Gastroenterological endoscopy

Gastroenterological Endoscopy
Media Center Information
Title Page
Copyright
Dedication
Preface
List of Contributors
Contents
Video Contents
Abbreviations
I Introduction to Endoscopy
	1 Education and Training in Endoscopy
		1.1 Introduction
		1.2 Clinical Education
			1.2.1 Clinical Training to Competency in Esophagogastroduodenoscopy and Colonoscopy: Studies, Guidelines, and Assessment
			1.2.2 Training in Endoscopic Retrograde Cholangiopancreatography
			1.2.3 Complementary E-learning and Video Courses
		1.3 Incorporation of Simulators in Training
		1.4 Endoscopy Simulators and Training Models
			1.4.1 Plastic Phantoms and Other Static Models
			1.4.2. Computer Simulators
			1.4.3 Training Courses with Live Animals
			1.4.4 Ex Vivo Porcine Tissue Models (EASIE, Erlanger Endo-Trainer, EASIE-R)
			1.4.5 Training Courses
			1.4.6 Incorporating Simulator Training into Educational Programs and Maintaining Skills in Complex Procedures
		References
	2 The Value of Clinical Research
		2.1 Introduction
		2.2 Keys to Success
			2.2.1 A Tough Skin
			2.2.2 Building Teams
		2.3 Designing Clinical Trials
			2.3.1 Generating Ideas
			2.3.2 Refining Ideas
			2.3.3 Clinical Trial Design
			2.3.4 Grant Writing
			2.3.5 Conducting Clinical Trials
			2.3.6 Presentation and National Meetings
			2.3.7 Manuscript Writing
		2.4 Ethics
			2.4.1 Conflict of Interest
			2.4.2 Registration of Clinical Trials and Underreporting of Negative Trials
			2.4.3 Falsification of Data
			2.4.4 Plagiarism
		2.5 Manuscript Submission and Review Process
			2.5.1 Expanding the Reach
			2.5.2 The Future of Scientific Publications
		References
II The Patient and Endoscopy
	3 Informed Consent for Gastrointestinal Endoscopy
		3.1 Introduction
		3.2 What Is “Informed Consent”?
		3.3 Clinician and Patient Relationship
		3.4 What Information Is Required?
		3.5 How Should the Information Be Provided?
		3.6 Where and When Should the Consent Be Taken?
		3.7 Withdrawal of Consent
		3.8 Exceptions to the Requirement of Consent
		References
	4 Patient Preparation and Sedation for Endoscopy
		4.1 Introduction
		4.2 Presedation Assessment
		4.3 Monitoring during Endoscopic Sedation
			4.3.1 Introduction
			4.3.2 Hemodynamic Monitoring
		4.4 Pharmacology
			4.4.1 Introduction
			4.4.2 Benzodiazepines
			4.4.3 Opioids
			4.4.4 Propofol
			4.4.5 Who Should Perform Endoscopic Sedation?
		4.5 Postprocedure Care
			4.5.1 Monitoring during Recovery
			4.5.2 Discharge
		References
	5 Design of the Endoscopy Suite
		5.1 Introduction
		5.2 General Questions and Considerations
		5.3 Guidelines for Planning an Endoscopy Suite
		5.4 Pathways for Patients, Staff, and Material
		5.5 Location of the Unit
		5.6 Number of Rooms
		5.7 X-Ray Requirements
		5.8 The Endoscopic Examination Room
			5.8.1 Size of the Rooms
			5.8.2 Equipment
			5.8.3 Monitor Systems and Anesthesia
			5.8.4 Video Integration and PC-Based Documentation
			5.8.5 Endoscopes and Endoscopic Equipment
		5.9 Endoscopic Ultrasound and Laser Treatment Room, Radiography Room
		5.10 Preparation and Recovery Room
		5.11 Cleaning and Disinfection Area
		5.12 Staffing
		References
	6 Cleaning and Disinfection in Endoscopy
		6.1 Introduction
		6.2 Principles of Disinfection
			6.2.1 Definitions
			6.2.2 Application to Gastrointestinal Endoscopes
			6.2.3 Liquid Chemical Germicides and Automated Endoscope Reprocessors
