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ویرایش: 1st ed. 2020 نویسندگان: Massimiliano Mutignani (editor), Jörg G. Albert (editor), Carlo Fabbri (editor) سری: ISBN (شابک) : 3030425681, 9783030425685 ناشر: Springer سال نشر: 2020 تعداد صفحات: 576 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 31 مگابایت
در صورت تبدیل فایل کتاب Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS: Two Techniques for One Vision به فرمت های PDF، EPUB، AZW3، MOBI و یا DJVU می توانید به پشتیبان اطلاع دهید تا فایل مورد نظر را تبدیل نمایند.
توجه داشته باشید کتاب اندوتراپی در بیماری های بیلیوپانکراس: ملاقات ERCP با EUS: دو تکنیک برای یک دید نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
این جلد، وضعیت فنی و فرهنگی هنر دو مورد از خطرناکترین، پیچیدهترین و وابستهترین تکنیکهای عمل گوارشی را ارائه میکند: کلانژیوپانکراتوگرافی رتروگراد آندوسکوپی (ERCP) و سونوگرافی آندوسکوپی (EUS). نویسندگان تکنیکهای قدیمی و جدید را با هم مقایسه میکنند و به جدیدترین و نوآورانهترین یافتههای علمی، از جمله آنهایی که در زمینه آسیبشناسی آناتومیک و زیستشناسی مولکولی مربوط به تجزیه و تحلیل نمونههای بافت جمعآوریشده در طول EUS هستند، میپردازند.
با توجه به مشکلات فنی خاص این تکنیکها، این کتاب همچنین دسترسی به ویدئوهای آنلاین و تصاویر متعدد را ارائه میدهد، که آن را به منبعی ارزشمند هم برای پزشکانی که برای اولین بار به این تکنیکها میپردازند و هم برای کسانی که قبلا از آنها استفاده می کنند
در 7 بخش سازماندهی شده است، و تمام تکنیک های مربوط به ERCP/EUS را به همراه تجهیزات فنی خاص مورد نیاز به تفصیل شرح می دهد. همچنین پارادایم جدیدی را بر اساس آخرین نتایج در زمینه های پیشگیری، تشخیص و مدیریت شایع ترین عوارض ارائه می دهد. نتایج بالینی ارائه شده در ادبیات بینالمللی و همچنین الگوریتمها - هم بر اساس شواهد علمی و هم بر اساس یافتههای متخصص - نشان داده شده و با درمانهای جایگزین مقایسه میشوند.
This volume presents the technical and cultural state of the art of two of the riskiest, most complex and operator-dependent digestive operative techniques: endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS). The authors compare old and new techniques, shedding light on the most recent and innovative scientific findings, including those in the field of anatomic pathology and molecular biology considered relevant for the analysis of tissue samples collected during EUS.
In view of the technical difficulties specific to these techniques, the book also offers access to online-videos and numerous images, making it a valuable resource both for physicians approaching these techniques for the first time as well as for those already using them.
Organized into 7 sections, it describes in detail all techniques related to ERCP/EUS, together with any specific technical equipment required. It also presents a new paradigm based on the latest results in the areas of prevention, diagnosis and management of the most common complications. Clinical outcomes presented in international literature, as well as algorithms – both based on scientific evidence and expert findings – are illustrated and compared to alternative treatments.
