Diagnosis and Endoscopic Management of Digestive Diseases : New Tools and Strategies

"In this book, leading international experts describe and discuss the various techniques available for the screening, diagnosis, management, and follow-up of digestive diseases, providing clinically useful, up-to-date reviews that draw upon their own experience and focus attention on the most recent advances in the field. Among the wide range of topics covered are the use of confocal laser endomicroscopy in the gastrointestinal tract, endoscopic suture systems, endoscopic submucosal dissection, per oral endoscopic myotomy, and cholangioscopy systems. The experience of a leading surgical group in the application of endoscopic radiofrequency ablation in pancreatic cancer is reported, and new surgical and endoscopic techniques for the treatment of Zenker's diverticulum are proposed. The closing chapters examine the present and future of esophageal motility testing and the diagnostic yield of novel parameters in reflux monitoring. In addition to the discussion of techniques, advice is provided on training, endoscopy and imaging equipment, and set-up of endoscopy units during procedures"--Publisher's description Foreword 6 Contents 7 1: Confocal Laser Endomicroscopy in GI Tract 9 1.1 Introduction 9 1.2 Physics 10 1.3 Systems 11 1.4 Gastrointestinal Applications 11 1.4.1 Barrett’s Esophagus (BE) 11 1.4.2 Gastritis and Early Gastric Cancer 14 1.4.3 Celiac Disease 15 1.4.4 Inflammatory Bowel Disease 15 1.4.5 Polyps 16 1.4.6 Pancreas 17 1.4.7 Biliary Tract 19 1.4.8 Primary Sclerosing Cholangitis (PSC) 21 1.4.9 Solid Organs 21 References 23 2: OTSC System in All Possible Applications 29 2.1 Introduction 29 2.2 Technical Concepts 30 2.3 OTSC in GI Bleeding 30 2.4 The New Device DC ClipCutter 36 2.5 Performance of Over-The-Scope Clip System in the Endoscopic Closure of Iatrogenic Gastrointestinal Perforations and Postsurgical Leaks 37 2.6 Perforation 39 2.7 Postsurgical Leaks 40 2.8 Gastrointestinal Fistulas 41 2.9 Over-The-Scope Clip Full-Thickness Resection Device (OTSC FTRD) 42 References 45 3: Radiofrequency Ablation of Pancreatic Mass 51 3.1 Introduction 51 3.2 Radiofrequency Ablation and Pancreatic Carcinoma 52 3.2.1 Operative Technique 53 3.3 The Pilot Study 55 3.4 Single-Center Overall Experience 56 3.4.1 Complications 57 3.5 Immunomodulatory Effects of RFA 59 3.6 Control of an Aggressive Disease 60 3.6.1 Imaging and Pathology After RFA 60 3.7 Timing of the Procedure 62 3.8 Clinical Trials 63 3.9 Endoscopic Ultrasound-Guided Ablation 64 References 69 4: TEM and TAMIS for Large Rectal Neoplasm 75 4.1 Introduction 75 4.1.1 Pit Pattern Classification 76 4.1.2 Endoscopic Ultrasound (EUS) 76 4.1.3 Biopsy 77 4.1.4 Lifting Sign 77 4.1.5 Digital Examination 77 4.2 Technique 78 4.2.1 Equipment 78 4.2.2 Positioning of the Patient on the Operating Table 78 4.2.3 Surgical Technique 80 4.2.3.1 Step 1: Dissection 80 4.2.3.2 Step 2: Wall Defect Suturing 81 4.2.4 Postoperative Management 82 4.3 TEM Versus ESD 82 4.4 TAMIS 83 4.5 Extended Indications 85 4.6 Future Perspectives 86 References 87 5: Unusual Applications of Metal Stents in Gastrointestinal Tract 90 5.1 Introduction 90 5.2 Unusual Application of Stents in Upper GI Tract 92 5.2.1 Upper Malignant Esophageal Strictures 92 5.2.2 Benign Esophageal Strictures 93 5.2.3 Benign Esophageal Leakages or Fistula 95 5.2.4 Variceal Bleeding 96 5.2.5 Esophageal Achalasia 96 5.2.6 Staple Line Leaks Postlaparoscopic Sleeve Gastrectomy 97 5.3 Unusual Application of Stents in Low GI Tract 98 5.3.1 Self-Expanding Metallic Stents for Malignant Obstruction 99 5.3.2 Colonic SEMS as a Bridge to Surgery 99 5.3.3 Colonic SEMS as Palliative Therapy 100 5.3.4 SEMS in Benign Colorectal Diseases 101 References 105 6: Endoscopic Suturing Systems 109 