;Introduction;113
1.12.2;Indications;114
1.12.3;Defining the Lateral Margins of the Lesion;114
1.12.4;Determining the Depth of Tumor Invasion;116
1.12.5;Endoscopic Appearances;116
1.12.6;Endoscopic Ultrasound;117
1.12.7;Contraindications;117
1.12.8;Procedure Description;118
1.12.8.1;Define the Margins of the Lesion for Resection;118
1.12.8.2;Submucosal Injection;118
1.12.8.3;Resection Techniques;118
1.12.8.3.1;Injection-Assisted EMR;118
1.12.8.3.2;Cap-Assisted EMR;118
1.12.8.3.3;Ligation-Assisted EMR;119
1.12.8.4;Retrieval of Resected Lesion;121
1.12.8.5;Complications;121
1.12.8.6;Postoperative Care;122
1.12.9;Results;122
1.12.9.1;Esophagus;122
1.12.9.1.1;Squamous Cell Carcinoma;122
1.12.9.1.2;Barrett’s Esophagus with High-Grade Dysplasia and Early Cancer;122
1.12.9.2;Stomach;122
1.12.9.3;Colorectum;123
1.12.10;Alternative Procedures;123
1.12.10.1;Cost;124
1.12.11;Conclusions;124
1.12.11.1;Summary of Key Points;124
1.12.12;References;125
1.13;8: Enteral Nutrition: From Formulations to Delivery;128
1.13.1;Enteral Feeding Formulas;129
1.13.1.1;Standard Formulas;129
1.13.1.2;Fiber Containing Formulas;131
1.13.1.3;High Protein Formulas;131
1.13.1.4;Peptide-Based Formulas;131
1.13.1.5;Elemental Formulas;131
1.13.1.6;Disease Specific;131
1.13.2;Enteral Formula Delivery Methods;133
1.13.3;Monitoring Tube Feeding;134
1.13.3.1;Gastrointestinal Tolerance;134
1.13.3.1.1;Nausea and Vomiting;135
1.13.3.1.2;Gastric Residual Volume;136
1.13.3.2;Diarrhea;137
1.13.3.2.1;Bloating and Distention;138
1.13.3.3;Determination of Adequate Gut Function;139
1.13.4;Summary of Key Points;140
1.13.5;References;140
1.14;9: Capsule Endoscopy;142
1.14.1;Introduction;142
1.14.1.1;Box 1Limitations of all VCE;144
1.14.1.2;Obscure GI Bleeding;144
1.14.1.3;Box 2Small bowel VCE indications;144
1.14.1.4;Small Bowel Tumors;149
1.14.1.5;Crohn’s Disease;151
1.14.1.6;Celiac Disease;153
1.14.2;Contraindications;154
1.14.3;Box 3Small bowel VCE contraindications;154
1.14.4;Equipment;154
1.14.5;Technique;157
1.14.6;Box 4Small bowel VCE technique;157
1.14.7;Reading;158
1.14.8;Outcomes;158
1.14.9;Problems;160
1.14.10;Box 5 Small bowel VCE problems;161
1.14.11;Overcoming the Problems;162
1.14.12;Esophageal VCE;164
1.14.12.1;Introduction;164
1.14.12.2;Indications;164
1.14.12.2.1;Box 6 Esophageal VCE indications;164
1.14.12.2.2;Gastroesophageal Reflux and Barrett’s Esophagus;165
1.14.13;Contraindications;169
1.14.14;Box 7Esophageal VCE contraindications;169
1.14.15;Technique;169
1.14.16;Box 8Esophageal VCE technique;170
1.14.17;Colon VCE;170
1.14.18;Box 9 Review;171
1.14.19;Box 10Indications for VCE;171
1.14.20;Box 11 Relative contraindications and solutions;172
1.14.21;Box 12VCE procedure checklist;172
1.14.22;Summary of Key Points;172
1.14.23;References;172
1.15;10: Double Balloon Enteroscopy;175
1.15.1;Introduction;175
1.15.2;Principle of DBE;176
1.15.3;Device Description;176
1.15.4;Preprocedure Preparation;178
1.15.4.1;Sedation;178
1.15.5;Procedure;178
1.15.6;Route of Insertion;180
1.15.7;Indications;180
1.15.7.1;Diagnosis;180
1.15.7.2;Therapeutic;180
1.15.7.3;Salvage Therapy;180
1.15.8;Contraindications;182
1.15.9;Disadvantages;183
1.15.10;Complications;184
1.15.11;Alternative Procedures;184
1.15.11.1;Wireless Video Capsule Endoscopy;184
1.15.11.2;Enteroscopy;185
1.15.11.2.1;Single Balloon Enteroscopy;185
1.15.11.2.2;Spiral Enteroscopy;185
1.15.11.2.3;Push-Enteroscopy;186
1.15.11.2.4;Intraoperative Enteroscopy;186
1.15.11.3;Small Bowel Series;186
1.15.12;Costs;187
1.15.13;References;187
1.16;11: Sphincterotomy and Stents in Benign and Malignant Disorders and Biliary ERCP;192
1.16.1;Introduction;192
1.16.2;Sphincterotomy;192
1.16.3;Bile Duct Stenting;195
