375

Index

AAblation, APC, 92–93Ablative therapies, Barrett’s esophagus (BE)

complications of, 26–27limitations of, 26

Acute colonic bleeding. See HematocheziaAcute respiratory distress syndrome (ARDS),

enteral formulations, 121AdvanCE capsule delivery system, VCE, 152Argon plasma coagulation (APC), 85

alternative procedures, 97–98complications, 96–97contraindications, 93costs of, 98indications for

ablation, 92–93hemostasis, 92

postoperative care, 97procedure

ERBE device, 94first-and second-generation, 95–96mechanics, 94–95monopolar vs. bipolar, 93–94plasma coagulator device, 93–95technique, 96

Autofluorescence imaging (AFI), Barrett’s esophagus (BE), 17–19

BBand ligation, variceal hemorrhage

and sclerotherapy, 85–88injection therapy, 82intravariceal injection, 83–84paravariceal injection, 84–85technique, 80–83

Barrett’s esophagus (BE)algorithm for, 21EMR, with HGD and early cancer, 110

gastro-esophageal (GEJ) and squamo-columnar junction (SCJ), 12

gastroesophageal reflux and, 154–158imaging of

autofluorescence imaging, 17–19chromoendoscopy, 15–16confocal laser endomicroscopy, 19–20high-resolution/high-definition/magnification, 15narrow band imaging (NBI), 16–17

surveillancewith HGD, 14with LGD, 13–14without dysplasia, 13

therapy inablative therapies, 26–27cryotherapy, 25–26diagnostic EMR, 22–23EMR, 27–28eradication therapies for, 23–24EUS, role of, 22photodynamic therapy, 24postendoscopic therapy, 29radiofrequency ablation, 24–25with HGD, 20–21with LGD, 20

under white light endoscopy, 13Benign and malignant disorders and biliary ERCP

bile duct stentingcharacteristics, 188endoscopic views, 186fluoroscopic ERCP image, 187

cystgastrostomyendoscopic view, 191fluoroscopic image, 190procedure, 189–190

pancreatic duct sphincterotomy and stents, 188–189

sphincterotomycomplications, 184

From: Clinical Gastroenterology: Diagnostic and Therapeutic Procedures in Gastroenterology, Edited by: G. Y. Wu, S. Sridhar, DOI 10.1007/978-1-59745-044-7,

© Springer Science+Business Media, LLC 2011

376 Index

Benign and malignant disorders and biliary ERCP (Continued)

post-ERCP pancreatitis, 185–186risks, 183–184

Bile duct stentingcharacteristics, 188endoscopic views, 186fluoroscopic ERCP image, 187

Biopsy, Jamshidi Menghini needle kit, 366–371Bolus gastrostomy tube feeding, 123

CCap-assisted EMR, 106Capsule endoscopy (VCE). See Video capsule

endoscopy (VCE)Celiac disease, VCE

with atrophy of villi, 142with scalloped mucosa, 142

Cholangioscopy, 195–196Chromoendoscopy, 15–16, 102, 104Chronic obstructive pulmonary disease, enteral

formulations, 121Colon VCE

contraindications and solutions, 161indications for, 160polyp in, 159, 160procedure checklist, 161review, 160

Colonic angiomas, 323Colonic lesions, hematochezia

colonic angiomas, 323delayed post-polypectomy hemorrhage, 321–322diverticular hemorrhage, 317–319internal hemorrhoids, 319–320ischemic colitis, 320–321solitary rectal ulcer syndrome, 321

Colonic stentsalternative procedures, 50clinical data, 49complications, 48contraindications, 47devices, 49indications, 46postoperative care, 48–49procedure, 47–48

Colonoscopic polypectomyalternatives, 303complications, 301–302contraindications, 293–294cost, 303–304indications, 292–293polyp retrieval, 298–301post-procedure care, 302–303

procedure description, 295–298procedure site, 294–295results, 303

Colonoscopyascending colon, 355bleeding, 334cecum, 354descending colon, 356duodenal bulb, 352duodenum, 353endoscopy preparation, 328–329ESGE, 352–353hepatic flexure, 355ileocecal valve, 354mid-transverse colon, 355perforation, 333rectal vault, 357sigmoid colon, 357splenic flexure, 356terminal ileum, 353, 354tissue sampling, 351–352

