This is trial version www.adultpdf.com ADVANCED DIGESTIVE ENDOSCOPY: ERCP This is trial version www.adultpdf.com ADVANCED DIGESTIVE ENDOSCOPY: ERCP EDITED BY PETER B. COTTON AND JOSEPH LEUNG This is trial version www.adultpdf.com © 2005 by Blackwell Publishing Ltd Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 2005 Library of Congress Cataloging-in-Publication Data Advanced digestive endoscopy: ERCP/edited by Peter Cotton and Joseph Leung. p. ; cm. Includes bibliographical references. ISBN-13: 978-1-4051-2079-1 ISBN-10: 1-4051-2079-7 1. Endoscopic retrograde cholangiopancreatography. 2. Gastroscopy. [DNLM: 1. Cholangiopancreatography, Endoscopic Retrograde—methods. 2. Digestive System Diseases. WI 750 A244 2005] I. Title: ERCP. II. Cotton, Peter B. III. Leung, J. W.C. RC847.5.E53A38 2005 616.3′07545—dc22 2005012661 ISBN-13: 978-1-4051-2079-1 ISBN-10: 1-4051-2079-7 A catalogue record for this title is available from the British Library Set in 10/13 1 /2 Sabon by Graphicraft Limited, Hong Kong Printed and bound by Replika Press PVT Ltd, Harayana, India Commissioning Editor: Alison Brown Development Editor: Julie Elliott Production Controller: Kate Charman For further information on Blackwell Publishing, visit our website: hppt://www.blackwellpublishing.com The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. This is trial version www.adultpdf.com Contents List of Contributors, vii Preface, ix 1 ERCP OverviewaA 30-Year Perspective, 1 Peter B. Cotton 2 ERCP Training, Competence, and Assessment, 9 Peter B. Cotton 3 Fundamentals of ERCP, 17 Joseph Leung 4 ERCP Communications, Recording, and Reporting, 81 Peter B. Cotton 5 Common Bile Duct Stones and Cholangitis, 88 Enders K.W. Ng and Sydney Chung 6 The Role of ERCP in Pancreatico-Biliary Malignancies, 120 Gulshan Parasher and John G. Lee 7 Management of Postsurgical Bile Leaks and Bile Duct Strictures, 142 Jacques J.G.H.M. Bergman 8 Sphincter of Oddi Dysfunction, 165 Evan L. Fogel and Stuart Sherman 9 ERCP in Acute Pancreatitis, 199 Martin L. Freeman 10 Endoscopy in Chronic Pancreatitis, 239 Lee McHenry, Stuart Sherman, and Glen Lehman v This is trial version www.adultpdf.com 11 Complications of Pancreatitis, 281 Douglas A. Howell 12 ERCP in Children, 309 Moises Guelrud 13 ERCP: Risks, Prevention, and Management, 339 Peter B. Cotton Index, 405 CONTENTSvi This is trial version www.adultpdf.com vii List of contributors BERGMAN, JACQUES J.G.H.M.,Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands CHUNG, SYDNEY, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong COTTON, PETER B.,Medical University of South Carolina, PO Box 250327, Ste 210 CSB, 96 Jonathan Lucas St, Charleston, SC 29425, USA FOGEL, EVAN L., Indiana University Medical Center, 550 N. University Drive, Suite 4100, Indianapolis, IN 46202, USA FREEMAN, MARTIN L., Hennepin County Medical Center, GI Division, 701 Park Avenue, Minneapolis, MN 55415, USA GUELRUD, MOISES, New England Medical Center, 750 Washington Street, Booth 213, Boston, MA 02111, USA HOWELL, DOUGLAS A., Portland Endoscopy Center, 1200 Congress Street #300, Portland, ME 04102, USA LEE, JOHN G., University of California Irvine, Division of Gastroenterology, 101 The City Drive, Bldg 53, Rm 113, Orange, CA 92817, USA LEHMAN, GLEN, Indiana University Medical Center, 550 N. University Blvd, Rm 4100, Indianapolis, IN 46202, USA LEUNG, JOSEPH, Division of GI UC Davis, 4150 V Street, Ste 3500, PSSB, Sacramento, CA 95817, USA MCHENRY, LEE, Indiana University Medical Center, 550 N. University Drive, Suite 4100, Indianapolis, IN 46202, USA This is trial version www.adultpdf.com NG, ENDERS K.W., Upper GI Division, Department of Surgery, The Chinese University of Hong Kong, Hong Kong PARASHER, GULSHAN,Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque NM87131-0001, New Mexico SHERMAN, STUART, Indiana University Medical Center, 550 N. University Drive, Suite 4100, Indianapolis, IN 46202, USA LIST OF CONTRIBUTORSviii This is trial version www.adultpdf.com Preface There was a time, long ago, when endoscopy was a small off-shoot of gastroen- terology, and when most of what budding endoscopists needed to know could be covered in a slim book. Thus Practical Gastrointestinal