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Handbook of
Gastroenterologic Procedures
Fourth Edition
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Handbook of
Gastroenterologic Procedures
Fourth Edition
SENIOR EDITOR
Douglas A. Drossman, M.D.
Professor
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
Chapel Hill, North Carolina
ASSOCIATE EDITORS
Ian S. Grimm, M.D.
Associate Professor
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
Chapel Hill, North Carolina
Nicholas J. Shaheen M.D., M.P.H.
Associate Professor
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
Chapel Hill, North Carolina
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Acquisitions Editor: Charley Mitchell
Developmental Editor: Nicole Dernoski
Project Manager: Alicia Jackson
Senior Manufacturing Manager: Benjamin Rivera
Marketing Manager: Kathy Neely
Designer: Larry Didona
Production Service: Publishing Solutions for Retail, Book, and Catalog;
Schawk Inc.
Printer: RR Donnelley, Crawfordsville
© 2005 by LIPPINCOTT WILLIAMS & WILKINS
530 Walnut Street
Philadelphia, PA19106 USA
LWW.com
3rd Edition, Manual of Gastroenterologic Procedures; Raven Press © 1983
All rights reserved. This book is protected by copyright. No part of this
book may be reproduced in any form by any means, including photocopying,
or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in
critical articles and reviews. Materials appearing in this book prepared by
individuals as part of their official duties as U.S. government employees are
not covered by the above-mentioned copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
Handbook of gastroenterologic procedures / senior editor, Douglas A. Drossman; associate
editors, Ian S. Grimm, Nicholas J. Shaheen.— 4th ed.
p. ; cm.
Rev. ed. of: Manual of gastroenterologic procedures / editor, Douglas A. Drossman. 3rd ed.
c1993.
Includes bibliographical references and index.
ISBN 0-7817-5008-3 (alk. paper)
1. Gastroenterology—Handbooks, manuals, etc. I. Drossman, Douglas A. II. Grimm, Ian
S. III. Shaheen, Nicholas J. IV. Manual of gastroenterologic procedures.
[DNLM: 1. Digestive System Surgical Procedures—Handbooks. 2. Diagnostic
Techniques, Digestive System—Handbooks. 3. Digestive System Diseases—Handbooks. 4.
Gastroenterology—methods—Handbooks. ]
RC801.H275 2005
616.3’3—dc22
2004030551
Care has been taken to confirm the accuracy of the information presented
and to describe generally accepted practices. However, the authors, editors,
and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no
warranty, expressed or implied, with respect to the currency, completeness, or
accuracy of the contents of the publication. Application of the information ina
particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure
that drug selection and dosage set forth in this text are in accordance with
current recommendations and practice at the time of publication. However,
in view of ongoing research, changes in government regulations, and the
constant flow of information relating to drug therapy and drug reactions, the
reader is urged to check the package insert for each drug for any change in
indications and dosage and for added warnings and precautions. This is
particularly important when the recommended agent is a new or
infrequently employed drug.
Some drugs and medical devices presented in the publication have Food
and Drug Administration (FDA) clearance for limited use in restricted
research settings. It is the responsibility of the health care provider to ascer-
tain the FDAstatus of each drug or device planned for use in their clinical
practice.
10 9 8 7 6 5 4 3 2 1
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In honor of John T. Sessions, Jr., MD, the distinguished founder of
