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ERCP.pdf

ERCP

nike128821
2010-05-09 0人阅读 举报 0 0 暂无简介

简介:本文档为《ERCPpdf》,可适用于自然科学领域

AnimprintofElsevierInc©,ElsevierIncAllrightsreservedFirstpublishedNopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,withoutthepriorpermissionofthePublishersPermissionsmaybesoughtdirectlyfromElsevier’sHealthSciencesRightsDepartment,JohnFKennedyBoulevard,Suite,Philadelphia,PA,USA:phone:()fax:()or,email:healthpermissionselseviercomYoumayalsocompleteyourrequestonlineviatheElsevierhomepage(http:wwwelseviercom),byselecting“Supportandcontact”andthen“CopyrightandPermission”ISBN:BritishLibraryCataloguinginPublicationDataAcataloguerecordforthisbookisavailablefromtheBritishLibraryLibraryofCongressCataloginginPublicationDataAcatalogrecordforthisbookisavailablefromtheLibraryofCongressNoticeMedicalknowledgeisconstantlychangingStandardsafetyprecautionsmustbefollowed,butasnewresearchandclinicalexperiencebroadenourknowledge,changesintreatmentanddrugtherapymaybecomenecessaryorappropriateReadersareadvisedtocheckthemostcurrentproductinformationprovidedbythemanufacturerofeachdrugtobeadministeredtoverifytherecommendeddose,themethodanddurationofadministration,andcontraindicationsItistheresponsibilityofthepractitioner,relyingonexperienceandknowledgeofthepatient,todeterminedosagesandthebesttreatmentforeachindividualpatientNeitherthePublishernortheauthorassumeanyliabilityforanyinjuryandordamagetopersonsorpropertyarisingfromthispublicationThePublisherPrintedinChinaLastdigitistheprintnumber:Workingtogethertogrowlibrariesindevelopingcountrieswwwelseviercom|wwwbookaidorg|wwwsabreorgCommissioningEditor:RollaCouchmanDevelopmentEditor:SharonNashEditorialAssistant:SarahPennyProjectManager:JessThompsonDesignManager:CharlesGrayIllustrationManager:GillianRichardsIllustrator:DebbieMaizelsBarkingDogMarketingManager(s)(UKUSA):KathyNeelyClaraToombsFMXinddiv::PMixPrefaceERCPPAST,PRESENTANDFUTUREERCPpastSinceitsinitialdescriptionover–decadesago,ERCPhasevolvedfromadiagnostictoatherapeuticprocedureSuchanevolution,however,hasrequireddevelopmentsintechnologytoincludemarketingofasideviewingduodenoscopewithanelevatortofacilitatecannulation,useoftherapeuticinstrumentswithlargeraccessorychannels,andcreationandmarketingofawidevarietyofendoscopicaccessoriesInadditiontotechnologyevolution,therehavebeenevolutionsintechniquesandtrainingtobringustoERCPpresentFromthelatterstandpoint,ERCPiscurrentlyrecognizedasanadvancedtherapeuticprocedureusuallyrequiringanadditionalyearoftrainingbeyondastandardyeargastroenterologytrainingprogramERCPpresentWiththeexceptionofperformingconcomitantsphincterofOddimanometry(SOM),diagnosticERCPhaslargelybeensupplantedbynoninvasiveimagingtoincludeabdominalCT,MRIMRCPandEUSTherapeuticERCPwasinitiallydescribedoveryearsagowhenClassenandKawaiindependentlydescribedendoscopicsphincterotomyinGermanyandJapan,respectivelyFromadiagnosticstandpoint,ERCPisstillusedtodefinetheetiologyofacuterelapsingpancreatitis(divisum,anomalousPBunion,annularpancreas,SOD),todifferentiatechronicpancreatitisfromintraductalpapillarymucussecretingneoplasm(IPMN),todefinethepresenceorabsenceofcommonbileductstonesinjaundice,cholangitis,oracutepancreatitisandtodistinguishbenignfrommalignantbiliarystricturesFromthelatterstandpoint,however,ERCPremainsanimperfecttechnology,andmetaanalysesofseriesreviewingbrushcytologyorendoscopicbiopsytodistinguishbenignfrommalignantbiliarystenosessuggestonlya–positivity,eveninthesettingofmalignancyERCPisalsouseddiagnosticallytodefinetheetiologyofsmolderingpancreatitistoincludediagnosisofductaldisruptionandsphincteredemaCurrently,ERCPhasevolvedintoaprimarytherapeuticmodalityForthepastthreedecades,therapeuticmaneuvershavebeencenteredon,andfacilitatedby,endoscopicsphincterotomyDespitechangesinsphincterotomedesign(pull,push,needleknife,longnose,–mmwire,monofilamentvsbraidedcuttingwire,standardvsrapidexchangesystem,singledoubletriplelumentechnology),techniqueofuse(purecut,blendedcurrent,pulsedcurrentErbegenerator)andlengthanddirectionofincision,enlargingthepancreaticobiliaryorificetofacilitateaccesstostrictures,stones,andductaldisruptionsremainsthemostcommontherapyundertakenwithERCPWhileballoondilationofthebiliarysphinctermaytheoreticallyoffercomparableaccesstobiliarysphincterotomywithoutthepotentialriskofbleedingandperforationcomplications,theratesofproceduralpancreatitis,oftensevere,areprohibitivewithouttheuseofadjunctivemeasuressuchaspancreaticductstentplacementAssuch,theuseofballoondilationofthepapillahasbeenrelegatedtobitpartsinourtherapeuticarmamentarium,mostcommonlyinthesettingofcoagulopathyandBillrothIIanatomyChangesthathaveoccurredoverthepastdecadeintheendoscopictreatmentofbiliarystoneshaveincludedimprovedmechanicallithotriptorsandelectrohydraulicandlaserlithotripsyunderdirectcholangioscopicvisualizationChangesinmalignantstricturetherapyincludeevolutionfromplasticprosthesestoselfexpandablemetalstents(SEMS)Forbenignstrictures,dilatingballoonshavebecomestrongerandhavebeenmarketedwithlargerdiametersTreatmenthasevolvedfromplacementofasinglepolyethyleneprosthesisto,,,andevenstentsinparallelStudiesarecurrentlyunderwaylookingattheuseofcompletelycovered–mmSEMSinanattempttotreatasubgroupofthesepatientswithasingleendoscopicmanipulationThetreatmentsofpostoperativebiliaryleakshavebecomeroutineandendoscopicpapillectomyhasreplacedsurgicalresectionformostampullaryadenomasOnthepancreaticside,obstructingcalculihavebecomeamajorindicationforpancreaticendotherapyalthoughapproximatelyofsuchpatientsrequirepretreatmentwithextracorporealshockwavelithotripsy(ESWL)priortoremovalObstructingstricturesarealsoroutinelybeingtreated,althoughresultsremainmorenebulousthanthosereportedforbenignbiliarystenosisandthereappearstobediscordancebetweenresolutionofthestricture(–)andsymptomaticimprovement(–)TreatmentofductaldisruptionhasnowbecomestandardtherapyinhighvolumeERCPcentersThelatterincludeamenablepancreaticocutaneousfistulas(externalfistula)andinternalfistulas(pseudocyst,highamylasepleuraleffusion,pancreaticascites,pancreaticoentericorpancreaticobiliaryfistula)DataareclearthatfistulasaremuchmorelikelytocloseifatranspapillarystentbridgestheareaofductdisruptionIncontrast,aglandulardisconnection(disconnectedglandsyndrome)inwhichthemajorFMXinddix::PMxcomponentofongoingglandularsecretionsisfromthedisconnectedupstreamductisunlikelytocloseunlessthereisconcomitanttransgastricortransentericdrainageofanassociatedfluidcollectionERCPfutureTherearemultiplepossiblescenariosforERCPinthefutureTheseincludewidespreadapplicationoftechniquesortechnologythatarecurrentlyusedonlyinhighvolumecentersExamplesincludesemiroutineuseofcholangioscopytoruleoutretainedCBDstonesortobetterdefinetheetiologyofbiliarystricturesThelatterwilllikelyrequiredisposablecholangioscopesOntheotherhand,widespreadapplicationofdurablevideocholangioscopesorpancreaticoscopesispotentiallyfeasibleOtherproceduresthatareutilizedinfrequentlymaybecomecommonplaceiftechnologicandreimbursementissuescanbesolvedTheseincludeendoscopicdeliveryofbrachytherapyorphotodynamictherapy(PDT)topatientswithunresectable,hilarcholangiocarcinomaTheyincludeamorewidespreadapproachtotheendotherapyofpancreaticnecrosis,treatingnotonlytheductaldisruptionthatisinvariableinseverenecrosisbutalsoitsconsequences,toincludedrainageofassociatedfluidcollectionsanddebridementofnecroticdebrisItispossiblethatERCPinthefuturewillbecomeaggressivelymoretherapeuticAnexamplemightbeinjectionofalitholyticagentintothepancreaticductinpatientswithchroniccalcificpancreatitisProstaglandininhibitorsaswellaslongactingneuromodulatorsmayalsobeinjectedintraductallyinpainfulchronicpancreatitisStentplacementmayevolvetosolvetheproblemsofocclusionbybacterialbiofilmormucosalhyperstasiawithplasticandmetalprostheses,respectivelyItispossiblethatintraductalinjectionofchemotherapeuticorimmunomodulatingdrugsmayplayabitpartoramajorroleinthefuturemanagementofpancreaticobiliarymalignanciesCertainlyworkwillcontinueonwaystominimizeprocedurallyrelatedpancreatitis,themajorcomplicationofERCPThelatterwillincludemodificationsoftechnique,prophylacticPDstentsandpreorintraprocedureinjectionofdrugs,intravenouslyordirectlyintothepancreaticductOntheotherhand,protenomicspromiseswhatconventionaltumormarkers(CA,CEA,alterationsinp,KRas)havenotdelivered:earlydiagnosisofPBmalignancyordefinitionofanextremelyhighriskpatientgroupwhoperhapsrequiremore,asopposedtofewer,diagnosticproceduresThefutureofERCPislike,“Thecheckisinthemail”ItmayormaynotarriveEvenifitdoes,thecheckmaybesodelayedastoprovealmostworthlessTheevolutionofERCP,ofcourse,willnotoccurinavacuumanditsfuturewillbecontingentuponparalleladvancementsinimagingandlabtestingandbreakthroughtechnologyortechniquesinotherdisciplinessuchaslaparoscopicortransgastricsurgery,moreeffectiveandlesstoxicchemoirradiation,orevenalternativeendoscopictherapiesdeliveredbyEUSNevertheless,wepredictabrightdecadeforERCPandsuggestthatevenatitsthanniversary,itwillremainavibranttechnologyandtechniqueinthecareofpatientswithPBdiseaseItiswiththistimelineandcumulativeperspectivethattheeditorshaveassembledthisERCPtextManyoftheworld’sexpertshavecontributedchaptersandvideomaterialinanattempttomakethisbooknotonlyrelevant,butcomprehensive,foranyendoscopistwhoutilizesERCPintheirpracticeOmissions,ifany,areoursTechnologychangesrapidlyandreusablecholangioscopes(egSpyScopeTM)willhavebeenintroducedbythetimethistextispublishedanditislikelythatothertechnologymayberenderedobsoleteClinicaltrialsmayfuelordampenourenthusiasmforoneprocedureoranotherDespitethis,theeditorshavedonetheirbesttoproduceatextthatwillputbothevolvingtechnologyandcurrenttechniquesintoclinicalperspectiveAfterall,ERCPremainsaclinicaltooltofacilitatepatientcareandimproveclinicaloutcomesItisourhopeandintentionthatthisbookfacilitatesandimprovesthatcareToddHBaron,MDRichardAKozarek,MDDavidLCarrLocke,MDPREFACEFMXinddx::PMxiListofContributorsDrDouglasGAdlerAssistantProfessorofMedicine,DirectorofTherapeuticEndoscopyHuntsmanCancerCenterUniversityofUtahSchoolofMedicineSaltLakeCityUTUSADrSushilKAhlawatAssistantProfessorofMedicineDepartmentofMedicine,GastroenterologyDivisionGeorgetownUniversitySchoolofMedicineGeorgetownUniversityHospitalWashingtonDCUSADrJawadAhmadAssistantProfessorofMedicineandCoMedicalDirectorofLiverTransplantationUniversityofPittsburghPittsburghPAUSADrFirasHAlKawasProfessorofMedicineandChiefofEndoscopyGastroenterologyDivisionGeorgetownUniversityHospitalWashingtonDCUSADrRaedMAlsulaimanAssistantProfessorofMedicineandConsultantInternist,GastroenterologistKingFaisalUniversityKingFahdHospitalofTheUniversityAlkhobarKingdomofSaudiaArabiaDrTiingLeongAngConsultantGastroenterologistDepartmentofMedicineChangiGeneralHospitalSingaporeDrJohnBaillieProfessorofMedicineDivisionofGastroenterologyWakeForestUniversityHealthSciencesWinstonSalemNCUSADrAlanBarkunProfessorofMedicineandChairholdertheDouglasGKinnearChairinGastroenterologyDirector,DivisionofGastroenterologyMcGillUniversityandtheMcGillUniversityHealthCentreMontréal,QuébecCanadaDrToddHBaronProfessorofMedicineMayoClinicCollegeofMedicineRochesterMNUSADrSuryaprakashBhandariAssociateConsultantInstituteofAdvancedEndoscopyJaslokHospitalMumbaiIndiaDrKennethFBinmoellerDirector,InterventionalEndoscopyServicesCaliforniaPacificMedicalCenterSanFranciscoCAUSADrWilliamRBruggeAssociateProfessorofMedicine,HarvardMedicalSchoolDirectorofEndoscopy,GIUnitMassachusettsGeneralHospitalBostonMAUSADrJonathanMBuscagliaTherapeuticEndoscopyFellowDivisionofGastroenterologyandHepatologyTheJohnsHopkinsUniversitySchoolofMedicineBaltimoreMDUSADrDavidLCarrLockeDirectorTheEndoscopyInstituteBrighamWomen’sHospitalBostonMAUSADrAnnieOnOnChanAssociateProfessorofMedicineDepartmentofMedicineUniversityofHongKongQueenMaryHospitalHongKongDrSuyiChangGastroenterologistKaiserPermanenteWalnutCreekCAUSADrAnnMChenClinicalInstructorUniversityofCalifornia,IrvineComprehensiveDigestiveDiseaseCenterOrangeCAUSAFMXinddxi::PMxiiProfessorGuidoCostamagnaProfessorofSurgeryandGastroenterologyDigestiveEndoscopyUnitUniversitaCattolica“AGemelli”RomaItalyDrGiovanniDDePalmaChief,SectionofDiagnosticandTherapeuticEndoscopyDepartmentofSurgeryandAdvancedTechnologiesUniversityofNaplesFedericoIINaplesItalyDrJacquesDeviereProfessorofMedicineChairman,DepartmentofGastroenterologyandHepatopancreatologyULBHôpitalErasmeBrusselsBelgiumDrJamesJFarrellDirectorofPancreaticobiliaryEndoscopyandEndoscopicUltrasoundDivisionofDigestiveDiseaseUCLASchoolofMedicineLosAngelesCAUSADrPaulFockensProfessorofGastrointestinalEndoscopyDirectorofEndoscopyAcademicMedicalCenterUniversityofAmsterdamAmsterdamNetherlandsDrVictorLFoxDirectorGIProcedureUnitandEndoscopyProgramChildren’sHospitalBostonHarvardMedicalSchoolBostonMAUSADrJamesTFrakesClinicalProfessorofMedicineUniversityofIllinoisCollegeofMedicineatRockfordandRockfordGastroenterologyAssociatesLtdRockfordILUSADrMartinLFreemanProfessorofMedicine,UniversityofMinnesotaDirector,PancreaticobiliaryEndoscopyFellowshipUniversityofMinnesotaandHennepinCountyMedicalCenterMinneapolisMNUSADrJosephEGeenenClinicalProfessorofMedicineMedicalCollegeofWisconsinDirector,PancreaticBiliaryCenterStLuke’sMedicalCenterMilwaukeeWIUSADrGregoryGGinsbergProfessorofMedicineDirectorofEndoscopicServicesGastroenterologyDivisionHospitaloftheUniversityofPennsylvaniaPhiladelphiaPAUSADrJaquelinaMGobeletFellowofTheLatinAmericanAdvancedGastrointestinalEndoscopyTrainingCenterSantiagoChileDrKheanLeeGohProfessorofMedicineHeadofGastroenterologyandHepatologyChiefofGIEndoscopyFacultyofMedicineUniversityofMalayaKualaLumpurMalaysiaDrNaliniMGudaClinicalAssistantProfessorofMedicineUniversityofWisconsinSchoolofMedicineandPublicHealthPancreaticBiliaryCenterStLuke’sMedicalCenterMilwaukeeWIUSADrRobertHHawesProfessorofMedicineDivisionofGastroenterologyHepatologyDigestiveDiseaseCenterMedicalUniversityofSouthCarolinaCharlestonSCUSADrJürgenHochbergerChefarztMedKlinkIIIGastroenterologieInterventEndoskopieStBernwardKrankenhausHildesheimGermanyDrKunalJajooAdvancedEndoscopyFellowTheEndoscopyInstituteBrighamandWomen’sHospitalBostonMAUSADrAnnMarieJoyceGastroenterologistGastroenterologyDepartmentLaheyClinicBurlingtonMAUSALISTOFCONTRIBUTORSFMXinddxii::PMxiiiDrAnthonyNKallooProfessorofMedicineDirector,DivisionofGastroenterologyandHepatologyTheJohnsHopkinsUniversitySchoolofMedicineBaltimoreMDUSADrPeterBKelseyAssistantProfessorofMedicineHarvardMedicalSchoolGastrointestinalUnitMassachusettsGeneralHospitalBostonMAUSADrMichaelBKimmeyProfessorofMedicineDivisionofGastroenterologyUniversityofWashingtonMedicalCenterSeattleWAUSADrMichaelLKochmanProfessorofMedicineandProfessorofMedicineinSurgeryGastroenterologyDivisionHospitaloftheUniversityofPennsylvaniaPhiladelphiaPAUSADrTadashiKodamaChiefofGastroenterologyKyotoShimogamoHospitalKyotoJapanDrTatsuyaKoshitaniChiefofEndoscopyUnitDepartmentofGastroenterologyKyotoCityHospitalKyotoJapanRichardAKozarekExecutiveDirector,DigestiveDiseaseInstituteVirginiaMasonMedicalCenterClinicalProfessorofMedicineUniversityofWashingtonSeattleWAUSADrYukTongLeeHonoraryClinicalAssociateProfessorTheChineseUniversityofHongKongPrinceofWalesHospitalShatin,NTHongKongDrGlenALehmanIndianaUniversityMedicalCenterIndianapolisINUSADrJosephWLeungMrMrsCWLawProfessorofMedicineDivisionofGastroenterologyandHepatologyUCDavisMedicalCenterSacramentoCAUSADrChiLeungLiuHonoraryProfessorofSurgeryDepartmentofSurgeryUniversityofHongKongQueenMaryHospitalHongKongDrSimonKLoDirectorofEndoscopy,CedarsSinaiMedicalCenterClinicalProfessorofMedicineDavidGeffenSchoolofMedicineatUCLADivisionofDigestiveDiseasesCedarsSinaiMedicalCenterLosAngelesCAUSADrJürgenMaissDepartmentofMedicineIUniversityErlangenNürnbergErlangenGermanyDrAmitMaydeoDirector,InstituteofAdvancedEndoscopyChief,DepartmentofEndoscopyandEUSJaslokHospitalMumbaiIndiaDrDetlevMenkeLeadingConsultantDepartmentofMedicineIIIStBernwardHospitalHildesheimGermanyDrDesireeEMorganAssociateProfessor,DiagnosticRadiologyDepartmentofRadiologyUniversityofAlabamaatBirminghamBirminghamABUSADrClaudioNavarreteDirectorofMinimallyInvasiveSurgeryClinicaAlemanaUniversidaddelDesarrolloChairofTheLatinAmericanAdvancedGastrointestinalEndoscopyTrainingCenterSantiagoChileDrHorstNeuhausProfessorofMedicineDepartmentofGastroenterologyEvangelischesKrankenhausDüsseldorfDüsseldorfGermanyDrWaiChoungOngAsianInstituteofGastrenterologyJubileeHillsHyderabadIndiaDrWaiChoungOngAsianInstituteofGastrenterologyJubileeHillsHyderabadIndiaLISTOFCONTRIBUTORSFMXinddxiii::PMxivDrWilliamMOutlawFellowDivisionofGastroenterologyWakeForestUniversityHealthSciencesWinstonSalemNCUSADrBretTPetersenProfessorofMedicineDivisionofGastroenterologyandHepatologyMayoClinicCollegeofMedicineRochesterMNUSADrJeffreyLP

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