Colorectum, EMR, 111Confocal laser endomicroscopy (CLM), 19–20Crohn’s disease, VCE

jejunal ulcer, 141NSAID-induced ulceration, 141with inflammatory exudates, 140

Cryotherapy, Barrett’s esophagus (BE), 25–26CT guided drainage, 242Cystgastrostomy

duodenostomy, 233–235endoscopic view, 191fluoroscopic image, 190procedure, 189–190

Cystoscopy-guided debridement, 215–217

DDBE. See Double balloon enteroscopyDelayed post-polypectomy hemorrhage, 321–322Diabetes, enteral formulations, 121Diarrhea, tube feeding

bloating and distention, 127–128etiology of, 126

Dilation. See Endoscopic esophageal dilationDiverticular hemorrhage, 317–319Double balloon enteroscopy (DBE)

alternative proceduresenteroscopy, 175–176small bowel series, 176wireless video capsule endoscopy, 174–175

characteristics, 167complications, 174contraindications, 172–173

377Index

costs, 177disadvantages, 173equipment, 167fluoroscopic images, 173indications

diagnosis, 170salvage therapy, 170–172therapeutic, 170

insertion, route of, 170preprocedure preparation

anterograde (oral) approach, 168retrograde (rectal) approach, 168sedation, 168

principle of, 166procedure, 168–169

EElectrohydraulic lithotripsy (EHL), 201–202Electrothermocoagulation, 61EMR. See Endoscopic mucosal resectionEndoCapsule computer software, for VCE, 146EndoCapsule data recorder, for VCE, 144Endoscopic drainage

complications and their avoidance, 236–238cystgastrostomy/duodenostomy, 233–235efficacy and cost-effectiveness, 232–233pancreatic fluid collections (PFCs)

alternative procedures, 217–218complications and management, 217cost effectiveness, 218cystoscopy-guided debridement, 215–217diagnosis, 212indications, 212patient preparation, 213post-procedural care, 217trans-mural pseudocyst drainage, 213–215trans-papillary pseudocyst drainage, 213

transpapillary drainage, 235–236Endoscopic esophageal dilation

alternative management, 8complications of, 8deflated and inflated balloon dilation catheter, 6indications for, 3over-the-wire, mechanical, taper-tipdilators, 5patient preparation for, 3–4wire-guided, mechanical, push-type dilators, 4with balloon, images of, 7

Endoscopic management, pancreatic pseudocysts. See Pancreatic pseudocysts, endoscopic management

Endoscopic mucosal resection (EMR), 342alternative procedures, 111–112appearances of, 104–105

colorectum, 111contraindications, 105–106cost, 112diagnostic, 22–23endoscopic ultrasound (EUS), 105esophagus

Barrett’s esophagus, with HGD and early cancer, 110

squamous cell carcinoma, 110indications, 102, 103lesion, lateral margins of, 102–104procedure

cap-assisted, 106, 107complications, 109injection-assisted, 106, 107lesion, margins of, 106ligation-assisted, 107–108postoperative care, 110resected lesion, retrieval of, 109submucosal injection, 106

stomach, 110–111therapeutic, 27–28tumor invasion, 104

Endoscopic procedures, documentation and description

colonoscopyascending colon, 355cecum, 354descending colon, 356duodenal bulb, 352duodenum, 353ESGE, 352–353hepatic flexure, 355ileocecal valve, 354mid-transverse colon, 355rectal vault, 357sigmoid colon, 357splenic flexure, 356terminal ileum, 353, 354tissue sampling, 351–352

findings, 357–359lesion

description, 360location, 359–360

photodocumentation, 348terminology, 359upper gastrointestinal endoscopy, 348–351

Endoscopic retrograde cholangiopancreatograpy (ERCP)

cardiopulmonary, 340complications, 340hemorrhage, 339infection, 339mortality, 340