Foreword Acknowledgement Contents Part I: ERCP and EUS: Armamentarium and Surroundings 1: ERCP/EUS Room 1.1 ERCP Room 1.1.1 Introduction 1.2 Some Definitions 1.3 The Room 1.3.1 Requirements 1.3.1.1 Postanesthetic Care Area 1.3.2 Infection Control 1.3.3 The Cleaning of the Room 1.3.4 Staffing 1.4 Technical Rules According to European Legislation 1.4.1 Technical Plant and Electrical Safety 1.5 Technological Layout Guidelines 1.5.1 Ceiling Pendant Technology 1.5.2 Gases Centralized 1.5.3 Multimedia Integrated Network 1.5.4 Auxiliary Displays 1.5.5 Use of Laser Instruments 1.5.6 Net Connection Point 1.6 EUS Room 1.6.1 Introduction 1.7 Requirements 1.7.1 Room 1.7.1.1 Leaded Walls 1.7.2 Equipment Support Tools 1.7.3 Staffing References 2: X-Rays in Endoscopy 2.1 When Were X-Rays Discovered? 2.2 Benefits of X-Rays 2.3 Why X-Rays in Endoscopy? 2.4 Which Radiological Instruments Were Used in the Past? 2.5 Change 3: Ultrasound Equipment 3.1 Fujifilm 3.2 Olympus-Aloka 3.3 Pentax-Hitachi 4: Endoscopes 4.1 Endoscopes 4.2 Duodenoscopes 4.3 Echoendoscopes 4.4 EUS Processors 4.5 ERCP Instruments 4.6 EUS Instruments References 5: ERCP Standard and Special Devices 5.1 Introduction 5.2 Armamentarium for a Standard ERCP Procedure 5.2.1 Duodenoscopes 5.2.2 Cannulation Catheters 5.2.3 Guidewires 5.2.4 Standard Sphincterotome, Pre-cut Sphincterotome and the Needle Knife 5.2.5 Balloon Catheters 5.2.6 Dormia Baskets 5.2.7 Dilatation Catheters and Bougies 5.2.8 Biopsy Forceps and Brush Cytology 5.2.9 Lithotripsy 5.2.10 Biliary Stenting 5.2.11 Devices for ERCP in the Surgically Altered GI Tract 5.3 Special Devices for Therapeutic ERCP Interventions 5.3.1 Radiofrequency Ablation (RFA) 5.3.2 Photodynamic Therapy (PDT) 5.3.3 Cholangioscopy 5.4 Conclusion References 6: EUS Standard Devices 6.1 EUS-FNA Devices 6.1.1 Overall Concepts 6.1.2 Types of Needles 6.1.2.1 Access Needle 6.1.2.2 Celiac Plexus Blockade and Neurolysis 6.1.3 EUS-FNA Technique 6.1.3.1 Application of Suction and Use of the Stylet 6.1.3.2 EUS-FNA/FNB Adverse Events 6.1.4 Through-the-Needle Devices 6.1.4.1 Cytology Brush 6.1.4.2 Microforceps 6.1.4.3 Needle-Based Confocal Laser Endomicroscopy Probe 6.1.4.4 Fiducial Placement 6.2 Interventional EUS 6.2.1 EUS-Guided Drainage of Intra-abdominal Fluid Collections 6.2.2 EUS-Guided Biliary Drainage 6.2.2.1 EUS-Guided Choledochoduodenostomy 6.2.2.2 EUS-Guided Hepaticogastrostomy 6.2.2.3 EUS-Guided Rendezvous Technique 6.2.2.4 EUS-Guided Antegrade Biliary Stenting 6.2.2.5 EUS-BD Versus ERCP References 7: Deep Sedation and Anesthesia for Advanced Gastrointestinal Endoscopy: Challenging a Continuum 7.1 Introduction 7.2 Sedation in Digestive Endoscopy: A Continuum from Deep Sedation to General Anesthesia 7.3 Location [10] 7.4 The Anesthesia Staff 7.5 Drugs 7.6 Equipment 7.7 Monitoring 7.8 Patient Assessment 7.9 The Challenge 7.10 Coming to a Conclusion: Sedation, the Proceduralist, and the Anesthesiologist References 8: Anatomy of the Biliary Tree 8.1 Overview 8.2 Intrahepatic Biliary Anatomy 8.2.1 Right Anterior Sectoral Ducts (Segments 5 and 8) 8.2.1.1 Segment 5 8.2.1.2 Segment 8 8.2.2 Right Posterior Sectoral Ducts (Segments 6 and 7) 8.2.2.1 Segment 6 8.2.2.2 Segment 7 8.2.3 Bile Ducts from Segments 2 and 3 (Left Lateral Sector) 8.2.4 Bile Ducts from Segment 4 (Left Medial Sector) 8.2.5 Bile Ducts from Segments 1 and 9 (Right Paracaval Region) 8.3 Extrahepatic Biliary Anatomy 8.3.1 Right Hepatic Duct 8.3.2 Left Hepatic Duct 8.3.3 Biliary Confluence 8.3.4 