Table Of ContentHandbook of Gastroenterologic
Procedures
FIFTH EDITION
Todd H. Baron, MD
Professor of Medicine
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
Chapel Hill, North Carolina
Ryan J. Law, DO
Assistant Professor of Medicine
Division of Gastroenterology
University of Michigan School of Medicine
Ann Arbor, Michigan
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Fifth edition
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Dedication
For my wife, Beatrice, who has been there for me from college to present, to my mentor Richard Kozarek, and to those
colleagues who have helped me along the way.—Todd H. Baron, MD
For my wife Laura and daughter Jocelyn, to my parents Bruce and Marjorie, to friends and colleagues who have supported
me throughout my career, and, last but not least, to my mentor and friend Todd Baron who has taught me so much about the
world of therapeutic endoscopy.—Ryan Law, DO
Acknowledgments
We would like to first, and foremost, thank our families for their unending support
throughout the creation of this book. We would like to acknowledge all of the hard work by
our editorial team at Wolters Kluwer and the publishing team at TNQ Technologies. Without
the constant push to continue forward momentum, this project would not have been
successful. Finally, we would like to thank our friends and colleagues from around the world
who have served as contributors to this work. The fifth edition of the Handbook of
Gastroenterologic Procedures will serve as technical reference for endoscopic interventions,
and without the tireless efforts of our contributors, this would not have been possible.
Preface
We are most pleased to offer the fifth edition of the Handbook of Gastroenterologic
Procedures. Initially created as a reliable and concise resource for almost all of the
gastroenterological (GI) procedures commonly used in clinical practice and academic
training programs, the fifth edition offers a significant update to include cutting-edge
procedures and techniques in evolution. The handbook aims for a broad readership, including
physicians, nurses, technicians, and students, to provide a wide range of procedural details
not easy to find elsewhere and in a standardized format. Thus, we have maintained the basic
format for the chapters, with section headings relating to indications, contraindications,
patient preparation, procedure techniques, and adverse events.
This updated edition retains all similarities of the prior edition, but the procedural landscape
in GI has changed dramatically since the fourth edition was published. To account for this
evolution, we have made important enhancements and modifications. The rapid growth in
technology coupled with the trend in endoscopy as a diagnostic and therapeutic discipline has
produced an unprecedented increase in the range of procedures now available. We have taken
care to include procedures that are commonly used or are growing rapidly in their application
frequency. The fifth edition has over 50 chapters on endoscopic techniques; however, we are
still able to retain the smaller book size compatible with our goal to provide a concise, direct,
and easy-to-access handbook for practicing endoscopists. We have recruited recognized
experts within the field of endoscopy to contribute to this book with a goal of providing
accurate, up-to-date, high-fidelity information on the given topic.
The handbook is not intended nor is it sufficient to provide complete endoscopic information
or a description of all possible endoscopic procedures. Instead, it serves as a supplement to
more comprehensive endoscopy textbooks by providing the essential information and helpful
tips regarding the most prevalent endoscopic procedures in practice today. All chapters have
been extensively revised, rewritten, in some cases removed, or added since the previous
edition. We have added several new chapters to reflect significant growth in the field of
endoscopy, including cutting-edge techniques in therapeutic endoscopic ultrasound,
endoscopic submucosal dissection, third space endoscopy (i.e., peroral endoscopic myotomy
[POEM]), and bariatric endoscopy.
Perhaps one of the most unique aspects to this handbook is the continued inclusion of
chapters devoted to nonendoscopic procedures, such as the insertion of the Minnesota tube
for refractory variceal bleeding; esophageal, small bowel, and anorectal motility testing;
percutaneous liver biopsy; paracentesis; feeding tube placement; and hydrogen breath testing
for disaccharidase deficiency or bacterial overgrowth. This compendium of information is
not easily found in any one resource.
Finally, we include chapters that contain generic information relating to the organization and
function of the endoscopy unit, preprocedure planning and bowel preps, and analgesia and
sedation (including the use of propofol).