		6.3 Transmission of Infection by Gastrointestinal Endoscopy
			6.3.1 Transmission by Endoscopes with Elevators
			6.3.2 Failure or Breach in Reprocessing
			6.3.3 Unusual Organisms
		6.4 Design and Oversight of Reprocessing Facilities
		References
	7 Electrosurgical Principles for Endoscopy
		7.1 Introduction
		7.2 Electrosurgical Principles
			7.2.1 Electrical and Tissue Variables
			7.2.2 Monopolar versus Bipolar Circuit
		7.3 Electrosurgical Units and Waveforms
		7.4 Practical Applications
			7.4.1 Snare Polypectomy
			7.4.2 Hot Biopsy
			7.4.3 Sphincterotomy
			7.4.4 Hemostasis
			7.4.5 Miscellaneous
		7.5 Electrosurgical Hazards and Safety
			7.5.1 Unintended Burn Injury
			7.5.2 Implanted Electromagnetic Devices
			7.5.3 Bowel Explosion
		7.6 Conclusion
		References
	8 Antibiotic Prophylaxis in Endoscopy
		8.1 Introduction
		8.2 Bacteremia Related to Endoscopic Procedures
			8.2.1 Procedures Associated with Low Risk of Bacteremia
			8.2.2 Procedures Associated with High Risk of Bacteremia
		8.3 Antibiotic Prophylaxis for the Prevention of Infective Endocarditis
			8.3.1 Antibiotic Prophylaxis for the Prevention of Procedural-Related Infections (Other Than IE)
		8.4 EUS-FNA
		8.5 Percutaneous Endoscopic Gastrostomy/Jejunostomy
		8.6 Cirrhosis with GI Bleeding
		8.7 Synthetic Vascular Grafts and Other Nonvalvular Cardiovascular Devices
		8.8 Orthopaedic Prostheses
		8.9 Patients Receiving Peritoneal Dialysis
		References
	9 Quality Assurance in Endoscopy
		9.1 The Importance of Quality
		9.2 Performance Measures
		9.3 Practicalities of Measurement
			9.3.1 Clinical Importance
			9.3.2 Standardization
			9.3.3 Practicality
			9.3.4 Governance Infrastructure
			9.3.5 Negative Aspects
		9.4 Quality Improvement
		9.5 Summary
		References
	10 Endoscopic Complications
		10.1 Introduction
		10.2 General Considerations
			10.2.1 Cardiopulmonary and Sedation-Related Events
			10.2.2 Infection
		10.3 Upper Gastrointestinal Endoscopy
			10.3.1 Diagnostic Upper Gastrointestinal Endoscopy
			10.3.2 Therapeutic Upper Gastrointestinal Endoscopy
			10.3.3 Management of Upper Gastrointestinal Perforation
			10.3.4 Management of Upper GI Bleeding
		10.4 Small Bowel Endoscopy
		10.5 Colonoscopy
			10.5.1 Perforation
			10.5.2 Management of Colonic Perforation
			10.5.3 Bleeding
			10.5.4 Unusual Complications
		10.6 ERCP
			10.6.1 Bleeding
			10.6.2 Perforation
			10.6.3 Infections
			10.6.4 Post-ERCP Pancreatitis
		10.7 Other Techniques
			10.7.1 EUS-Guided Celiac Block/Neurolysis
			10.7.2 EUS-Guided Drainage of Pancreatic Fluid Collections
			10.7.3 Peroral Endoscopic Myotomy
		10.8 Conclusion
		10.9 Key Points
		References
	11 Anticoagulation and Endoscopy
		11.1 Introduction
		11.2 Antithrombotics
			11.2.1 Antiplatelet Agents
			11.2.2 Anticoagulants Agents
		References
III General Diagnostic and Therapeutic Procedures and Techniques
	12 Upper Gastrointestinal Endoscopy
		12.1 History of Upper Gastrointestinal Endoscopy
		12.2 General Diagnostic Techniques
			12.2.1 Indications
			12.2.2 Contraindications
		12.3 Preparation of the Patient
		12.4 Sedation
		12.5 Use of Antifoaming Agents and Antispasmotics
		12.6 Procedural Steps for Upper Gastrointestinal Endoscopy
			12.6.1 Insertion and Observation
			12.6.2 Esophagus
			12.6.3 Esophagogastric Junction
			12.6.4 Stomach and Duodenum
			12.6.5 Transnasal Upper Endoscopy
		12.7 Common Pathologies for Upper Gastrointestinal Endoscopy