378 Index

Endoscopic retrograde cholangiopancreatograpy (ERCP) (Continued)

pancreatitis, 338–339perforation, 340

Endoscopic sphincterotomy, 183–186Endoscopic ultrasound (EUS), 22, 105

bleeding, 341complications, 342infection, 341pancreatitis, 341–342perforation, 341

Endoscopic ultrasound drainage, 243Endoscopic ultrasound guided fine needle aspiration

(EUS-FNA)advantages, 250complications

acute pancreatitis, 270bleeding, 270–271infection, 271perforation, 265–270

contraindications, 250echoendoscope, 251–252indications, 250needles, 254–255position, 251pre-evaluation, 250–251preparation, 251prior radial EUS, 252–253suction syringes, 255–256technique

alignment, 259apposition, transducer, 259color Doppler evaluation, 259–260identification/selection, target lesion, 257–258needle puncture, 260–263needle withdrawal, 264sampled tissue/fluid transfer, 264–265sampling targeted lesion, 263–264transducer stabilizement, 259

Endoscopic variceal band ligation (EVL), 80–85Enteral nutrition (EN)

feeding formulascategorization of, 119–120delivery methods, 122–123disease-specific, 120–122elemental, 120fiber, 120high protein, 120immune enhancing, 122peptide-based, 120standard, 118

interventions for, 118tube feeding, monitoring

diarrhea, 126–128

gastrointestinal tolerance, 123–126gut function, determination of, 128–129

Enteral stent placementabdominal CT scan, 43alternative treatments, 46clinical efficacy, 45complications, 44–45contraindications, 42devices, 45–46indications, 41–42postoperative care, 45technique, 42–44

Enteroscopy, DBEintraoperative, 176push-enteroscopy, 176single balloon, 175spiral, 175

Eradication therapies, Barrett’s esophagus (BE), 23–24Esophageal adenocarcinoma (EAC), 11Esophageal stent placement

chest CT scan, 35complications, 37–38contraindications, 34–35indications, 33–34outcomes, 38–40postoperative care, 38technique, 35–37

Esophageal stricturesand endoscopic dilation

alternative management, 8complications of, 8deflated and inflated balloon dilation catheter, 6indications for, 3over-the-wire, mechanical, taper-tipdilators, 5patient preparation for, 3–4wire-guided, mechanical, push-type dilators, 4with balloon, images of, 7

diagnostic work-up, 2–3etiology of, 2

Esophageal varices, 73–75, 81, 155, 157Esophageal VCE (ECE)

contraindications, 158gastroesophageal reflux and Barrett’s esophagus,

154–158indications, 153

EsophagusEMR, 110normal, 153

EUS. See Endoscopic ultrasoundEUS-guided drainage, pelvic abscesses

CT guided drainage, 242endoscopic ultrasound drainage, 243limitations, 246procedural technique, 243–245

379Index

surgery, 242–243technical outcomes, 245–246transvaginal/transrectal ultrasound-guided

drainage, 242

FFiber containing formulas, in enteral nutrition, 120Forrest classification, UGIB, 58, 59

GGastric lavage, UGIB, 60Gastric residual volume (GRV), 125–126Gastric ulcer, in antrum, 108Gastric varices, 85–87Gastroesophageal reflux and Barrett’s esophagus, VCE

distal esophagitis, 154erosive esophagitis, with stricture, 157normal Z-line, 154Schatzki’s ring, 157tumor, 156ulcer, 155varices, 155, 157

Gastrointestinal endoscopyadvanced therapeutic techniques

endoscopic mucosal resection (EMR), 342radiofrequency ablation (RFA), 342

aspiration, 334–335bleeding

colonoscopy, 334upper endoscopy, 334

complicationscardiovascular, 330endoscopy preparation, 328–329percutaneous endoscopic gastrostomy (PEG),