1.16.4;Pancreatic Duct Sphincterotomy and Stents;197
1.16.5;Cystgastrostomy;198
1.16.6;References;201
1.17;12: The Use of SpyGlass Direct Visualization System in the Management of Pancreato Biliary Disease;203
1.17.1;Introduction;203
1.17.2;Procedure Description;205
1.17.3;Indications;206
1.17.3.1;Diagnostic Indications;206
1.17.3.2;Therapeutic Indications;209
1.17.4;Contraindications;211
1.17.5;Complications and Safety;211
1.17.6;Post-Procedure Care;212
1.17.7;Comparative Procedures;212
1.17.8;Cost;213
1.17.9;Summary of Key Points;213
1.17.10;References;213
1.18;13: Endoscopic Drainage of Pancreatic Fluid Collections;218
1.18.1;Introduction;218
1.18.2;Diagnostic Work-up;219
1.18.3;Indications;219
1.18.4;Patient Preparation for Pseudocyst Drainage;220
1.18.5;Procedure;220
1.18.5.1;Transpapillary Pseudocyst Drainage;220
1.18.5.2;Transmural Pseudocyst Drainage;220
1.18.5.3;Cystoscopy-Guided Debridement;222
1.18.6;Post-procedural Care;224
1.18.7;Complications and Management;224
1.18.8;Alternative Procedures;224
1.18.9;Cost Effectiveness;225
1.18.10;References;225
1.19;14: Endoscopic Management of Pancreatic Pseudocysts;227
1.19.1;Introduction;227
1.19.2;Incidence and Etiology of Pseudocysts;227
1.19.3;Pathogenesis and Classification;228
1.19.4;Clinical Presentation and Diagnosis;231
1.19.4.1;History, Physical Examination, and Laboratory Evaluations: Narrowing the Differential;231
1.19.4.2;Imaging Studies and Possible Fluid Sampling;233
1.19.4.2.1;Conventional Abdominal Ultrasound;233
1.19.4.2.2;CT, MRI, and ERCP;233
1.19.4.2.3;EUS and Possible Fine Needle Aspiration with Fluid Analysis;234
1.19.5;Treatment of Pancreatic Pseudocysts;235
1.19.5.1;Preprocedural Assessment;235
1.19.5.2;Surgical Drainage;236
1.19.5.3;Percutaneous Drainage;237
1.19.5.4;Endoscopic Drainage;237
1.19.5.4.1;Efficacy and Cost-Effectiveness of Endoscopic Management;238
1.19.5.4.2;Technique of Cystgastrostomy/Duodenostomy;239
1.19.5.4.3;Transpapillary Drainage;241
1.19.5.4.4;Complications and Their Avoidance;242
1.19.6;References;244
1.20;15: EUS-Guided Drainage of Pelvic Abscesses;247
1.20.1;Introduction;247
1.20.2;Transvaginal/Transrectal Ultrasound-Guided Drainage;248
1.20.3;CT Guided Drainage;248
1.20.4;Surgery;248
1.20.5;Why Endoscopic Ultrasound Drainage?;249
1.20.6;Procedural Technique;249
1.20.7;Technical Outcomes;251
1.20.8;Limitations;252
1.20.9;References;252
1.21;16: Technique of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA);254
1.21.1;Introduction;254
1.21.2;Indications;255
1.21.3;Contraindications;255
1.21.4;Pre-evaluation;255
1.21.5;Preparation;256
1.21.6;Position;256
1.21.7;Equipment;256
1.21.7.1;The Echoendoscope;256
1.21.7.2;Prior Radial EUS;257
1.21.7.3;The Needle;259
1.21.7.4;Suction Syringes;260
1.21.8;Technique;261
1.21.8.1;Identification/Selection of the Target Lesion;262
1.21.8.2;Alignment of the Lesion in the Projected Path of the Needle;264
1.21.8.3;Stabilizing the Transducer;264
1.21.8.4;Apposition of the Transducer;264
1.21.8.5;Color Doppler Evaluation;264
1.21.8.6;Needle Puncture;265
1.21.8.7;Sampling the Targeted Lesion with or without Suction;268
1.21.8.8;Withdrawal of the Needle;269
1.21.8.9;Transfer of the Sampled Tissue or Fluid for Cytopathology;269
1.21.9;Complications;270
1.21.9.1;Perforation;270
1.21.9.2;Acute Pancreatitis;275
1.21.9.3;Bleeding;275
1.21.9.4;Infection;276
1.21.10;References;276
1.22;17: The Role of Endoscopic Ultrasound in Pain Management;278
1.22.1;Introduction;278
1.22.2;Pathophysiology;278
1.22.3;EUS-Guided Celiac Plexus Block and Neurolysis;279
1.22.4;Techniques for Performing EUS-Guided CPN and CPB;280
1.22.5;Superior Hypogastric Plexus Neurolysis;286
1.22.6;Ganglion Impar Neurolysis;290
