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Esophageal strictures are a relatively common problem in gastroenterology and are broadly divided into benign and malignant types. Recent data suggest that the overall incidence of new and recurrent esophageal strictures have decreased by about 10% and 30%, respectively, over the last decade (El-Serag 2006). This decline in the incidence of esophageal strictures is most likely due to the reduction...
Barrett’s esophagus (BE) is a well-recognized premalignant condition for development of esophageal adenocarcinoma (EAC). It is defined as the displacement of the squamo-columnar junction proximal to the gastroesophageal junction, with the presence of intestinal metaplasia (IM) on biopsies (Wang and Sampliner 2008; Sharma et al. 2004). Chronic gastroesophageal reflux disease (GERD) is the most frequent...
Enteral stent placement for disorders of the gastrointestinal tract has evolved significantly over the past decade. While the majority of enteral stent placement is still performed for malignant obstruction, advancements in endoscopic technique and device technology have opened the door for the use of enteral stenting for benign disease as well. This chapter focuses on the indications, techniques,...
Acute upper GI bleeding (UGIB) is a common medical emergency with an annual rate of 150–200 hospitalizations per 100,000 population and a 5–10% mortality rate. It is the result of bleeding from any part of the GI tract proximal to the ligament of Treitz (Lewis et al. 2002).
Acute variceal hemorrhage is a medical emergency. Approximately 40% of patients with cirrhosis are found to have esophageal varices on endoscopic evaluation (Bosch et al.2003), and approximately one third of patients will experience variceal hemorrhage (Kleber et al. 1991; The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices 1988). The mortality of an initial variceal...
Argon plasma coagulation (APC) is an electrosurgical procedure in which electrical energy in the form of ionized argon gas is transferred to target tissue. The APC device uses non-contact thermal energy in the form of ionized gas or plasma for coagulation of the tissue. This technique was first used in open surgical and laparoscopic procedures nearly 2 decades ago. With the development of flexible...
Endoscopic mucosal resection (EMR) is an advanced endoscopic technique used to resect sessile or flat lesions confined to the superficial layers of the gastrointestinal (GI) tract, which cannot be resected by conventional endoscopic techniques. It is increasingly being recognized as a highly effective and minimally invasive alternative to surgery in the management of superficial early GI cancers....
In hospitalized and chronically ill patients, malnutrition is associated with impaired immune function, increased infections, increased lengths of hospital stay, and a reduction in overall body function (Isabel and Correia 2003). Malnutrition is present in up to 40% of intensive care unit (ICU) patients and is associated with increased morbidity and mortality (Giner et al. 1996). With these facts,...
Wireless video capsule endoscopy (VCE) is a significant advancement in gastrointestinal (GI) imaging for the evaluation of small bowel mucosa. VCE is a noninvasive endoscopic tool comprised of an ingestible 11 × 26 mm capsule. It is a self-contained camera and antenna that transmits images to a sensor array/data recorder worn by a patient. The recorded images captured by the data recorder are downloaded...
Endoscopic examination of the small bowel, until recently, has been elusive because of the bowel’s relative inaccessibility. Standard endoscopic examinations evaluate only short segments of the proximal and distal small bowel. Until recently, intraoperative enteroscopy was considered the gold standard, providing the highest diagnostic and therapeutic yield in patients with bleeding from the small...
Advances in cross-sectional imaging, including magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), have rendered endoscopic retrograde cholangiopancreatography (ERCP) a primarily therapeutic modality. Biliary sphincterotomy and stent placement are frequently part of the management of large bile duct stones, the relief of obstructive jaundice associated with benign and...
Intraductal endoscopy consists of the use of an endoscope to directly visualize the pancreato-biliary ductal systems. Visual inspection of the biliary tree is called cholangioscopy, and that of the pancreatic duct is termed pancreatoscopy. There have been significant technological challenges encountered in creating an endoscope that allows direct examination of these ducts. However, the recently developed...
Pancreatic fluid collections (PFCs) are non-epithelial-lined, cystic, fluid-filled cavities that develop as a result of inflammatory conditions of the pancreas in acute or chronic pancreatitis, pancreatic trauma, or pancreatic duct obstruction (Bollen et al. 2007). Approximately 16–50% of episodes of acute pancreatitis and 20–40% of chronic pancreatitis complicate with fluid collections (Bollen et...
A pseudocyst is a persisting localized pancreatic or peripancreatic fluid collection that is generally rich in pancreatic enzymes. It lacks a true wall and is surrounded by a fibrous tissue wall without true epithelialization (Bradley 1993). Pseudocysts are thought to form as a result of a leak from a disrupted pancreatic duct, or more commonly a side branch, and are frequently asymptomatic. They...
Deciding how to treat pelvic abscesses can pose a clinical dilemma. They usually occur after surgery or in patients with medical conditions such as Crohn’s disease, diverticulitis, ischemic colitis, sexually transmitted diseases, or septic emboli from endocarditis. However, the anatomical challenges are what make this a clinical obstacle, with navigation needed around bony pelvis, bladder, bowel,...
The advent of endoscopic ultrasound (EUS) and guided fine needle aspiration (FNA) has significantly altered the management of benign and malignant gastrointestinal, biliary-pancreatic and mediastinal disorders. Over the past two decades, EUS has evolved from being a diagnostic imaging modality to an interventional modality. Several evolving therapeutic applications are paving the way to previously...
Pain is one of the most common symptoms that leads to medical evaluation. The international association for the study of pain, IASP, defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey and Bogduk 1994). Numerous national and international surveys have demonstrated that 60–90% of patients with...
In the past three decades, flexible colonoscopy has proven to be the best tool available for the detection of both colonic polyps and cancer. The colonoscope provides not only superior diagnostic accuracy for detecting and obtaining biopsies of colonic luminal lesions, but also, in the case of polyps, the potential for simultaneous minimally invasive definitive therapy as polypectomy (Tolliver and...
The term “lower gastrointestinal (LGI) bleeding” usually refers to a bleeding site starting below the ligament of Treitz (Jensen and Machicado 1988). “Hematochezia” is the clinical term applied to the passage of bright red blood or maroon colored stool, with or without clots, per rectum. We prefer to use “severe hematochezia” rather than lower gastrointestinal (LGI) or colonic bleeding, because the...
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