Common Hepatic Duct and Common Bile Duct 8.3.5 Gallbladder and Cystic Duct References 9: Anatomy of the Pancreas 9.1 Introduction 9.2 Morphology of the Pancreas 9.3 Blood Supply 9.4 Lymphatic Drainage and Innervation 9.5 Ductal Anatomy 9.5.1 Normal Ductal Anatomy 9.5.2 Pancreas Divisum 9.5.3 Incomplete Pancreas Divisum 9.5.4 Abnormal Pancreatobiliary Junction 9.5.5 Annular Pancreas 9.5.6 Ansa Pancreatica 9.5.7 Dominant Dorsal Duct 9.6 Conclusion References 10: CT: What We Need to Know to Start to Interpret Radiological Pictures 10.1 Computed Tomography Imaging Technique 10.2 CT Imaging of the Biliary System 10.2.1 Choledocholithiasis 10.2.2 Mirizzi Syndrome 10.2.3 Cholangitis: Biliary Tract Infection and Inflammation 10.2.3.1 Acute Cholangitis 10.2.3.2 Recurrent Pyogenic Cholangitis 10.2.3.3 Primary Sclerosing Cholangitis 10.2.3.4 Autoimmune Pancreatitis-Related Cholangitis 10.2.4 Cholangiocarcinoma 10.2.5 Biliary Injuries 10.2.5.1 Bile Leaks 10.2.5.2 Biliary Necrosis 10.2.5.3 Hemobilia 10.3 CT Imaging of the Pancreas 10.3.1 Acute Pancreatitis 10.3.1.1 Interstitial Oedematous Pancreatitis Versus Necrotizing Pancreatitis 10.3.1.2 Pancreatic and Peripancreatic Collections 10.3.1.3 Infection and Other Local Complications 10.3.2 Chronic Pancreatitis 10.3.2.1 Autoimmune Pancreatitis 10.3.2.2 Paraduodenal Pancreatitis 10.3.3 Solid Pancreatic Lesions 10.3.3.1 Pancreatic Adenocarcinoma 10.3.3.2 Pancreatic Neuroendocrine Tumours References 11: MR: What We Need to Know to Start to Interpret Radiological Pictures 11.1 Magnetic Resonance Cholangiopancreatography 11.1.1 Imaging Protocol 11.1.2 MRCP Technique 11.1.3 Secretin-Enhanced MRCP 11.2 MR Imaging of the Biliary System 11.2.1 Congenital Diseases of Biliary System 11.2.1.1 Choledochal Cysts 11.2.1.2 Anomalous Pancreaticobiliary Junction 11.2.2 Choledocholithiasis 11.2.3 Biliary Stricture 11.2.3.1 Benign Biliary Stricture Iatrogenic Causes Primary Sclerosing Cholangitis 11.2.3.2 Malignant Biliary Stricture Cholangiocarcinoma Ampullary Carcinoma 11.3 MR Imaging of the Pancreatic Ducts 11.3.1 Congenital Pancreatic Anomalies 11.3.1.1 Pancreas Divisum 11.3.1.2 Santorinicele 11.3.1.3 Annular Pancreas 11.3.2 Pancreatitis 11.3.2.1 Acute Recurrent Pancreatitis Sphincter of Oddi Dysfunction 11.3.2.2 Chronic Pancreatitis 11.3.3 Solid Pancreatic Lesions 11.3.3.1 Pancreatic Adenocarcinoma 11.3.3.2 Pancreatic Neuroendocrine Tumours 11.3.4 Cystic Pancreatic Lesions 11.3.4.1 Pseudocyst 11.3.4.2 Intraductal Papillary Mucinous Neoplasm 11.3.4.3 Serous Cystadenoma 11.3.4.4 Mucinous Cystadenoma 11.3.4.5 Solid Pseudopapillary Tumour References 12: Patient Management before and after EUS/ERCP 12.1 Pre-endoscopy Considerations 12.2 Informed Consent 12.3 Conscious Sedation (see also Chap. 7) 12.4 Radiation Protection and Patient Position 12.5 “Team-Time-Out” 12.6 Patient Management Before and During ERCP/EUS 12.7 Intra- and Postprocedural Considerations 12.8 Monitoring After ERCP/EUS, Postprocedural Complications 12.9 Discharge 12.10 Conclusion/Summary: Patient Management Before and After ERCP/EUS References Part II: ERCP: What and How 13: Cannulation Techniques 13.1 Accessing the Papilla 13.2 Pre-cannulation 13.3 Cannulation 13.3.1 Double-Wire Technique 13.3.2 When to Stop/Cut 13.4 Special Situations 13.4.1 Previous Sphincterotomy 13.4.2 Ampullary Tumor 13.4.3 Impacted Stone 13.4.4 Diverticulum 13.4.5 Altered Anatomy 14: Biliary Sphincterotomy and Precut 14.1 Introduction 14.2 Biliary Sphincterotomy 14.2.1 