			12.7.1 I: Upper Gastrointestinal Cancers
			12.7.2 II: Upper Gastrointestinal Hemorrhage
			12.7.3 III: GERD and Barrett’s Esophagus
		12.8 Screening for BE
		12.9 Surveillance for BE
		12.10 Barrett’s Esophagus–Related Dysplasia
		12.11 Complications of Upper Gastrointestinal Endoscopy
		References
	13 Enteroscopy Techniques
		13.1 Introduction
		13.2 Overview of Enteroscopy Procedures
			13.2.1 Anatomical Characteristics of the Small Intestine
			13.2.2 Classification and Principles of Device-Assisted Enteroscopy
			13.2.3 Balloon-Assisted Enteroscopy (Double-Balloon Endoscopy/Single-Balloon Endoscopy)
			13.2.4 Spiral Endoscopy
		13.3 General Diagnostic Techniques
		13.4 General Therapeutic Techniques
			13.4.1 Hemostasis
			13.4.2 Balloon Dilation
			13.4.3 Polypectomy/Endoscopic Mucosal Resection
			13.4.4 Retrieval of Foreign Bodies
		13.5 Accessory Devices and Techniques
		13.6 Indications for the Use of Device-Assisted Enteroscopy
			13.6.1 Indications for Diagnostic Use
			13.6.2 Indications for Follow-Up of Small Intestinal Lesions
			13.6.3 Therapeutic Indications for Device-Assisted Enteroscopy
			13.6.4 Miscellaneous Indications for Device-Assisted Enteroscopy
		13.7 Procedure-Specific Quality Measures
		13.8 Procedure-Specific Training Requirements
			13.8.1 Minimizing Air Insufflation for Deep Intubation
			13.8.2 Necessity of X-Ray Fluoroscopy during Device-Assisted Enteroscopy
		13.9 Minimizing Procedure-Specific Complications
			13.9.1 Complications of Balloon-Assisted Endoscopy
			13.9.2 Complications of Spiral Endoscopy
		13.10 Conclusions
		References
	14 Wireless Video Capsule Endoscopy
		14.1 Introduction
		14.2 Technology
		14.3 Setting and Preparation for Video Capsule Endoscopy
		14.4 VCE Administration
		14.5 Indications for VCE
		14.6 Contraindications to VCE
		14.7 Risk of VCE Retention
		14.8 Reading a VCE Study
		14.9 Conclusion
		References
	15 Colonoscopy: Preparation, Instrumentation, and Technique
		15.1 Introduction
		15.2 Preparation
			15.2.1 Indications and Contraindications
			15.2.2 Patient Preparation
		15.3 Basic Instrumentation
			15.3.1 Sedation
			15.3.2 Colonoscope
			15.3.3 Accessories
		15.4 Technique
			15.4.1 Scope Insertion
			15.4.2 Scope Withdrawal
			15.4.3 Polypectomy
			15.4.4 Complications
		15.5 Quality Measures
		References
	16 Endoscopic Retrograde Cholangiopancreatography
		16.1 Introduction
		16.2 Overview of Procedure
		16.3 General Diagnostic Techniques
			16.3.1 Biliary Cannulation
			16.3.2 Sphincter of Oddi Manometry
		16.4 General Therapeutic Techniques
			16.4.1 Biliary Sphincterotomy
			16.4.2 Endoscopic Papillary Balloon Dilation
			16.4.3 Stone Extraction
			16.4.4 Biliary Stenting
		16.5 Accessory Devices and Techniques
			16.5.1 Endoscopes
			16.5.2 Equipment
		16.6 Accepted Indications
		16.7 Procedure-Specific Quality Measures
		16.8 Procedure-Specific Training Requirements
		16.9 Procedure-Specific Complications
		References
	17 Cholangioscopy
		17.1 Introduction
		17.2 Overview of Cholangioscopy
		17.3 General Diagnostic Techniques
			17.3.1 Two-Operator Systems: Mother-Baby Scopes
			17.3.2 Single-Operator System: SpyGlass Cholangiopancreatoscopy
			17.3.3 Direct Cholangioscopy
		17.4 Accessory Devices and Techniques
			17.4.1 Confocal Microscopy
			17.4.2 Lithotripsy Probes
			17.4.3 Intraductal Biopsy Forceps
		17.5 Accepted Indications
			17.5.1 Evaluation of Indeterminate and Malignant Biliary Strictures