336–338sedation and anesthesia, 329–330

endoscopic retrograde cholangiopancreatograpy (ERCP)

cardiopulmonary, 340complications, 340hemorrhage, 339infection, 339mortality, 340pancreatitis, 338–339perforation, 340

endoscopic ultrasound (EUS)bleeding, 341complications, 342infection, 341pancreatitis, 341–342perforation, 341

entrapment, 336

infection, 331–332perforation

colonoscopy, 333upper endoscopy, 332–333

post-polypectomy syndrome, 333pregnant/lactating women, 343–344splenic injury, 336vasovagal reactions, 336

Gastrointestinal tolerance, tube feedinggastric residual volumes, 125–126nausea and vomiting, 124–125

Gastrointestinal tract stentingbenign disease

devices, 40–41Food and Drug Administration approved, 41

colonic stentingalternative procedures, 50clinical data, 49complications, 48contraindications, 47devices, 49indications, 46postoperative care, 48–49procedure, 47–48

enteral stent placementalternative treatments, 46clinical efficacy, 45complications, 44–45contraindications, 42devices, 45–46indications, 41–42postoperative care, 45technique, 42–44

esophageal stent placementcomplications, 37–38contraindications, 34–35indications, 33–34outcomes, 38–40postoperative care, 38technique, 35–37

Gastrostomy tube feedingbolus, 123pump-driven, 124

Gut function, tube feeding, 128–129

HHematochezia

bowel preparation, 312clinical terms, 307–308colonic lesions

colonic angiomas, 323delayed post-polypectomy hemorrhage, 321–322diverticular hemorrhage, 317–319

380 Index

Hematochezia (Continued)internal hemorrhoids, 319–320ischemic colitis, 320–321solitary rectal ulcer syndrome, 321

colonoscopy, 311–312cost assessment, 324CURE hemostasisresearchgroup, 313diagnostic evaluations, 310–311emergency abdominal angiography, 315–316epidemiology, 308hematochezia–clinical algorithm, 310red cell scanning, 316–317resuscitation and initial evaluation, 308–309traditional approach

management, 313–314results, 313–314

Hemorrhagedelayed post-polypectomy, 321–322diverticular, 317–319

Hemostasis, APC, 92Hepatic disease, enteral formulations, 121High-grade dysplasia (HGD), 14, 20–21

IIleal carcinoid tumor, 139Immune enhancing enteral formulations, 121–122Injection therapy

band ligation, 82UGIB

agents, 62–63technique, 63–64thrombin/fibrin glue, 63

Injection-assisted EMR, 106, 107Internal hemorrhoids, 319–320Intraductal endoscopy, 195

contraindications, 203diagnostic uses, 199therapeutic applications, 201

Intraoperative enteroscopy, 176Intravariceal injection, 83–84Ischemic colitis, 320–321

JJamshidi Menghini needle kit biopsy, 366–371Japanese Gastric Cancer Association, 104, 105Jejunal Crohn’s ulcer, 141Jejunal Dieulafoy’s lesion, with active bleeding, 150

LLigation-assisted EMR

antrum, gastric ulcer in, 108variceal ligation device, 108

Liver biopsy gun, 372Low-grade dysplasia (LGD), 13–14, 20Lower gastrointestinal (LGI) bleeding.

See HematocheziaLugol’s solution, 15

MM2A/Pillcam capsule, VCE, 144Mallory-Weiss tears, 69Methylene blue, 15–16, 103

NNarrow band imaging (NBI), 16–17Nausea, in enteral nutrition patients, 124–125Nematodes, VCE, 149Non-variceal upper gastrointestinal bleeding. See

Upper GI bleeding (UGIB), endoscopic management

Nonelectrothermocoagulation, 61–62

OObscure GI bleeding (OGIB), VCE

active bleeding in, 136ampulla of Vater, 134cecum and, 135ileocecal valve, 135jejunum, with active bleeding, 137pylorus, 133small bowel telangiectasia, 136small bowel villi, 134small bowel, indications, 133

PPain management, EUS

celiac plexus block and neurolysis, 274–275CPN/CPB, 275–280ganglion impar neurolysis, 285–288pathophysiology, 273–274superior hypogastric plexus neurolysis, 281–285