Technique and Devices 14.2.2 Procedure 14.2.3 Indications and Contraindications 14.2.4 Adverse Events 14.3 Precut 14.3.1 Devices 14.3.2 How and When 14.3.3 Adverse Events References 15: Pancreatic Sphincterotomy 15.1 Introduction 15.2 Endoscopic Technique 15.2.1 Patient Preparation 15.2.2 Pancreatic Duct Cannulation 15.2.3 Pull-Type Sphincterotomy 15.2.4 Needle-Knife Sphincterotomy 15.2.5 Precut Sphincterotomy 15.2.6 Post-sphincterotomy Plastic Stent Placement 15.3 Indications for Pancreatic Sphincterotomy 15.3.1 Pancreatic Sphincterotomy as Primary Therapy 15.3.2 SOD 15.3.3 Chronic Pancreatitis 15.3.4 IPMN-Associated Recurrent Pancreatitis 15.3.5 Post-distal Pancreatectomy Fistula 15.3.6 Pancreatic Sphincterotomy as Precursor of Other Endotherapy 15.4 Complications 15.5 Minor Papilla Sphincterotomy 15.5.1 Minor Papilla Identification 15.5.2 Dorsal Duct Cannulation 15.5.3 Pull-Type Sphincterotomy 15.5.4 Needle-Knife Sphincterotomy 15.5.5 Wire-Assisted Sphincterotomy 15.5.6 Precut Sphincterotomy 15.5.7 Post-sphincterotomy Plastic Stent Placement 15.5.8 Complications References 16: Biliary Stones Extraction 16.1 Introduction: “Difficult” Biliary Stones 16.2 Bile Ducts Anatomy and Biliary Stones 16.2.1 Narrowing of the Distal Common Bile Duct 16.2.2 Bile Duct Angulation 16.2.3 Cystic Duct Stones 16.2.4 Intrahepatic Stones 16.3 Biliary Stones Extraction: Technical Points 16.3.1 The Sphincterotomy 16.3.2 The Axis and the Traction 16.3.3 Fogarty Balloon or Dormia Basket? 16.3.4 “Soft” and “Hard” Stones 16.3.5 Endoscopic Papillary Large Balloon Dilatation (EPLBD) and Mechanical Lithotripsy: When and How References 17: Intraductal Lithotripsy 17.1 Introduction 17.2 Mechanical Lithotripsy 17.3 Cholangioscopy-Guided Lithotripsy 17.4 Cholangioscopy-Guided Laser Lithotripsy and Electrohydraulic Lithotripsy 17.4.1 Technical Background 17.5 General Tips and Tricks for Successful Lithotripsy 17.6 Conclusion References 18: Biliary and Pancreatic ESWL 18.1 General Principles About ESWL 18.2 Technical Principles of ESWL 18.3 Specific Issues on Pancreatic ESWL 18.4 Specific Tools on Biliary ESWL 18.5 Conclusions References 19: Biliary Stenting 19.1 Introduction 19.2 Plastic Stents 19.3 Self-Expandable Metal Stents 19.4 Multiple Biliary Stenting References 20: Endoscopic Papillectomy 20.1 Clinical Features 20.2 Classification and Staging 20.3 Indication of Endoscopic Papillectomy 20.4 Staging 20.5 Techniques 20.6 Complications 20.7 Surveillance References 21: Ductoscopy 21.1 History and Technical Background 21.1.1 Technical Details 21.2 Current Indications for Biliary Ductoscopy 21.2.1 Indeterminate Biliary Strictures 21.2.2 Bile Duct Stones 21.2.3 Other Indications for Cholangioscopy 21.3 Indications for Pancreatoscopy 21.4 Retrograde Cholangioscopy 21.4.1 Sphincter Management 21.4.2 Cannulation and Manoeuvrability 21.4.3 Safety 21.4.4 Limitations 21.5 Anterograde (Percutaneous) Cholangioscopy 21.5.1 Limitations 21.5.2 Safety of Anterograde Cholangioscopy References 22: Intraductal Ablation Techniques 22.1 Introduction 22.2 Radiofrequency Ablation 22.3 Photodynamic Therapy 22.4 Argon Plasma Coagulation (APC) 22.5 Summary References 23: Stent Removal (Plastic and Metal) 23.1 Indications for Removal 23.2 Removal Techniques of Biliary Stents 23.3 Removal of Proximally Migrated Stents 23.4 Complications from Stent Removal 23.5 Indications for Removal of Pancreatic Stents 23.6 Removal Techniques of Pancreatic Stents 23.7 Removal of Migrated Pancreatic