Endoscopy was con- ceived by Christopher Williams and myself over 25 years ago, and had a success- ful run through four editions. The field has expanded enormously over that time. The number and variety of procedures, and the relevant scientific liter- ature, have proliferated, and there is now a hierarchy within endoscopy. There are ‘standard’ procedures which most clinical gastroenterologists master during their training. These constitute routine upper endoscopy and colonoscopy, with their common therapeutic aspects, which may be needed at work every day (and some nights). Then there are recognized ‘advanced’ procedures, such as ERCP and EUS, and the more adventurous therapeutic aspects of upper endoscopy and colonoscopy, such as fundoplication, EMR, and tumor ablation. These are practiced by only a small percentage of endoscopists, who need more focused and intensive training. In addition, for a few of the leaders, there is much to be learned in related fields, such as unit design, management, teaching, and quality improvement. It is clear that no one person (or two) can speak or write about all of this territory with any authority. Advice and instruction are best given by acknowledged experts in each specific area. My publishing journey reflects these changes. Thus, the latest (5 th ) Edition of Practical Gastrointestinal Endoscopy, sub-titled ‘The Fundamentals’, pub- lished in 2003, is devoted solely to the basic facts which all trainees need in their first year or two. It is accompanied by 2 practical CDRoms, one devoted to each ‘end’. We removed all of the ‘advanced stuff ’, such as ERCP, teaching methods, and unit management. We then sought to serve the needs of the established endoscopists, and of those learning more advanced aspects, with a new series called ‘Advanced Digestive Endoscopy’. Reflecting the acceleration of our world, we saw this pri- marily as a virtual ‘ebook’, presented electronically for speed of posting and for easy updating. This is now evolving on the comprehensive Blackwell Publishing website www.gastrohep.com. It has 5 separate sections:aEndoscopic Practice ix This is trial version www.adultpdf.com and Safety, Upper Endoscopy, Colonoscopy, ERCP, and EUS. I was delighted to be joined in this endeavor by new partners; Joseph Leung, Joseph Sung, Jerry Waye, and Rob Hawes. Between us we have persuaded over 40 distinguished colleagues from all over the world to make contributions. Despite the multiple benefits of electronic publishing, there is still a demand for print books. Jerry Waye’s book on Colonoscopy, co-edited with Doug Rex and Christopher Williams, is already in print (the ebook version consists of a selection of those chapters). Here we present the print version of ERCP. I am enormously grateful to Joseph Leung and to the 12 other contributors who have labored long and hard to bring it to fruition. The fact that most of the authors are based in the USA should not be misinterpreted, for the expertise and methods of ERCP are now truly international. The electronic version will continue, and will be updated every year or so. We welcome your criticism and suggestions for improvement. Joseph and I offer our sincere thanks to our families for their support and forbearance, and to our colleagues and trainees who have taught us so much, not least how much we still have to learn. Peter B Cotton MD FRCP FRCS February 2005 Digestive Disease Center, Medical University of South Carolina, Charleston, USA PREFACEx This is trial version www.adultpdf.com [...]... 11 5 (27%) 84 (20%) 64 (15 %) 57 (13 %) 54 (13 %) 20 (5%) 85% 10 6 ( 21% ) 11 8 (27%) 42 (11 %) 52 (13 %) 40 (10 %) 6 (2%) 88% 98 (29%) 84 (25%) 43 (13 %) 52 (15 %) 38 (11 %) 10 (7%) Difficulty scores Grade 1 Grade 2 Grade 3 38% 18 % 44% 30% 12 % 58% 33% 12 % 55% Time taken (minutes) 37 ( 19 ) 39 (± 21) 39 ( 19 ) Biliary cannulation rate 98% 98% 97% Minor papilla cannulation rate 75% 86% 87% 10 0% 10 0% 10 0% Stone extraction... biliares et pancreatiques Nouv Presse Med 19 72; 1: 313 18 11 Safrany L, Tari J, Barna L, Torok I Endoscopic retrograde cholangiography: experience of 16 8 examinations Gastrointest Endosc 19 73; 19 : 16 3–8 12 Liguory C, Gouero H, Chavy A, Coffin JC, Huguier M Endoscopic retrograde cholangiopancreatography Br J Surg 19 74; 61: 359–62 13 Cotton PB ERCP Gut 19 77; 18 : 316 – 41 14 Morrissey JF To cannulate or not to... Fatal 5 (1. 