Title Page

Copyright Page

Contents

List of Contributors

Preface

About the Companion Website

Chapter 1 Equipment, Patient Safety, and Training

Introduction

Equipment

Endoscopy Room Setup

Endoscopic Stack

Image Enhancing Modalities

New Advances in Image Enhancement

Endoscopes

Accessories and Consumables

Patient Safety and Training

Cleaning and Disinfection of Endoscopes

Patients

Health Personnel and Training Issues

Acknowledgment

References

Chapter 2 Sedation and Analgesia in Endoscopy of the Patient with Liver Disease

Introduction

Midazolam

General

Administration

Propofol

General

Administration

Opiate Analgesics

Combination Therapy

Combination of Midazolam with Fentanyl or Pethidine (Meperidine)

Combination of Propofol with Midazolam

Combination of Propofol with Fentanyl or Pethidine (Meperidine)

Emergency Therapeutic Endoscopy

Unsedated Endoscopy

Conclusion

References

Chapter 3 Endoscopy in the Setting of Coagulation Abnormalities in the Patient with Liver Disease

Introduction

Coagulation Mechanism

The “Normal” Patient

The “Liver” Patient

Measuring the Bleeding Risk in Liver Disease: Knowns and Unknowns

Prophylactic Interventions: Advantages and Disadvantages

Plasma

Platelets

Thrombopoietin Receptor Agonists

Cryoprecipitate

Clotting Factors

Desmopressin

Antifibrinolytic Agents

Relative Risk of Endoscopic Procedures

Colonoscopy with Polypectomy

Variceal Band Ligation and Post-Banding Ulcer Bleeding

Endoscopic Retrograde Cholangiopancreatogaphy and Sphincterotomy

Rescue Approach

Pharmacological Management of Portal Hypertension

Platelets and Procoagulants

Antifibrinolytics

Conclusion

References

Chapter 4 Varices: Screening, Staging, and Primary Prophylaxis

Introduction

Natural History of Varices

Variceal Screening and Staging

Esophagogastroduodenoscopy

Capsule Endoscopy

Ultrasonography

Transient Elastography

Primary Prophylaxis of Esophageal Varices

Preprimary Prophylaxis

Patients with Small Varices

Patients with Large Varices and High Risk Features

Measurement of Hepatic Venous Pressure Gradient

Gastric Varices

Primary Prophylaxis

Conclusion

References

Chapter 5 Endoscopic Management of Acute Variceal Bleeding

Introduction

Pathophysiology of Variceal Bleeding

Definitions

General Treatment Measures

Resuscitation

Ascites and Renal Function

Nutrition

Pharmacological Management

Prophylaxis and Treatment of Infection

Pre-Endoscopic Vasoactive Therapy

Esophageal Varices

Endoscopic Management of Acute Esophageal Variceal Bleeding

Endoscopic Injection Sclerotherapy

Rescue Therapies for Refractory Esophageal Variceal Bleeding

Gastric Varices

Management Overview

Balloon Tamponade

Endoscopic Management

Rescue Therapies for Refractory Gastric Variceal Bleeding

Ectopic Varices

Management Overview

Conclusion

References

Chapter 6 Prevention of Recurrent Bleeding from Esophageal Varices

Introduction

Natural History, Prognosis, and Rationale for Therapy

Risk Stratification in Secondary Prophylaxis

Therapies for Secondary Prophylaxis of Variceal Bleeding

Non-Selective Beta-Blockers With or Without Isosorbide Mononitrate

Endoscopic Therapy

Combination of Endoscopic Variceal Ligation and Non-Selective Beta-Blockers: Current Standard Therapy

Rescue Therapy when Standard Treatment Fails

Transjugular Intrahepatic Portosystemic Shunts

Surgical Shunts

Special Situations

Hepatic Venous Pressure Gradient Guided Therapy

Pre-Emptive TIPS

Novel Drug Therapies

Gastric Varices

References

Chapter 7 Refractory Variceal Bleeding: When First Endoscopy Fails, What Next?

Introduction

Rescue Therapies

Second Endoscopic Treatment

Balloon Tamponade

Self-Expandable Metal Stents

Shunting Procedures

Balloon-Occluded Retrograde Transvenous Obliteration

High Risk Patients: Strategies to Prevent Rebleeding

Pharmacological Therapy

Pre-Emptive TIPS

Conclusion

References

Chapter 8 Portal Hypertensive Gastropathy and Gastric Vascular Ectasia

Introduction

Portal Hypertensive Gastropathy

Pathophysiology

Diagnosis

Association with Portal Hypertensive Enteropathy and Colopathy

Relationship of Portal Hypertensive Gastropathy with Variceal Eradication

Management

Gastric Vascular Ectasia

Pathophysiology

Diagnosis

Management

Conclusion

References

Chapter 9 Portal Hypertensive Enteropathy and Obscure Gastrointestinal Bleeding

Introduction

Epidemiology of Obscure Gastrointestinal Bleeding in Patients with Portal Hypertension

Small Bowel Evaluation in Patients with Portal Hypertension and Obscure Gastrointestinal Bleeding

Capsule Endoscopy

Ileoscopy, Push Enteroscopy, and Device Assisted Enteroscopy

Therapy

Portal Hypertensive Colopathy

Conclusion

References

Chapter 10 Endoscopic Management of Upper Gastrointestinal Pathology in the Patient with Liver Disease