Stents 23.8 Complications of Pancreatic Stent Removal 23.9 Conclusion References 24: ERCP in Altered Anatomy 24.1 Surgical Reconstruction 24.2 Increased Incidence of Biliopancreatic Disease Requiring ERCP 24.3 Preparation for ERCP 24.4 Reaching the Papilla and/or Ductal Anastomosis 24.5 Device-Assisted ERCP, DAERCP 24.6 EUS-Guided Methods 24.7 Alternatives in RYGB/ ERCP via Gastrostomy 24.8 Laparoscopy-Assisted ERCP 24.9 Cannulation, Sphincterotomy, and Other Interventions 24.10 Adverse Events 24.11 Conclusion References 25: PTC and PTC-ERCP Rendezvous Procedures 25.1 Introduction 25.2 Technique of PTCD 25.3 Patient Preparation 25.4 Procedure of PTCD 25.5 PTCD-ERCP Rendezvous 25.6 Indication for PTCD-ERCP Rendezvous References Part III: EUS: What and How 26: EUS Diagnostic Puncture 26.1 Indications 26.1.1 What Can I Puncture? 26.2 Contraindications 26.3 Starting the Exam 26.4 Scope Positioning to Perform Puncture 26.5 Puncturing: How to Perform It Step-by-Step 26.6 Choosing the Needle 26.7 Additional Tips and Tricks to Get More and Higher-Quality Material 26.8 Cytopathology 26.8.1 Cytology or Histology? 26.9 Markers in Pancreatic Cystic Fluid 26.10 Complications 26.11 What to Remember After the Puncture 26.12 Future Perspectives in EUS Diagnostic Punctures 26.12.1 Confocal Laser Endomicroscopy (CLE) 26.12.2 Microbiopsy Forceps 26.12.3 Cytology Brush 26.12.4 Fine Needle Vein Puncture References 27: Ancillary Diagnostic Techniques in EUS 27.1 EUS Elastography 27.2 Contrast-Enhanced EUS 27.3 Endoscopic Ultrasound-Guided Needle-Based Confocal Laser Endomicroscopy References 28: EUS-Guided Transenteric Pancreatic Duct Drainage 28.1 Technical Considerations 28.2 Clinical Algorithm 28.3 Conclusion References 29: EUS-Assisted Ablation Techniques 29.1 Introduction 29.2 Indications 29.2.1 Pancreatic Adenocarcinoma 29.2.2 Pancreatic Neuroendocrine Tumours 29.2.3 Pancreatic Cystic Lesions 29.2.4 Extra-Pancreatic Indications 29.3 Ablative Techniques 29.3.1 Radiofrequency Ablation 29.3.1.1 Mechanism of Action 29.3.1.2 Clinical Data 29.3.2 Cryothermablation 29.3.2.1 Mechanism of Action 29.3.2.2 Clinical Data 29.3.3 Photodynamic Treatment 29.3.3.1 Mechanism of Action 29.3.3.2 Clinical Data 29.3.4 Neodymium-Doped Yttrium Aluminium Garnet Laser Ablation 29.3.4.1 Mechanism of Action 29.3.4.2 Clinical Data 29.3.5 Ethanol Injection 29.3.5.1 Mechanism of Action 29.3.5.2 Clinical Data 29.3.6 Chemotherapy Injection 29.3.6.1 Mechanism of Action 29.3.6.2 Clinical Data Chemotherapy Cytoimplant Dendritic Cells (DCs) Adenovirus ONYX-015 Tumour Necrosis Factor Alpha (TNF-α) BC-819 29.4 Future Perspectives References 30: Intraductal US 30.1 Introduction 30.2 Technical Consideration 30.3 Normal Endosonographic Imaging 30.4 Biliary Tree: Indications 30.4.1 Choledocholithiasis 30.4.2 Bile Duct Strictures 30.4.3 Staging of Malignancy 30.4.4 Evaluation of Idiopathic Acute or Recurrent Pancreatitis 30.4.5 Gallbladder Lesions 30.4.5.1 Ampulla 30.4.5.2 Pancreas 30.5 Other Nonconventional Indications 30.5.1 Primary Sclerosing Cholangitis, IgG-4-Related Cholangitis 30.5.2 Directed Endoscopic Biliary Procedures 30.5.3 Portal Hypertensive Biliopathy 30.6 Conclusions References Part IV: Complications: Prevention, Diagnosis and Management 31: Post-ERCP Acute Pancreatitis 31.1 Acute Post-ERCP Pancreatitis 31.2 Diagnosis 31.3 Pathogenesis of PEP 31.4 Risk Factors 31.5 Prevention 31.5.1 Patient Selection 31.5.2 Pharmacological Prophylaxis 31.5.3 Periprocedural Fluid Replacement 