Pancreatic duct sphincterotomy and stents, 188–189Pancreatic fluid collections (PFCs)

alternative procedures, 217–218complications and

avoidance, 236–238management, 217

cost effectiveness, 218, 232–233cystgastrostomy/duodenostomy, 233–235diagnosis, 212efficacy, 232–233indications, 212patient preparation, 213

381Index

post-procedural care, 217procedure

cystoscopy-guided debridement, 215–217trans-mural pseudocyst drainage, 213–215trans-papillary pseudocyst drainage, 213

transpapillary drainage, 235–236Pancreatic pseudocysts, endoscopic management

clinical presentation and diagnosisimaging studies and possible fluid sampling,

227–229physical examination and laboratory evaluation,

225–226endoscopic drainage

complications and their avoidance, 236–238cystgastrostomy/duodenostomy, 233–235efficacy and cost-effectiveness, 232–233transpapillary drainage, 235–236

incidence and etiology, 221–222pathogenesis and classification, 222–225percutaneous drainage, 231preprocedural assessment, 229–230surgical drainage, 230–231

Pancreato biliary disease managementcomparative procedures, 204–205complications and safety, 203–204contraindications, 203cost, 205diagnostic indications

bile duct stone, 198, 199direct visualization, 198SpyBite biopsy forceps, 200

intraductal endoscopy, 195pancreatoscopy, 195post-procedure care, 204procedure description, 197–198SpyScope, 196–197therapeutic indications

electrohydraulic lithotripsy (EHL), 201–202

photodynamic therapy, 202Pancreatoscopy, 195Paravariceal injection, 84–85Peptic ulcers, endoscopic therapy, 58Peptide-based formulas, in enteral nutrition, 120Percutaneous drainage, 231Percutaneous endoscopic gastrostomy (PEG)

buried bumper syndrome, 337fistula, 336–337hemorrhage, 338pneumoperitoneum, 338stoma leak/enlargement, 337tube dislodgement, 338wound/tube infection, 337

Percutaneous transhepatic cholangioscopy (PTCS), 204

Photodynamic therapy (PDT)Barrett’s esophagus (BE), 24intraductal endoscopy, 202

Pillcam colon, 132Pillcam ESO, 132Pillcam SB, 132Plasma coagulator device, 93–95Polyflex stent, 40Polyp, in colon VCE, 159, 160Post-ERCP pancreatitis, 185–186Post-polypectomy syndrome, 333Postendoscopic therapy, UGIB, 69Pump-driven gastrostomy tube feeding, 124Push-enteroscopy, DBE, 176

RRadiation telangiectasia. See Colonic angiomasRadiofrequency ablation (RFA)

Barrett’s esophagus (BE), 24–25gastrointestinal endoscopy, 342

Rectalulcers, 321Renal-specific formulas, enteral nutrition, 121Roux-en-Y anastomosis, DBE, 172

SSalvage therapy, DBE

clinical findings, 171Roux-en-Y anastomosis, 172

Sclerotherapy, variceal hemorrhage, 85–88Self-expandable metal stent (SEMS) placement,

34, 39, 40Self-expandable plastic stent (SEPS), 39Sengstaken–Blakemore tube, 79Single balloon enteroscopy, 175Small bowel tumors, VCE

angioectasia, 138ileal carcinoid tumor, 139polypoid mass, 140stromal tumor, 138submucosal jejunal mass, 139

Solitary rectal ulcer syndrome, 321Sphincterotomy

complications, 184post-ERCP pancreatitis, 185–186risks, 183–184

Spiral enteroscopy system, 175SpyGlass direct visualization system. See Pancreato

biliary disease managementSquamous cell carcinoma (SCC), 110Stents. See Gastrointestinal tract stentingStomach, EMR, 110–111Submucosal injection, EMR, 106Surgical drainage, 230–231