			17.5.2 Diagnosis and Management of Choledocholithiasis
			17.5.3 Photodynamic Therapy of Cholangiocarcinoma
		17.6 Complications of Cholangioscopy
		References
	18 Advanced Imaging Methods
		18.1 Introduction
		18.2 High-Definition Endoscopes
		18.3 Virtual Chromoendoscopy
		18.4 Narrow-Band Imaging
		18.5 Flexible Spectral Imaging Color Enhancement
		18.6 i-Scan and Optical Enhancement
		18.7 Clinical Application of Virtual Chromoendoscopy
		18.8 Chromoendoscopy
		18.9 Clinical Application of Chromoendoscopy
		18.10 Confocal Laser Endomicroscopy
		18.11 Probe-Based CLE
		18.12 Endoscope-Based CLE
		18.13 Clinical Application
		18.14 Optical Coherence Tomography
		18.15 Conclusions
		References
	19 The Contribution of Histopathology to Endoscopy
		19.1 Prerequisites
		19.2 Clinical Impact of Histopathology by Segment within the Gastrointestinal Tract
			19.2.1 Esophagus
			19.2.2 Stomach
			19.2.3 Small Bowel
			19.2.4 Colorectum
		19.3 Endoscopic Resections
		19.4 Conclusion
		References
	20 Endoscopic Ultrasonography
		20.1 Introduction
		20.2 Overview of the Procedure
		20.3 General Diagnostic and Therapeutic Techniques
			20.3.1 Conditions of Implementation
			20.3.2 Endoscopes and Probe
			20.3.3 EUS Semiology of the Bowel Wall
			20.3.4 Techniques
		20.4 Accessory Devices and Techniques
			20.4.1 Elastography
			20.4.2 Contrast-Enhanced EUS
			20.4.3 Needles and EUS-Guided Sample
		20.5 Accepted Indications
		20.6 Quality Measures
		20.7 Training
		20.8 Complications and Prevention
			20.8.1 Noninterventional EUS
			20.8.2 EUS-FNA
			20.8.3 Interventional EUS
		20.9 Prevention
		References
	21 Hybrid, Natural Orifice, and Laparoscopy-Assisted Endoscopy: New Paradigms in Minimally Invasive Therapy
		21.1 Introduction
		21.2 History of NOTES
		21.3 Submucosal Surgery
		21.4 Back to NOTES
		21.5 Laparoscopy-Assisted Endoscopy
		21.6 Laparoscopy-Assisted Endoscopic Resection
		21.7 Endoscopy-Assisted Laparoscopic Resection
		21.8 Combined Laparoscopic–Endoscopic Resection
		21.9 Summary
		References
IV Upper Gastrointestinal Tract Disease
	22 Gastroesophageal Reflux Disease and Infectious Esophagitis
		22.1 Diagnostic Approaches
		22.2 Therapeutic Approaches
		22.3 Surgical Therapy
		22.4 Endoscopic Therapy for GERD
		22.5 Infectious Esophagitis
			22.5.1 Candida Esophagitis
			22.5.2 Herpes Simplex Virus Esophagitis
			22.5.3 Cytomegalovirus Esophagitis
			22.5.4 Other Infections
		References
	23 Barrett's Esophagus and Early Neoplasia
		23.1 Diagnostic Work-Up for Barrett’s Esophagus and Early Neoplasia
			23.1.1 General Approach to Barrett’s Esophagus
			23.1.2 Endoscopic Imaging of Barrett’s Esophagus
		23.2 Endoscopic Surveillance for Barrett’s Esophagus
		23.3 Management of Dysplasia and Early Cancer in Barrett’s Esophagus
			23.3.1 Indications for Endoscopic Treatment
			23.3.2 Endoscopic Treatment Techniques
			23.3.3 Current Guidelines for Endoscopic Treatment and Subsequent Follow-Up
		23.4 Areas of Uncertainty, Experimental Techniques, and Research
			23.4.1 Biological Markers in Barrett’s Esophagus
			23.4.2 Low-Risk Submucosal Cancer
			23.4.3 Novel Developments in Endoscopic Ablation
		23.5 Conclusion
		References
	24 Squamous Neoplasia of the Esophagus
		24.1 Introduction
			24.1.1 Epidemiology and Risk Factors
			24.1.2 Precursor Lesions for Squamous Neoplasia
		24.2 Diagnostic Approaches
			24.2.1 Nonendoscopic Techniques
			24.2.2 Endoscopic Techniques