31.5.4 Guidewire Cannulation 31.5.5 Cannulation Attempts and Precut 31.5.6 Pancreatic Duct Stents 31.6 Management References 32: Bleeding 32.1 ERCP-Related Bleeding 32.2 EUS-Related Bleeding 32.3 Risk Factors - Preventive Measures 32.4 Management 32.5 Conclusion References 33: ERCP-Related Perforations 33.1 Epidemiology and Types of Perforation 33.2 Mechanisms of Perforation and Risk Factors 33.3 Diagnosis 33.4 Prevention 33.5 Therapy 33.5.1 Type 1 Perforations 33.5.1.1 Endoscopy 33.5.1.2 Surgery 33.5.2 Type 2 and 3 Perforations 33.5.2.1 Conservative Treatment 33.5.2.2 Endoscopy 33.5.2.3 Surgery 33.5.3 Type 4 Perforations 33.6 Summary References 34: Miscellany Complications of ERCP 34.1 Infectious Adverse Events 34.1.1 Cholangitis 34.1.2 Cholecystitis 34.1.3 Duodenoscope-Related Infections 34.2 Hepatic Hematoma 34.3 Hepatic Abscess 34.4 Stent-Related Complication 34.5 Splenic Injury 34.6 Cardiopulmonary Adverse Events 34.6.1 Air Embolism References 35: EUS Complications 35.1 Introduction 35.2 Complications of Diagnostic EUS 35.3 Complications of EUS-FNA 35.3.1 Infection 35.3.2 Pancreatitis 35.3.3 Hemorrhage 35.3.4 Tumor Seeding 35.3.5 Bile Peritonitis 35.4 Complications of EUS Fine-Needle Injection Procedures 35.5 Complications of Pancreatic Fluid Collection Drainage 35.5.1 Perforation 35.5.2 Bleeding 35.5.3 Buried LAMS 35.5.4 Stent Migration 35.5.5 Maldeployment 35.5.6 Direct Endoscopic Necrosectomy (DEN) 35.6 Complications of EUS-Guided Biliary Drainage 35.6.1 Bile Leak 35.6.2 Stent Migration and Maldeployment 35.7 Complication of EUS-Guided Gallbladder Drainage References Part V: Biliopancreatic Diseases: Clinical Results 36: Common Bile Duct Stones 36.1 Introduction 36.2 Etiology and Risk Factors 36.3 Clinical Spectrum of Common Bile Duct Stones 36.3.1 Symptomatic Bile Duct Stones with Cholestasis 36.3.2 Symptomatic Bile Stones Without Cholestasis 36.3.3 Asymptomatic Bile Duct Stones 36.3.4 Recurrent Common Bile Duct Stones 36.3.5 Acute Cholecystitis and Common Bile Duct Stones 36.3.6 Mirizzi Syndrome 36.4 Diagnosis of Common Bile Duct Stones 36.4.1 Laboratory Evaluation 36.4.2 Transabdominal Ultrasound 36.4.3 Endoscopic Ultrasound 36.4.4 Magnetic Resonance Imaging (MRI/MRCP) 36.4.5 Computed Tomography (CT) 36.4.6 Endoscopic Retrograde Cholangiopancreatography (ERCP) 36.5 Indication for Treatment of Common Bile Duct Stones 36.5.1 CBDS in Elderly Patients 36.6 Extraction Techniques 36.6.1 ERCP 36.6.1.1 Cannulation of the Papilla 36.6.1.2 Endoscopic Sphincterotomy 36.6.1.3 Pre-cut Sphincterotomy and Fistulotomy 36.6.1.4 Large Balloon Dilatation of the Papilla 36.6.2 Stone Extraction 36.6.2.1 Stone Extraction Balloon 36.6.2.2 Stone Extraction Basket 36.6.2.3 Mechanical Lithotripsy 36.6.3 Prophylactic Saline Irrigation of the Bile Duct to Reduce the Rate of Residual Common Bile Duct Stones 36.6.3.1 Stent Placement 36.6.3.2 Intraductal Lithotripsy 36.6.4 Cholangioscopy with Lithotripsy 36.6.5 Extracorporeal Shock Wave Lithotripsy (ESWL) 36.6.6 Percutaneous Transhepatic Cholangiography (PTC) 36.6.6.1 Cholecysto-Choledocholithiasis References 37: Intrahepatic Stones 37.1 Introduction 37.2 Diagnosis 37.3 Treatment 37.3.1 ERCP 37.3.2 Cholangioscopy 37.3.3 Endoscopic Ultrasound-Guided Drainage 37.3.4 Extracorporeal Shock Wave Lithotripsy (ESWL) 37.3.5 Surgical Treatment References 38: Acute Cholangitis 38.1 Introduction 38.2 Symptoms 38.3 Diagnosis of Cholangitis 38.4 Initial Management 38.4.1 Grade III (Severe Acute Cholangitis) 38.4.2 Grade II (Moderate Acute Cholangitis) 38.4.3 Grade I (Mild Acute Cholangitis) 38.5 Antimicrobial Therapy [6] 38.6 Biliary Decompression References 39: Papillectomy: Clinical Results 39.1 Indications 39.2 Contraindications 39.3 Clinical Results 39.4 Results in Relation to EP Techniques 39.5 Adverse Events 39.6 Surveillance for Residual or Recurrent Neoplastic Tissue 39.7 Treatment of Residual or Recurrent Endobiliary Neoplastic Tissue 39.8 Ablative Therapies 39.9 Comparison of EP and Surgery References 40: Endoscopic Management in Malignant Biliary Strictures: Tips and Tricks 40.1 Tips and Tricks for Malignant Biliary Strictures 40.2 Distal Malignant Biliary Stricture (DMBO) 40.2.1 Surgery Versus Endoscopic Approach 40.2.2 Is the ERCP the First Choice Compared to EUS-BD? 40.2.3 How to Treat Patients in Case of ERCP Failure? 40.2.4 EUS-BD: Intrahepatic (HGS) Versus Extrahepatic (CDS) Approach. Which Is the Best? 40.2.5 EUS-BD Versus PTBD After Failed ERCP: The Winner Is 40.2.5.1 When Percutaneous Biliary Drainage Should Be Used? 40.2.6 Do We Need to Perform ES Before SEMS Placement? 40.2.7 Is There a Greater Risk of Cholecystitis After Placing an FCSEMS? 40.2.8 Treatment of Malignant Bilioduodenal Obstruction (Type II GOO); Is It Always Possible to Place a Stent? 40.2.9 Which Stent: Plastic Versus Metal? 40.2.10 ESGE Recommends SEMS Insertion for Palliative Drainage of Malignant Extrahepatic Biliary Obstruction 40.2.10.1 Which Metal Stent Should Be Used: USEMS Versus PCSEMS Versus CSEMS? A Battle of Superiority? 40.2.11 How to Drain DMBO of Unconfirmed Etiology 40.2.12 Preoperative Biliary Drainage (PBD) in DMBO 40.2.12.1 Which Route of PBD Is Preferred? PTBD Versus ERCP 40.2.12.2 Which Stent Should Be Placed in Case of PBD? 40.2.13 Proximal Malignant Biliary Stricture (Hilar) (HMBO) 40.2.13.1 Introduction 40.2.13.2 Diagnosis 40.2.13.3 Treatment 40.2.13.4 Endoscopic Versus Percutaneous Approach 40.2.13.5 Is the Drainage of Advanced Hilar Stricture for All? 40.2.14 Endoscopic Stenting 40.2.14.1 Should We Perform ES Before Stent Placement? Yes. We Should Do 40.2.14.2 Which Stent for Hilar Malignant Stricture? Plastic Versus Metal 40.2.14.3 Do We Need to Perform Unilateral or Bilateral Drainage? 40.2.14.4 Complete Versus Incomplete Drainage 40.2.14.5 How Do You Drain? 40.2.14.6 How to Perform Biliary Drainage? 40.2.14.7 Is There a Role of CSEMS in the Hilar Tumor? 40.2.15 Stent in Stent (SIS) Versus Side by Side (SBS): Which Is the Best Technique? 40.2.15.1 How to Treat Stent Dysfunction? 40.2.15.2 Preoperative Biliary Drainage (PBD): Is There a Role 40.2.15.3 How to Perform PBD? 40.2.15.4 Which Stent Should Be Used for PBD? 40.2.15.5 Which Length? Is the Length Important? 40.2.15.6 Is There a Role of Drug-Eluting SEMS? 40.2.15.7 Endoscopic Adjuvant Treatment of Biliary Obstruction: Advance Beyond the SEMS 40.2.15.8 Radiofrequency Ablation References 41: Results of EUS Transmural Biliary Drainage 41.1 Introduction 41.2 Techniques 41.2.1 Intrahepatic Approach 41.2.2 Extrahepatic Approach 41.2.3 Algorithm for EUS-BD Guidance 41.3 Summary References 42: Postoperative Biliary Stricture 42.1 Epidemiology and Risk Factors 42.2 Classifications 42.3 Clinical Presentation and Diagnosis 42.4 Endoscopic Therapy 42.5 Non-endoscopic Therapies References 43: Biliary Complications After Liver Transplantation 43.1 Introduction 43.2 Considering Surgical Technique Before Starting Endoscopic Treatment 43.3 Diagnostics Before Interventional Treatment 