382 Index

TThermal therapy, UGIB, 61Thrombin/fibrin glue, UGIB, 63Trans-mural pseudocyst drainage, 213–215Trans-papillary pseudocyst drainage, 213Transjugular intrahepatic portosystemic shunt

(TIPS), 79Transpapillary drainage, 235–236Transvaginal/transrectal ultrasound-guided drainage,

242Tubulovillous adenoma, injection-assisted EMR, 111Tumor invasion, EMR, 104

UUltrasound-guided/assisted percutaneous liver biopsy

alternate devices, 371–372biopsy, Jamshidi Menghini needle kit, 366–371complications, 372–373contraindications, 365–366costs, 373indications, 364–365liver biopsy gun, 372procedure, 366

Upper endoscopybleeding, 334endoscopy preparation, 328–329gastrointestinal, 348–351perforation, 332–333

Upper GI bleeding (UGIB), endoscopic managementcauses of

bleeding ulcer, anatomy of, 57endoscopy, timing of, 57–58Forrest classification, 58, 59initial evaluation of, 56–57mortality, independent predictors of, 57peptic ulcers, 58rebleeding rates and mortality of, 60

injection therapyagents, 62–63technique, 63–64thrombin/fibrin glue, 63

mechanical clipsapplication, 66types of, 65

nonelectrothermocoagulation, 61–62patient monitoring, 58patient position, 61

endoscopic treatment, 60gastric lavage, 60

techniques, selection ofclip placement, needle injection, 68clot removal, 69endoscopic therapy recommendations, 68

Forrest class Ia and Ib, 67–68Forrest class IIa, 68Forrest class IIb, 68–69Mallory-Weiss tears, 69postendoscopic therapy, 69second-look endoscopy, 69thermal therapy, needle injection, 67

thermal therapyelectrothermocoagulation, 61technique, 61

VVariceal hemorrhage, endoscopic management

band ligationinjection therapy, 82intravariceal injection, 83–84paravariceal injection, 84–85technique, 80–83

combination treatment, band ligation and sclerotherapy

argon plasma coagulation (APC), 85follow-up, 87gastric varices, 85–87

grade 1 and grade 2 esophageal varices, 74grade 3 esophageal varices

with stigmata, 75without stigmata, 75

initial management of, 77–80primary prophylaxis, 75–76risk assessment of, 74secondary prophylaxis, 76

Variceal ligation device, 108VCE. See Video capsule endoscopyVideo capsule endoscopy (VCE)

AdvanCE capsule delivery system, 152Agile Patency Capsule, 151, 152celiac disease

with atrophy of villi, 142with scalloped mucosa, 142

coloncontraindications and solutions, 161indications for, 160polyp in, 159, 160procedure checklist, 161review, 160

contraindications, 143Crohn’s disease

jejunal ulcer, 141NSAID-induced ulceration, 141with inflammatory exudates, 140

endocapsule, 132equipment

EndoCapsule computer software for, 146

383Index

EndoCapsule data recorder, 144Imaging software interface for, 145M2A/Pillcam capsule, 144

esophageal VCE (ECE)contraindications, 158gastroesophageal reflux and Barrett’s

esophagus, 154–158indications, 153

issues, 149–151limitations of, 133obscure GI bleeding (OGIB)

active bleeding in, 136ampulla of Vater, 134cecum and, 135ileocecal valve, 135jejunum, with active bleeding, 137pylorus, 133small bowel telangiectasia, 136small bowel villi, 134small bowel, indications, 133

outcomesfindings, 148jejunal Dieulafoy’s lesion, with active

bleeding, 150

nematodes, 149small bowel diverticula, 149small bowel ulcer, 148

Pillcam colon, 132Pillcam ESO, 132Pillcam SB, 132reading, 147self-dissolvable agile patency capsule, 151small bowel tumors

angioectasia, 138ileal carcinoid tumor, 139polypoid mass, 140stromal tumor, 138submucosal jejunal mass, 139

technique, 146–147, 158–159wireless, 174–175

Vomiting, in enteral nutrition patients, 124–125

WWall flex enteral stent, 46Wireless video capsule endoscopy (CE),

174–175