		24.3 Treatment for Squamous Neoplasia of the Esophagus
			24.3.1 Endoscopic Resection
		24.4 Thermal Therapy
			24.4.1 Radiofrequency Ablation
			24.4.2 Cryotherapy
			24.4.3 Other Ablative Techniques
		24.5 Areas of Uncertainty, Experimental Techniques, and Research
		24.6 Summary
		References
	25 Benign Esophageal Strictures and Esophageal Narrowing Including Eosinophilic Esophagitis
		25.1 Introduction
		25.2 Diagnostic Approaches
			25.2.1 General Approach Including Causes, Symptoms, and Diagnosis
		25.3 Classification System
		25.4 Therapeutic Approaches
			25.4.1 Standard Technique
			25.4.2 Variations of Standard Techniques
		25.5 Novel Diseases Causing Esophageal Stricturing
			25.5.1 Eosinophilic Esophagitis
		25.6 Post–Endoscopic Resection
		25.7 Areas of Uncertainty, Experimental Techniques, and Research
		References
	26 Achalasia
		26.1 Introduction
			26.1.1 Epidemiology
			26.1.2 Pathophysiology
			26.1.3 Etiology
			26.1.4 Clinical Presentation
		26.2 Diagnostic Approaches
			26.2.1 General Approach Including Equipment and Techniques
			26.2.2 Achalasia Subtypes
			26.2.3 Guidelines and Systematic Reviews
		26.3 Therapeutic Approaches
			26.3.1 Standard Techniques
			26.3.2 Guidelines and Systematic Reviews
		26.4 Areas of Uncertainty, Experimental Techniques, and Research
		References
	27 Advanced Esophageal Cancer
		27.1 Introduction
		27.2 Diagnosis and Classification
			27.2.1 Malignant Dysphagia
			27.2.2 Stents
			27.2.3 Cryotherapy
			27.2.4 Feeding Tubes
			27.2.5 Esophagorespiratory Fistulas
			27.2.6 Stents
			27.2.7 Clips
			27.2.8 Sutures
			27.2.9 Bleeding
		27.3 Conclusion
		References
	28 Peptic Ulcer Disease and Bleeding, Including Duodenal Ulcer
		28.1 Introduction
		28.2 Diagnosis of Peptic Ulcer Disease and Bleeding
		28.3 Choice of Instrument for Peptic Ulcer Bleeding
		28.4 Therapeutic Modalities for Peptic Ulcer Bleeding
			28.4.1 Injection Therapy
			28.4.2 Thermal
			28.4.3 Mechanical Therapy
			28.4.4 Topical Hemostatic Powders
		28.5 New Hemostatic Modalities
			28.5.1 Endoscopic Suturing
			28.5.2 Endoscopic Ultrasound–Guided Angiotherapy
		28.6 Conclusion
		Reference
	29 Gastric Cancer Including Early Neoplasia and Preneoplastic Conditions
		29.1 Introduction
		29.2 Diagnostic Approach
			29.2.1 Preparation
			29.2.2 Endoscopic Technique
			29.2.3 Knowledge for Diagnosis
		29.3 Therapeutic Approach
			29.3.1 Principle of Endoscopic Resection
			29.3.2 Indication for Endoscopic Resection
			29.3.3 Clinical Management after Endoscopic Resection
		29.4 Future Prospects
		29.5 Repeat as Needed for Each Condition
		References
	30 Obesity: Endoscopic Approaches
		30.1 Introduction
		30.2 Obesity: Endoscopic Approaches
		30.3 Diagnostic Approach and the Multidisciplinary Obesity Center Concept
			30.3.1 General Approach, Equipment, and Techniques
			30.3.2 Therapeutic Approaches: Currently Available Techniques
			30.3.3 Gastric Techniques
			30.3.4 Small Bowel Techniques
			30.3.5 Endoscopic Revision of Prior Gastric Bypass
			30.3.6 Other Postoperative Issues That Lead to Weight Gain and May Require Endoscopic Intervention
			30.3.7 Guidelines and Systematic Reviews
			30.3.8 Experimental Techniques
		30.4 Summary
		References
	31 Small Intestinal Diseases Beyond the Duodenum
		31.1 Introduction
		31.2 Suspected Small Bowel Bleeding
			31.2.1 Diagnostic Approaches
			31.2.2 Therapeutic Approaches
		31.3 Small Bowel Crohn’s Disease