our division. In recognition of Eugene M. Bozymski, MD, William
D. Heizer, MD, and Henry T. Lesesne, MD for their commitment to
our division through teaching and patient care and of Don
W. Powell, MD for his support, leadership, and mentoring.
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Contents
Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Preface to the Third Edition . . . . . . . . . . . . . . . . . . . . . . xxi
Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
I. Preparation of the Patient
1. Preprocedure Assessment of Patients
Undergoing Gastrointestinal Procedures
Douglas J. Robertson 3
2. Bowel Preps
Alphonso Brown 10
3. Analgesia and Sedation
Henning Gerke and John Baillie 13
II. Basic Techniques
4. Oral and Nasal Gastrointestinal Intubation
David M.S. Grunkemeier 21
5. Esophagogastroduodenoscopy (EGD)
Kim L. Isaacs 30
6. Small Bowel Enteroscopy
Sauyu Lin and Michael A. Shetzline 38
7. Endoscopic Retrograde Pancreatography
Nina Phatak and Michael L. Kochman 47
8. Colonoscopy
Jerome D. Waye 56
9. Anoscopy and Rigid Sigmoidoscopy
Kim L. Isaacs 64
10. Abdominal Paracentesis
Kimberly L. Beavers 72
11. Percutaneous Liver Biopsy
Kimberly L. Beavers 78
III. Advanced and/or Secondary Techniques
12. Injection Therapy for Hemostasis and Anal Fissures
Lisa M. Gangarosa 87
13. Bipolar Electrocautery and Heater Probe
Lisa M. Gangarosa 93
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viii Contents
14. Clips and Loops
Emad M. Abu-Hamda and Todd H. Baron 97
15. Injection Therapy of Esophageal and Gastric
Varices: Sclerosis and Cyanoacrylate
Stephen H. Caldwell, Vanessa M. Shami, and
Elizabeth E. Hespenheide 103
16. Endoscopic Variceal Ligation
Jason D. Conway and Roshan Shrestha 112
17. Balloon Tamponade
Kim L. Isaacs 119
18. Polypectomy, Endoscopic Muscosal Resection,
and Tattooing
Gregory G. Ginsberg and Nina Phatak 127
19. Feeding Tubes (Nasoduodenal, Nasojejunal)
William D. Heizer 138
20. Percutaneous Endoscopic Gastrostomy (PEG) and
Percutaneous Endoscopic Jejunostomy (PEJ)
Todd H. Baron 147
21. Colonic Decompression
Jeffrey T. Wei and Nicholas J. Shaheen 156
22. Dilation of the Esophagus: Mercury-Filled
Bougies (Hurst Maloney)
Douglas Morgan 160
23. Dilatation of the Esophagus: Wire-Guided Bougies
(Savary and American Endoscopy)
Nicholas J. Shaheen 164
24. Pneumatic Dilation for Achalasia
Joel E. Richter 168
25. Through-the-Scope Balloon Dilation
Elena I. Sidorenko and Prateek Sharma 176
26. Stenting of Esophageal Cancers: Placement of
Expandable Stents
Kenneth K. Wang 183
27. Biliary Sludge Analysis
Jason D. Conway 191
28. Endoscopic Sphincterotomy (Including Precut)
John S. Goff 194
29. Management of Lithiasis: Balloon and Basket
Extraction, Endoprosthesis, and Lithotripsy
David Horwhat and M. Stanley Branch 201
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Contents ix
30. Management of Biliary and Pancreatic Ductal
Obstruction: Endoprosthesis and
Nasobiliary/Nasopancreatic Drain Placement
Nalini M. Guda and Martin L. Freeman 214
31. Management of Fluid Collections
Richard A. Kozarek 229
32. Argon Plasma Coagulation
Ian S. Grimm 235
33. Photodynamic Therapy for Barrett’s
High-grade Dysplasia
Bergein F. Overholt, Masoud Panjehpour, and
Mary Phan 239
34. Infrared Coagulation of Hemorrhoids
Sidney E. Levinson 246
35. Endoscopic Management of Foreign Bodies of the
Upper Gastrointestinal Tract
Craig J. Cender 251
36. Capsule Endoscopy
Blair S. Lewis 263
37. Stretta
Douglas Corley 270
38. Enteryx Injection for Gastroesophageal
Reflux Disease
David A. Johnson 277
39. Endoscopic Sewing—EndoCinch
David A. Johnson 283
IV. Tests of GIFunction
40. Esophageal Manometry
Janice Freeman and Donald O. Castell 291
41. Ambulatory 24-hour Esophageal pH Monitoring
Ronnie Fass, Leslie Eidelman, and Wilder
Garcia-Calderaon 299
42. Gastric Secretory Testing
Robert S. Bulat and Roy C. Orlando 306
43. Secretin Test
Alphonso Brown 313
44. Sphincter of Oddi Manometry
Daniel J. Geenen 317
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45. Small Bowel Motility and the Role of
Scintigraphy in Small Bowel Motility
Jonathan Gonenne and Michael Camilleri 322
46. Breath Hydrogen Text for Lactose Intolerance
and Bacterial Overgrowth
Syed I.M. Thiwan and William E. Whitehead 333
47. Anorectal Manometry and Biofeedback
Yolanda V. Scarlett 341
V. Endoscopic Ultrasound
48. Endoscopic Ultrasound
Poonputt Chotiprasidhi and James M. Scheiman 349
49. Endosonography-guided Fine Needle
Aspiration Biopsy
Maurits J. Wiersema and Michael J. Levy 357
50. Endosonography-guided Celiac Plexus Neurolysis
Maurits J. Wiersema and Michael J. Levy 364
Appendices
A. The Procedure Unit
Melissa C. Brennen 371
B. Handling of Specimens
Jason D. Conway 378
C. Doses of Common GI Drugs Used in GI Procedures
Sanjib Mohanty 380
D. Guidelines for Endoscopic Screening and
Surveillace
Jason D. Conway 382
E. DDW Cards/Useful Websites
Sanjib P. Mohanty 387
F. CPT Modifiers
Sanjib P. Mohanty 393
G. Complete Listing of CPT Codes 394
Index 405