2%) 4 1 0 0 17 (5%) 13 2 2 0 3 2 0 0 Pancreatitis Infection Bleeding Other 15 (4%) 13 1 1 0 11 3 1 0 12 2 1 2 increasingly to ask their potential interventionists about their experience Some patients will certainly hesitate if their practitioners are not able or willing to provide data when requested Well-trained and skillful practitioners should wear their data as badges of quality An ERCP. .. Fiberduodenoscopy: analysis of 353 examinations Gastrointest Endosc 19 71; 18 : 9 16 6 Classen M, Koch H, Fruhmorgen P, Grabner W, Demling L Results of retrograde pancreaticography Acta Gastroenterologica Japonica 19 72; 7: 13 1–6 7 Cotton PB Progress report: cannulation of the papilla of Vater by endoscopy and retrograde cholangiopancreatography (ERCP) Gut 19 72; 13 : 10 14–25 8 Cotton PB, Salmon PR, Blumgart LH, Burwood... Gastroenterology 19 72; 63: 3 51 2 15 Blackwood WD, Vennes JA, Silvis SE Post-endoscopy pancreatitis and hyperamylasuria Gastrointest Endosc 19 73; 20: 56–8 16 Classen M, Demling L Hazards of endoscopic retrograde cholangio-pancreaticography (ERCP) Acta Hepatogastroenterol (Stutt) 19 75; 22: 1 3 17 Nebel OT, Silvis SE, Rogers G, Sugawa C, Mandelstam P Complications associated with endoscopic retrograde cholangio-pancreatography:... FUNDAMENTALS OF ERCP Monitors X-Ray monitor X-Ray Endoscopes C-arm VCR Vital signs N Foot controls E Storage Diathermy Fluoro Scope tower A Worktop Fig 3 .1 Room set-up and floor plan A, assistant; E, endoscopist; N, nurse Section I: Preparation for ERCP Room set-up and floor plan (Figs 3 .1 and 3.2) Correct layout of the ERCP room is easier if it is located in a purpose-built endoscopy suite with in-house fluoroscopy... force for improving the quality of ERCP services References 1 NIH State-of-the-Science Conference Statement ERCP for diagnosis and therapy, 14 16 January 2002 Gastrointest Endosc 2002; 56: 803–9 2 Cotton PB, Williams CB (19 96) Practical Gastrointestinal Endoscopy, 4th edn Blackwell Science, Oxford 3 Sivak MV, Vennes JA, Cotton PB, Geenen JE, Benjamin SB, Lehman GA Advanced training programs in gastrointestinal... Gastrointest Endosc 19 93; 39: 462–4 4 Wicks ACB, Robertson GSM, Veitch PS Structured training and assessment in ERCP has become essential for the Calman era Gut 19 99; 45: 15 4–6 5 Baillie J ERCP training for the few, not for all Gut 19 99; 45: 9 10 6 Hellier MD, Morris AI ERCP trainingatime for change Gut 2000; 47: 459–60 7 Allison MC, Ramanaden DN, Fouweather MG, Davis DKK, Colin-Jones DG Provision of ERCP services... (www.bsg.org.uk/ training/jag_99.html) 14 American Society for Gastrointestinal Endoscopy Guidelines for advanced endoscopic training Gastrointest Endosc 20 01; 53: 846–8 15 Kowalski T, Kanchana T, Pungpapong S Perceptions of gastroenterology fellows regarding ERCP competency and training Gastrointest Endosc 2003; 58: 345–9 16 Sivak MV Jr Trained in ERCP Gastrointest Endosc 2003; 58: 412 14 17 Waye JD, Bornman PC,... retrograde cholangio-pancreatography: results of the 19 74 A/S/G/E survey Gastrointest Endosc 19 75; 22: 34–6 This is trial version www.adultpdf.com ERCP OVERVIEWaA 30-YEAR PERSPECTIVE 18 Bilbao MK, Dotter CT, Lee TG, Katon RM Complications of endoscopic retrograde cholangiopancreatography (ERCP) : a study of 10 000 cases Gastroenterology 19 76; 70: 314 –20 19 Classen M, Demling L Endoskopische sphinkterotomie . 750 A244 2005] I. Title: ERCP. II. Cotton, Peter B. III. Leung, J. W.C. RC847.5.E53A38 2005 616 .3′07545—dc22 2005 012 6 61 ISBN -1 3 : 97 8 -1 -4 05 1- 2 07 9 -1 ISBN -1 0 : 1- 4 05 1- 2 07 9-7 A catalogue record for. references. ISBN -1 3 : 97 8 -1 -4 05 1- 2 07 9 -1 ISBN -1 0 : 1- 4 05 1- 2 07 9-7 1. Endoscopic retrograde cholangiopancreatography. 2. Gastroscopy. [DNLM: 1. Cholangiopancreatography, Endoscopic Retrograde—methods. 2. Digestive System. Cotton PB. ERCP. Gut 19 77; 18 : 316 – 41. 14 Morrissey JF. To cannulate or not to cannulate [Editorial]. Gastroenterology 19 72; 63: 3 51 2. 15 Blackwood WD, Vennes JA, Silvis SE. Post-endoscopy pancreatitis