Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS Two Techniques for One Vision Massimiliano Mutignani Jörg G. Albert Carlo Fabbri Editors 123 Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS Massimiliano Mutignani • Jörg G. Albert Carlo Fabbri Editors Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS Two Techniques for One Vision Editors Massimiliano Mutignani Jörg G. Albert Digestive and Interventional Hepatologie und Endokrinologie Endoscopy Unit Abteilung für Gastroenterologie, Grande Ospedale Metropolitano Robert-Bosch-Krankenhaus Niguarda Auerbachstraße, Stuttgart Piazza dell'Ospedale Maggiore, Milano Germany Italy Carlo Fabbri Department of Gastroenterology Azienda USL di Forlì-Cesena Bologna Italy ISBN 978-3-030-42568-5 ISBN 978-3-030-42569-2 (eBook) https://doi.org/10.1007/978-3-030-42569-2 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Marilena, Elena and Lucrezia who with affect be close to me despite of my work ethic —Massimiliano Mutignani Foreword Biliopancreatic endoscopy described in this collaborative book has very little to do with the one I have learned in the early 1980s. Thanks to the extraordinary improvements in technologies and techniques, and to the marriage of ERCP with therapeutic EUS, biliopancreatic endoscopy has become today the first-line treatment for an impressive number of clinical scenarios involving the liver, the pancreas and the biliopancreatic ductal system. While ERCP, thanks to the advent and development of non-invasive cross- sectional imaging techniques, has currently become almost exclu- sively a therapeutic tool, for some decades after its introduction EUS has been mostly used as a diagnostic technique. Only recently, especially thanks to the development of lumen-apposing metal stents, and to the improvement of EUS- guided needles and devices for local tissue abla- tion, EUS has permanently joined and integrated ERCP in the operative treatment of several biliopancreatic diseases. I believe that this “mar- riage” has no chances to experience a “divorce” in the next decades, but we are still in the phase where we try to understand which technique is better for the particular indication and when. By whom we already know: more and more the protagonist will be the same physician, trained in both ERCP and therapeutic EUS. We are not yet completely there because training in ERCP and EUS needs at least one additional year (if not two!) after completion of the regular post-graduate training in gastroenterol- ogy or surgery, and this is not structured in most countries. The hope is that this issue will be considered and solved in the appropriate way very soon. The authors of this book have to be commended because they have embraced this modern concept of complementarity between ERCP and EUS providing a comprehensive overview of the current available endoscopic techniques in biliopancreatic diseases, also by entrusting several chapters to very well-known experts in the field. The last part of the book, which is dedicated to therapeutic algorithms, is an original and extremely useful tool for all those clinicians involved in the management of biliopancreatic diseases. vii viii Foreword Finally, I would like to emphasize my personal gratification in seeing Massimiliano Mutignani as leading author of this book: Max has been my first trainee when he was a student and then for many years my principal co- worker. This book certifies the outstanding position he has been able to reach in the world of therapeutic endoscopy. Guido Costamagna Digestive Endoscopy Unit Department of Translational Medicine and Surgery Fondazione Policlinico Universitario A. Gemelli—IRCCS Università Cattolica S. Cuore Rome, Italy Acknowledgement A special thanks by the editors to Dr. Lorenzo Dioscoridi. Without his perse- verance and “self-sacrifice”, this book would not be released. ix Contents Part I E RCP and EUS: Armamentarium and Surroundings 1 ERCP/EUS Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Rita Conigliaro, Claudio Conti, Giuseppe Grande, and Helga Bertani 2 X-Rays in Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Andrea Brameri 3 Ultrasound Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Anna Cominardi and Pietro Fusaroli 4 Endoscopes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Arianna Massella and Paolo Bocus 5 ERCP Standard and Special Devices . . . . . . . . . . . . . . . . . . . . . . 37 Andrea Oliver Tal and Jörg G. Albert 6 EUS Standard Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Danilo Castellani, Ugo Germani, Gabrio Bassotti, and Raffaele Manta 7 Deep Sedation and Anesthesia for Advanced Gastrointestinal Endoscopy: Challenging a Continuum . . . . . . . . . . . . . . . . . . . . . 65 Aldo Cristalli and Andrea De Gasperi 8 Anatomy of the Biliary Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Giuseppe M. Ettorre and Roberto L. Meniconi 9 Anatomy of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Marianna Arvanitakis 10 CT: What We Need to Know to Start to Interpret Radiological Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Marialavinia Catalano, Consolato Gullì, Alessandro Cina, Carmine Di Stasi, and Riccardo Manfredi 11 MR: What We Need to Know to Start to Interpret Radiological Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Martina Sbarra, Matteo Napoleone, Alessandro Cina, Carmine Di Stasi, Gennaro Restaino, and Riccardo Manfredi xi xxiiii Contents 12 Patient Management before and after EUS/ERCP . . . . . . . . . . . 147 Katja S. Rothfuss and Jörg G. Albert Part II E RCP: What and How 13 Cannulation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Lars Aabakken 14 Biliary Sphincterotomy and Precut . . . . . . . . . . . . . . . . . . . . . . . . 163 Vincenzo Cennamo, Marco Bassi, Stefano Landi, and Stefania Ghersi 15 Pancreatic Sphincterotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Stefano Francesco Crinò, Laura Bernardoni, and Armando Gabbrielli 16 Biliary Stones Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Andrea Tringali 17 Intraductal Lithotripsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Jörg G. Albert and Jan Peveling-Oberhag 18 Biliary and Pancreatic ESWL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Lorenzo Dioscoridi, Francesco Pugliese, Edoardo Forti, Alberto Tringali, Marcello Cintolo, Giulia Bonato, and Massimiliano Mutignani 19 Biliary Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Edoardo Forti, Giulia Bonato, and Massimiliano Mutignani 20 Endoscopic Papillectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Laura Bernardoni, Stefano Francesco Crinò, and Armando Gabbrielli 21 Ductoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Manuel Pagitz and Jörg G. Albert 22 Intraductal Ablation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . 245 Brian C. Brauer 23 Stent Removal (Plastic and Metal) . . . . . . . . . . . . . . . . . . . . . . . . 251 Feng Li, Prabhleen Chahal, and Manuel Perez-Miranda 24 ERCP in Altered Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Stefanos M. Dokas 25 PTC and PTC-ERCP Rendezvous Procedures . . . . . . . . . . . . . . 269 Jörg G. Albert Part III EUS: What and How 26 EUS Diagnostic Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Paolo Giorgio Arcidiacono and Livia Archibugi