			31.3.1 Diagnosis
			31.3.2 Therapeutics
		31.4 Dilation of Small Bowel Stricture
		31.5 Small Bowel Tumors
			31.5.1 Diagnosis
			31.5.2 Therapeutics
		31.6 Malabsorption Disorders of the Small Bowel
			31.6.1 Diagnostics and Therapeutics
		31.7 Small Intestinal Infections
		31.8 Congenital Lesions
		31.9 Miscellaneous Conditions
		31.10 Conclusion
		References
	32 Sporadic Neoplastic Polyps of the Duodenum and Ampulla
		32.1 Introduction
		32.2 Ampullary Neoplastic Polyps
			32.2.1 Types of Ampullary Polyps
			32.2.2 Clinical Manifestations
			32.2.3 Diagnosis
			32.2.4 Management of Ampullary Neoplasms
			32.2.5 Endoscopic Ampullectomy
			32.2.6 Endoscopic Outcomes: Clinical Success, Recurrence Rates
			32.2.7 Surveillance
		32.3 Conclusion
		32.4 Nonampullary Sporadic Neoplastic Duodenal Polyps
			32.4.1 Types of Nonampullary Duodenal Polyps
			32.4.2 Diagnosis
			32.4.3 Management of Nonampullary Duodenal Adenomas
			32.4.4 Outcomes of Endoscopic Mucosal Resection
			32.4.5 Adverse Events
			32.4.6 Post–Endoscopic Mucosal Resection Care
			32.4.7 Role of Endoscopic Submucosal Dissection
			32.4.8 Surveillance
		32.5 Conclusion
		References
	33 Malabsorption and Food Allergy/Intolerance
		33.1 Introduction
		33.2 Standard Endoscopy
			33.2.1 Water-Immersion Technique
		33.3 Chromoendoscopy and Magnification Endoscopy
		33.4 Narrow-Band Imaging
		33.5 Confocal Laser Endomicroscopy
		33.6 Optical Coherence Tomography
		33.7 Device-Assisted Enteroscopy
			33.7.1 Capsule Endoscopy
		33.8 Selected Small Bowel Diseases
			33.8.1 Celiac Disease
			33.8.2 Tropical Sprue
			33.8.3 Small Bowel Bacterial Overgrowth
			33.8.4 Sprue-Like Enteropathy Associated with Olmesartan
		33.9 Conclusion
		References
	34 Portal Hypertension, Varices, Gastropathy, and Gastric Antral Vascular Ectasia
		34.1 Introduction
		34.2 Portal Hypertension: What Do We Need to Know?
			34.2.1 Pathophysiology of Portal Hypertension
			34.2.2 Noncirrhotic Portal Hypertension
			34.2.3 Cirrhotic Portal Hypertension: Natural History, Risk Stratification, and Individualizing Care
		34.3 Diagnosis of Portal Hypertension
			34.3.1 Hepatic Venous Pressure Gradient
			34.3.2 Noninvasive Tests
		34.4 Treatment of Portal Hypertension
			34.4.1 Primary Prophylaxis
			34.4.2 Management of Acute Variceal Bleeding
		34.5 Secondary Prophylaxis
		34.6 Management of Treatment Failure
		34.7 New Modality in Management of AVB: Hemospray
		34.8 Management of Gastric Varices
		34.9 Management of Ectopic Varices
		34.10 Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
		34.11 Areas of Uncertainty, Experimental Techniques, and Research
		34.12 Conclusion
		References
V Lower Gastrointestinal Tract Disease
	35 Colorectal Polyps and Cancer Screening/Prevention
		35.1 Introduction
		35.2 Polyp Classification and Polyp Cancer Sequences
		35.3 Conventional Adenomas
			35.3.1 Low-Risk versus Advanced Conventional Adenomas
			35.3.2 Shape and Colonic Distribution of Conventional Adenomas
			35.3.3 Surface Features of Conventional Adenomas
			35.3.4 Resection of Conventional Adenomas
		35.4 Serrated Class Lesions
			35.4.1 Terminology and Histology
			35.4.2 Endoscopic Presentation
			35.4.3 Resection of Serrated Lesions
		35.5 Colorectal Cancer Screening
			35.5.1 Approaches to Offering Screening
			35.5.2 Factors That Affect Colorectal Cancer Risk
			35.5.3 Choices of Individual Screening Tests