43.4 Stricturing Disease After Liver Transplantation 43.5 Bile Duct Leaks 43.6 Adverse Events from Bile Duct Content 43.7 Bilioma and Liver Abscess Formation 43.8 Summary and Diagnostic Algorithm References 44: Biliary Leaks: Role of ERCP in Post-operative Biliary Complications 44.1 Introduction 44.2 ERCP in Bile Duct Injury 44.3 Evaluation and Subsequent Treatment of Bile Duct Injury 44.4 Other Post-operative Complications 44.5 Summary References 45: Primary Sclerosing Cholangitis 45.1 Introduction 45.2 Symptoms and Diagnosis 45.3 Variants of PSC and Differential Diagnosis 45.4 Medical Therapy 45.5 Role of ERCP 45.6 Role of Cholangioscopy, EUS, and Intraductal Ultrasound 45.7 Surgery and Liver Transplantation 45.8 Conclusion References 46: Acute Cholecystitis 46.1 Introduction 46.2 Diagnosis 46.3 Treatment 46.4 Percutaneous Cholecystostomy 46.5 Endoscopic Transpapillary Gallbladder Drainage (ETGBD) 46.6 EUS-Guided Gallbladder Drainage (EUS-GBD) 46.7 Comparison Between Non-surgical Drainage Techniques References 47: Acute Pancreatitis 47.1 Introduction 47.2 Symptoms and Diagnosis 47.3 Scoring Systems for Severity Prediction 47.4 Fluid Resuscitation 47.5 Nutrition 47.6 Role of ERCP in Biliary Pancreatitis 47.7 Antibiotic Therapy 47.8 Cholecystectomy and Prevention of Relapse 47.9 Necrosectomy and Peripancreatic Fluid Collections 47.10 Conclusion References 48: Chronic Pancreatitis 48.1 Introduction 48.2 Main Pancreatic Duct Drainage 48.2.1 Main Pancreatic Duct Drainage by ERCP 48.2.1.1 Clinical Results Stricture-Predominant Disease Single Plastic Stenting Multiple Plastic Stenting Self-Expandable Metal Stenting Stone(s)-Predominant Disease 48.2.1.2 Factors Predictive of Clinical Results 48.2.2 Main Pancreatic Duct Drainage by EUS 48.3 Common Bile Duct Drainage 48.3.1 Common Bile Duct Drainage by ERCP 48.3.1.1 Clinical Results Single Plastic Stenting Multiple Plastic Stenting Self-Expandable Metal Stenting 48.3.1.2 Factors Associated with Clinical Success Pancreatic Calcifications in the Head of Pancreas Concomitant Acute Pancreatitis Stricture Length 48.3.2 Common Bile Duct Drainage by EUS 48.4 Conclusions References 49: Pancreatic Fistulas 49.1 Initial Diagnosis: Symptoms 49.2 Management of Pancreatic Fistula 49.3 Biliary and Pancreatic Leaks 49.4 General Principles of Fluid Circulation 49.5 Endoscopic Management of Pancreatic Fistulas 49.6 Endotherapy Complications 49.7 Surgical Treatment 49.8 Conclusion References Part VI: The Cytopathologist’s Point of View 50: EUS Tissue Sampling: What Are We Talking About? 50.1 Introduction 50.2 Handling of Aspirated Samples 50.2.1 Fixation of Slides 50.2.2 Rapid On-Site Diagnostic Evaluation (ROSE) 50.2.3 Cell Block 50.3 Handling of Core Biposy Specimens 50.4 Diagnostic Role of EUS-Guided Sampling 50.5 Conclusions References 51: Molecular Biology of Biliopancreatic Lesions 51.1 Molecular Biology of Biliopancreatic Lesions 51.2 Deep Sequencing of PDAC 51.3 Most Commonly Mutated Genes in Biliopancreatic Lesions 51.3.1 KRAS 51.3.2 TP53 51.3.3 SMAD4 51.3.4 CTNNB1 51.3.5 GNAS 51.3.6 CDKN2A 51.3.6.1 Other Genetic Alterations 51.4 Techniques References Part VII: Clinical Algorithms 52: Suspected Common Bile Duct Stones (Algorithm) Bibliography 53: Acute Cholangitis (Algorithm) Bibliography 54: Diagnosis of Etiology in Acute Pancreatitis References 55: Periampullary Biliary Strictures (Algorithm) 56: Hilar Strictures: Algorithm References 57: Diagnosis of Pancreatic Cyst: Algorithm Bibliography