Introduction

Barrett’s Esophagus

Prevalence

Diagnosis and Surveillance

Other Diagnostic Modalities

Management

Gastroesophageal Reflux Disease

Celiac Disease

Esophageal Strictures

Peptic Ulcer Disease

Non-Variceal Upper Gastrointestinal Bleeding

Peptic Ulcer Bleeding

Gastric Antral Vascular Ectasia

Portal Hypertensive Gastropathy

Mallory–Weiss Tear

Hemobilia

Upper Gastrointestinal Tumors

Novel Endoscopic Intervention for Non‐Variceal Bleeding

Conclusion

References

Chapter 11 Colonoscopic Screening and Surveillance in the Patient with Liver Disease (Including Post-Transplant)

Introduction

Screening Colonoscopy in Average Risk Populations

Surveillance for Colorectal Neoplasia

Bowel Preparation in Patients with Liver Disease

Sedation in Patients with Liver Disease Undergoing Colonoscopy

Colonoscopic Findings in Liver Disease

Risks of Colonoscopy and Polypectomy in Liver Disease

Risk of Septicemia After Colonoscopy in Patients with Ascites

Colorectal Neoplasia in Primary Sclerosing Cholangitis

Liver Transplantation

Pre-Transplant Screening in Liver Transplant Candidates

Post-Transplant Screening and Surveillance

Conclusion

References

Chapter 12 Endoscopic Retrograde Cholangiopancreatography and Cholangioscopy in Hepatobiliary Disease

Introduction

General Aspects of Endoscopic Retrograde Cholangiopancreatography and Cholangioscopy

Patient Preparation

Sedation and Patient Position

General Endoscopic Retrograde Cholangiopancreatography Techniques in Patients with Chronic Liver Disease

Cannulation of the Biliary Tract

Endoscopic Sphincterotomy and Endoscopic Papillary Balloon Dilation

Biliary Stents

Self-Expandable Metal Stents

Plastic Versus Self-Expandable Metal Stents

Diseases Associated with Biliary Obstruction or Damage in Chronic Liver Disease

Biliary Stones

Primary Sclerosing Cholangitis

Hepatobiliary Injury

Hepatobiliary Malignancy

Cholangioscopy

References

Chapter 13 Endoscopic Ultrasound in the Diagnosis of Hepatobiliary Malignancy

Introduction

Endoscopic Ultrasound in Cholangiocarcinoma

Published Data

Stricture/Tumor Detection

Performance of Endoscopic Ultrasound Fine Needle Aspiration and Diagnostic Sensitivity

Tumor Seeding

Staging and Resectability

Nodal Staging and Features of Malignant and Benign Lymph Nodes

Potentially Confounding Variables and Complications

Endoscopic Ultrasound and Hepatic Lesions

Characteristics of Malignancy

Performance and Impact

Comparison of Endoscopic and Percutaneous Fine Needle Aspiration

Complications

Conclusion

References

Chapter 14 Endoscopic Ultrasound Guided Biliary Drainage

Introduction

Techniques

Rendezvous Technique

Direct Transluminal Technique

Antegrade Stenting Technique

Outcomes

Comparison of Different Techniques

Rendezvous Versus Direct Transluminal Techniques

Intrahepatic Versus Extrahepatic Access Routes

Endoscopic Ultrasound Guided Biliary Drainage in Patients with Pre‐Existing Duodenal Stents

Endoscopic Ultrasound Guided Biliary Drainage in Patients with Hepaticoduodenostomy

Endoscopic Ultrasound Guided Biliary Drainage Versus Percutaneous Transhepatic Biliary Drainage

Timing of Endoscopic Ultrasound Guided Biliary Drainage

Current Limitations and Recent Advances

Conclusion

Conflicts of Interest

References

Chapter 15 Hepatobiliary Endoscopy in the Patient with Liver Disease and Altered Anatomy

Introduction

General Considerations

Anatomical Descriptions

Indications

Patient Positioning and Preparation

Selection of Endoscopes, Device Accessories, and General Technique

Techniques

Endoscopic Retrograde Cholangiography in Billroth Anatomy

Device Assisted Endoscopic Retrograde Cholangiography in Billroth Anatomy

Specialized Technique in Billroth II Procedures

Clinical Data Predating Single Balloon Enteroscopy for Endoscopic Retrograde Cholangiography in Roux-en-Y Anatomy

Overtube-Assisted Enteroscopy for Endoscopic Retrograde Cholangiography in Roux-en-Y Anatomy

Double Balloon Enteroscopy Assisted Endoscopic Retrograde Cholangiography

Single Balloon and Rotational Enteroscopy Assisted Endoscopic Retrograde Cholangiography

Alternative Methods of Biliary Intervention in Long Limb Altered Anatomy

Limitations and Complications

Conclusion

References

Chapter 16 Management of Post‐Liver Transplant Hepatobiliary Complications

Introduction

Liver Transplant Anatomy

Diagnosis of Biliary Complications

Biliary Strictures

Bile Leaks and Bilomas

Bile Duct Filling Defects

Sphincter of Oddi Dysfunction and Papillary Stenosis

Special Clinical Scenarios

Living Donor Liver Transplantation

Roux-en-Y Anatomy

Pediatric Patients

References

Chapter 17 Endoscopic Confocal and Molecular Imaging in Hepatobiliary Disease

Introduction

Current Tools

Confocal Laser Endomicroscopy

Fluorescent Dyes and Molecular Probes

Bile Duct

Liver

Perspective on Future Applications

Conclusion

References

Chapter 18 Laparoscopy in Patients with Hepatobiliary Disease

Introduction

Assessment and Staging

Laparoscopic Staging

Laparoscopic Staging Technique

Laparoscopic Ultrasound

Laparoscopic Intervention in Patients with Hepatobiliary Disease

Benign Hepatobiliary Disease

Malignant Hepatobiliary Disease

Conclusion

References

Index

EULA