			35.5.4 Surveillance after Cancer Resection
		35.6 Conclusion
		References
	36 Advanced Colorectal Polyps and Early Cancer Resection
		36.1 Introduction
		36.2 Technical Aspects and Preparation
			36.2.1 Patient Preparations
			36.2.2 Techniques of Endoscopic Resection
			36.2.3 Equipment Required
		36.3 Lesion Assessment
		36.4 Resection Technique
			36.4.1 Endoscopic Mucosal Resection
			36.4.2 Endoscopic Submucosal Dissection
		36.5 Unique Situations
			36.5.1 EMR of LSLs at the Anorectal Junction
			36.5.2 EMR of LSLs at the Ileocecal Valve
			36.5.3 EMR of Circumferential LSLs
			36.5.4 EMR of Lumen Filling Lesions
			36.5.5 EMR of Periappendiceal LSLs
			36.5.6 EMR of Multiple Recurrent LSLs
			36.5.7 Sessile Serrated Lesions
			36.5.8 Endoscopic Resection of Large Pedunculated Lesions
		36.6 Endoscopy versus Surgery
		36.7 Complications
			36.7.1 Intraprocedural Bleeding
			36.7.2 Clinically Significant Postendoscopic Bleeding
			36.7.3 Deep Injury
			36.7.4 Postprocedural Pain
		36.8 Residual and Recurrent Disease
			36.8.1 Recurrence and EMR
			36.8.2 Techniques at the Initial EMR to Prevent Recurrence
			36.8.3 Triaging Patients to Follow Up Based on Risk of Recurrence
			36.8.4 Accurate Assessment of the Post-EMR Scar
			36.8.5 Endoscopic Treatment of Post-EMR Recurrence
		36.9 Future Direction of ER
		References
	37 Inheritable Cancer Syndromes
		37.1 Introduction
		37.2 Nonpolyposis Syndromes
			37.2.1 Lynch’s syndrome
			37.2.2 Familial CRC
		37.3 Polyposis Syndromes
			37.3.1 Familial Adenomatous Polyposis
			37.3.2 Attenuated Familial Adenomatous Polyposis
			37.3.3 MUTYH-Associated polyposis
			37.3.4 Serrated Polyposis Syndrome
			37.3.5 Hamartomatous Polyposis Syndromes
		References
	38 Inflammatory Bowel Disease and Microscopic Colitis
		38.1 Introduction
		38.2 Endoscopic Characteristics of IBD
			38.2.1 Lower Endoscopy
			38.2.2 Upper Endoscopy
			38.2.3 Small Bowel Imaging
			38.2.4 Endoscopic Ultrasonography
			38.2.5 Endoscopic Retrograde Cholangiopancreatography
		38.3 Endoscopy in Established IBD
			38.3.1 Acute Colitis
			38.3.2 Routine Endoscopy
		38.4 Endoscopic Evaluation of IBD Disease Activity
			38.4.1 Crohn’s Disease
			38.4.2 Ulcerative Colitis
		38.5 Endoscopy after Surgery
			38.5.1 Lower Endoscopy
		38.6 Endoscopic Surveillance in IBD
		38.7 Therapeutic Endoscopic Approaches in IBD
		38.8 Microscopic Colitis
		References
	39 Lower Intestinal Bleeding Disorders
		39.1 Introduction
		39.2 General Aspects
			39.2.1 Epidemiology
			39.2.2 Clinical Course and Prognosis
		39.3 Diagnostic Approach
			39.3.1 History
			39.3.2 Physical Examination
			39.3.3 Laboratory Studies
			39.3.4 Endoscopy
			39.3.5 Nonendoscopic Methods
		39.4 Differential Diagnosis
			39.4.1 Diverticula
			39.4.2 Vascular Diseases
			39.4.3 Inflammation
			39.4.4 Neoplasia
			39.4.5 Anorectal Diseases
		39.5 Therapy
			39.5.1 Initial Resuscitation
			39.5.2 Endoscopy
		39.6 Injection Therapy
		39.7 Thermocoagulation
		39.8 Topical Agents
			39.8.1 Hemospray (Cook Medical) TG 325
			39.8.2 EndoClot (EndoClot Plus Inc.)
			39.8.3 Ankaferd Blood Stopper (Ankaferd Health Products)
		39.9 Mechanical Methods
			39.9.1 Over-the-scope Clip System (OTSC) (Ovesco, Tübingen, Germany)
		39.10 Differential Endoscopic Therapy
			39.10.1 Diverticula
			39.10.2 Vascular Diseases
			39.10.3 Inflammation
			39.10.4 Neoplasia
			39.10.5 Bleeding after Colonic Polypectomy
		References