References 117 7: Endoluminal Therapy for Treatment of Gastroesophageal Reflux Disease 119 7.1 Introduction 119 7.2 Endoluminal Techniques 120 7.2.1 Implantations and Injections 120 7.2.2 Radiofrequency Ablation 121 7.2.3 Endoscopic Tissue Apposition Techniques 122 7.3 Techniques for Transoral Incisionless Fundoplication 125 7.3.1 Pre-procedure Evaluation 125 7.3.2 Transoral Fundoplication by EsophyX® Device 125 7.3.3 Transoral Fundoplication by MUSETM System 129 7.3.4 Postoperative Care 133 7.4 Outcomes 134 7.5 Complications 138 References 139 8: The Point on the POEM: Comparison Between Different Techniques and Outcomes 144 8.1 Introduction 144 8.2 Standard Technique 144 8.2.1 Variations in Technique 146 8.3 Orientation 150 8.4 Depth of Myotomy 152 8.5 Tools 153 8.6 Techniques for Mucosal Closure 154 8.7 Technique of Simultaneous Tunnel and Muscle Dissection 155 8.8 Distal to Proximal (“Retrograde”) Myotomy 155 8.9 Techniques for Confirming Adequate Cardiomyotomy 155 8.10 Functional Assessment to Ensure Adequacy of the Myotomy 157 8.11 POEM for Non-achalasia Motility Disorders 158 8.11.1 POEM Outcomes 158 8.12 Incidence of GERD After POEM 162 8.13 POEM Versus LHM 164 References 164 9: News in ESD 169 9.1 Introduction 169 9.2 Devices 169 9.3 How to Create Countertraction 170 References 173 10: ERCP in Altered Anatomy 174 10.1 ERCP Using Balloon Enteroscopy 174 10.2 Percutaneous Transhepatic Techniques 176 10.3 Percutaneous Transgastric Access 176 10.4 EUS-Assisted Transgastric Techniques 178 10.5 Discussion 179 References 180 11: Endoscopic and Surgical Management of Zenker’s Diverticulum: New Approaches 181 11.1 Introduction 181 11.2 Pathophysiology 181 11.3 Symptoms and Diagnosis 182 11.4 Surgical Treatment 183 11.5 Endoscopic Treatment 185 References 189 12: Cholangioscopy Systems: State of the Art 190 12.1 Introduction 190 12.2 Direct Cholangioscopy 191 12.3 Dedicated Cholangioscopy (or Indirect Cholangioscopy) 192 12.4 SpyGlass System 192 12.4.1 Equipment 193 12.4.2 Clinical Applications 193 12.4.3 Treatment of Difficult Biliary Stones 194 12.4.4 Treatment of Pancreatic Lithiasis 196 12.4.5 Assessment of the Indeterminate Strictures of the Bile Duct 196 12.4.6 Complications 198 References 199 13: Esophageal Motility Testing: The Present and the Future 201 13.1 Introduction 201 13.2 Where Esophageal Pressure Topography Come From? 202 13.3 The Present 203 13.3.1 Metrics and Swallow Pattern Characterization 203 13.3.2 Esophagogastric Junction 204 13.3.3 Disorders with EGJ Outflow Obstruction 205 13.3.4 EPT Metrics to Score Individual Swallows 206 13.3.5 Major Motility Disorders 208 13.3.6 Minor Motility Disorders 210 13.4 The Future 211 13.4.1 The Near Future: Multiple Rapid Swallows 211 13.4.2 Future Role of the HRM Working Group 212 References 213 14: The Diagnostic Yield of Novel Parameters in Reflux Monitoring 216 References 223 Front Matter....Pages i-x Confocal Laser Endomicroscopy in GI Tract....Pages 1-20 OTSC System in All Possible Applications....Pages 21-42 Radiofrequency Ablation of Pancreatic Mass....Pages 43-66 TEM and TAMIS for Large Rectal Neoplasm....Pages 67-81 Unusual Applications of Metal Stents in Gastrointestinal Tract....Pages 83-101 Endoscopic Suturing Systems....Pages 103-112 Endoluminal Therapy for Treatment of Gastroesophageal Reflux Disease....Pages 113-137 The Point on the POEM: Comparison Between Different Techniques and Outcomes....Pages 139-163 News in ESD....Pages 165-169 ERCP in Altered Anatomy....Pages 171-177 Endoscopic and Surgical Management of Zenker’s Diverticulum: New Approaches....Pages 179-187 Cholangioscopy Systems: State of the Art....Pages 189-199 Esophageal Motility Testing: The Present and the Future....Pages 201-215 The Diagnostic Yield of Novel Parameters in Reflux Monitoring....Pages 217-227