1.22.7;References;294
1.23;18: Colonoscopic Polypectomy;296
1.23.1;Introduction;296
1.23.2;Indications;297
1.23.3;Contraindications;298
1.23.4;Procedure Site;299
1.23.5;Procedure Description;300
1.23.6;Polyp Retrieval;303
1.23.7;Complications;306
1.23.8;Post-procedure Care;307
1.23.9;Results;308
1.23.10;Alternatives;308
1.23.11;Cost;308
1.23.12;References;309
1.24;19: Acute Colonic Bleeding;311
1.24.1;Introduction;311
1.24.2;Epidemiology;312
1.24.3;Resuscitation and Initial Evaluation;312
1.24.4;Approach to the Patient with Severe Hematochezia–Clinical Algorithm;314
1.24.5;Diagnostic Evaluations;314
1.24.6;Colonoscopy;315
1.24.7;Bowel Preparation;316
1.24.8;CURE Hemostasis Group Results with an Urgent Endoscopic Approach to Severe Hematochezia;317
1.24.9;Alternate Procedures;317
1.24.9.1;Traditional Management of Severe Hematochezia in Adults;317
1.24.9.2;Emergency Abdominal Angiography;319
1.24.9.3;Red Cell Scanning;320
1.24.9.4;Results of Traditional Approach to Severe Hematochezia;321
1.24.10;Specific Colonic Lesions;321
1.24.10.1;Diverticular Hemorrhage;321
1.24.10.2;Internal Hemorrhoids;323
1.24.10.3;Ischemic Colitis;324
1.24.10.4;Solitary Rectal Ulcer Syndrome;325
1.24.10.5;Delayed Post-polypectomy Hemorrhage;325
1.24.10.6;Colonic Angiomas;327
1.24.10.7;Cost Assessment;328
1.24.11;References;328
1.25;20: Complications and Their Risk Factors in Gastrointestinal Endoscopy;331
1.25.1;Introduction;331
1.25.2;Complications Related to Preparation for Endoscopy;332
1.25.2.1;Upper Endoscopy;332
1.25.2.2;Colonoscopy;332
1.25.3;Complications Related to Sedation and Anesthesia;333
1.25.4;Cardiovascular Complications;334
1.25.5;Infection;335
1.25.6;Perforation;336
1.25.6.1;Upper Endoscopy;336
1.25.6.2;Colonoscopy;337
1.25.7;Post-polypectomy Syndrome;337
1.25.8;Bleeding;338
1.25.8.1;Upper Endoscopy;338
1.25.8.2;Colonoscopy;338
1.25.9;Aspiration;338
1.25.10;Vasovagal Reactions;340
1.25.11;Splenic Injury;340
1.25.12;Entrapment of the Endoscope;340
1.25.13;Complications of Percutaneous Endoscopic Gastrostomy;340
1.25.13.1;Fistula;340
1.25.13.2;Buried Bumper Syndrome;341
1.25.13.3;Stoma Leak or Enlargement;341
1.25.13.4;Wound/Tube Infection;341
1.25.13.5;Tube Dislodgement;342
1.25.13.6;Pneumoperitoneum;342
1.25.13.7;Hemorrhage;342
1.25.14;Endoscopic Retrograde Cholangiopancreatography;342
1.25.14.1;Pancreatitis;342
1.25.14.2;Infection;343
1.25.14.3;Hemorrhage;343
1.25.14.4;Perforation;344
1.25.14.5;Cardiopulmonary Complications;344
1.25.14.6;Mortality;344
1.25.14.7;Miscellaneous Complications;344
1.25.15;Endoscopic Ultrasound;344
1.25.15.1;Perforation;345
1.25.15.2;Bleeding;345
1.25.15.3;Infection;345
1.25.15.4;Pancreatitis;345
1.25.15.5;Miscellaneous;346
1.25.16;Advanced Therapeutic Techniques;346
1.25.16.1;Endoscopic Mucosal Resection;346
1.25.16.2;Radiofrequency Ablation;346
1.25.17;Endoscopy in Pregnant or Lactating Women;347
1.25.18;References;348
1.26;21: Documentation and Description of Endoscopic Procedures;351
1.26.1;Introduction;351
1.26.2;Photodocumentation of Endoscopic Procedures;352
1.26.3;Upper Gastrointestinal Endoscopy;352
1.26.4;Colonoscopy;357
1.26.5;Accurate Description of Endoscopic Findings;362
1.26.6;Terminology;363
1.26.7;Location of the Lesion;363
1.26.8;Description of Lesions;363
1.26.9;References;366
1.27;22: Ultrasound-Guided/Assisted Percutaneous Liver Biopsy;367
1.27.1;Introduction;367
1.27.2;Indications;368
1.27.3;Contraindications;369
1.27.4;Procedure Technique: Percutaneous Ultrasound-Assisted Liver Biopsy;370
1.27.5;Biopsy with a Jamshidi-Menghini Needle Kit;370
1.27.6;Alternate Devices;375
1.27.7;Liver Biopsy Gun;376
1.27.8;Complications;376
1.27.9;Costs;377
1.27.10;References;378
1.28;Index;379