	40 Anorectal Diseases
		40.1 Introduction
		40.2 Inflammation
			40.2.1 Crohn’s Disease
			40.2.2 Perianal Abscesses
			40.2.3 Anorectal Fistula
		40.3 Infection
			40.3.1 Chlamydial Infection
			40.3.2 Gonococcal Proctitis
			40.3.3 Herpes Simplex Virus
			40.3.4 Syphilis
			40.3.5 Lymphogranuloma Venereum
		40.4 Vascular Cause
			40.4.1 Ischemic Proctitis
			40.4.2 Radiation Proctitis
		40.5 Neoplasm
			40.5.1 Anal Cancer
			40.5.2 Anal Intraepithelial Neoplasia
		40.6 Mechanical Cause
			40.6.1 Hemorrhoids
			40.6.2 Rectal Prolapse
			40.6.3 Solitary Rectal Ulcer Syndrome
			40.6.4 Anal Fissure
			40.6.5 Stercoral Ulcer
		References
VI Biliopancreatic, Hepatic, and Peritoneal Diseases
	41 Benign Biliary Disorders
		41.1 Introduction
		41.2 Postoperative Biliary Stricture
		41.3 Chronic Pancreatitis and Biliary Strictures
		41.4 Primary Sclerosing Cholangitis
		41.5 Bile Duct Leaks
		References
	42 Malignant Biliary Disease
		42.1 Introduction
		42.2 Diagnostic Approach
			42.2.1 Radiologic Imaging
			42.2.2 Endoscopic Retrograde Cholangiopancreatography
			42.2.3 Fluorescence In-Situ Hybridization
			42.2.4 Cholangioscopy
			42.2.5 Endoscopic Ultrasound-Fine Needle Aspiration
			42.2.6 Intraductal Ultrasound
			42.2.7 Probe-based Confocal Laser Endomicroscopy
		42.3 Classification Systems
		42.4 Guidelines and Systematic Reviews
		42.5 Therapeutic Approaches
			42.5.1 Standard Techniques
			42.5.2 Liver Transplantation
			42.5.3 Variation of Standard Techniques
		42.6 Guidelines and Reviews
		42.7 Areas of Uncertainty
		References
	43 Acute and Chronic Pancreatitis
		43.1 Introduction
		43.2 Diagnostic Approaches
			43.2.1 Overview
			43.2.2 Equipment and Techniques
			43.2.3 Guidelines and Systematic Reviews
		43.3 Therapeutic Approaches
			43.3.1 Standard Techniques
			43.3.2 Guidelines and Systemic Reviews
		43.4 Areas of Uncertainty, Experimental Techniques, and Research
			43.4.1 Diagnostic Procedures
			43.4.2 Therapeutic Procedures
		43.5 Conclusion
		References
	44 Pancreatic Cancers and Cystic Neoplasms
		44.1 Introduction
		44.2 Pancreatic Cancers
			44.2.1 Ductal Adenocarcinoma of the Pancreas
			44.2.2 Pancreatic Neuroendocrine Tumors
		44.3 Cystic Lesions of Pancreas
			44.3.1 Nonneoplastic Cysts
			44.3.2 Pancreatic Cystic Neoplasms
		References
	45 Subepithelial Tumors of the Gastrointestinal Tract
		45.1 Introduction
		45.2 Types of SETs
			45.2.1 Gastrointestinal Stromal Tumors
			45.2.2 Leiomyomas
			45.2.3 Carcinoids
			45.2.4 Other Subepithelial Lesions of the Gastrointestinal Tract
		45.3 Risk Stratification of Subepithelial Tumors
		45.4 Methods for Tissue Acquisition
			45.4.1 Endoscopic Ultrasound-Guided Fine-Needle Aspiration
			45.4.2 Endoscopic Ultrasound-Guided Fine-Needle Biopsy and Trucut Biopsy
			45.4.3 Other Tissue Acquisition Techniques
		45.5 Management of Subepithelial Lesions
		45.6 Endoscopic Resection of Subepithelial Tumors
		References
	46 Gastrointestinal Foreign Bodies
		46.1 Introduction
		46.2 Clinical Epidemiology
			46.2.1 Overview of Pathophysiology
		46.3 Patient Presentation
		46.4 Diagnosis
			46.4.1 Treatment
			46.4.2 Pharmacologic therapies
			46.4.3 Endoscopic accessories and interventions
			46.4.4 Esophageal food impaction
			46.4.5 Sharp foreign bodies
			46.4.6 Coins and button batteries
			46.4.7 Bezoars
			46.4.8 Rectal foreign bodies
		46.5 Complications
		46.6 Conclusion and Future Trends
		References
Index