We hope that this fifth edition will continue to serve many purposes for all of us involved in
the diagnosis, treatment, and care of patients with gastrointestinal disorders.
Todd H. Baron, MD
Ryan J. Law, DO
Contributors
Hiroyuki Aihara, MD, PhD
Assistant Professor of Medicine, Gastroenterology, Hepatology, and Endoscopy, Brigham and Womens Hospital, Boston,
Massachusetts
Harry R. Aslanian, MD
Professor, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
Jason R. Baker, PhD
Associate Director, GI Physiology Laboratory, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Subhas Banerjee, MD
Professor, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
Monique T. Barakat, MD
Instructor, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
Todd H. Baron, MD
Professor of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine,
Chapel Hill, North Carolina
Michael C. Bennett, MD
Assistant Professor, Division of Gastroenterology, Washington University , St. Louis, Missouri
Sean Bhalla, MD
Gastroenterology Fellow, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
John C. Byrn, MD
Associate Professor of Surgery, Colon and Rectal Surgery, University of Michigan, Ann Arbor, Michigan
Dustin A. Carlson, MD
Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
David R. Cave, MD
Professor, Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
Joan W. Chen, MD, MS
Assistant Professor of Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Enad Dawod, MD
Resident, Weill Cornell Medical College, New York, New York
Qais Dawod, MD
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
Ana DeRoo, MD
Surgery Resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan
David L. Diehl, MD, FACP, FASGE
Division of Gastroenterology, Geisinger , Danville, Pennsylvania
Rami El Abiad, MD
Associate Professor, James A. Clifton Digestive Health Center, University of Iowa, Iowa City, Iowa
Larissa Fujii-Lau, MD
Faculty Physician, Department of Gastroenterology, The Queen’s Medical Center, Honolulu, Hawaii
Norio Fukami, MD
Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
Sarah Gerken, MD
Instructor, Department of Anesthesiology, University of Toledo, Toledo, Ohio
Karthik Gnanapandithan, MD, MS
Hospitalist, Yale New Haven Health, Northeast Medical Group, New Haven, Connecticut
Mishita Goel, MBBS
Resident Physician, Department of Medicine, Wayne State University, Detroit, Michigan
Ian S. Grimm, MD
Professor, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
Kimberly N. Harer, MD
Clinical Lecturer, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
William L. Hasler, MD
Professor, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Tadd K. Hiatt, MD
Assistant Professor of Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Amy Hosmer, MD
Assistant Professor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, Ohio
Donovan Inniss, BS
Medical Student, University of Michigan Medical School, Ann Arbor, Michigan
Shayan Irani, MD
Faculty Physician, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington
Theodore W. James, MD
Fellow, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
Salmaan A. Jawaid, MD
Advanced Endoscopy Fellow, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville,
Florida
Allon Kahn, MD
Associate Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
Sergey V. Kantsevoy, MD, PhD
Faculty Physician, Director, The Center for Therapeutic Endoscopy, Mercy Hospital, Baltimore, Maryland
Rajesh Keswani, MD, MS
Associate Professor of Medicine, Digestive Health Center, Northwestern Medicine, Chicago, Illinois
Mouen A. Khashab, MD
Associate Professor, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland
Richard A. Kozarek, MD, FACG, FASGE, AGAF, FACP
Faculty Physician, Executive Director, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington
Richard S. Kwon, MD, MS
Associate Professor, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Ryan Law, DO
Assistant Professor, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Allen A. Lee, MD
Clinical Lecturer, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Cadman L. Leggett, MD
Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Laura E. Lehrian, DO
Assistant Professor , Department of Anesthesia, University of Michigan, Ann Arbor, Michigan
Amar Mandalia, MD
Gastroenterology Fellow, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Maen Masadeh, MD
Advanced Endoscopy Fellow, Division of Gastroenterology, University of California-San Francisco, San Francisco,
California
Stephen McClave, MD
Professor, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky
Sarah K. McGill, MD
Assistant Professor, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North
Carolina
Shaffer R.S. Mok, MD, MBS
Digestive Health Institute, University Hospitals , Westlake, Ohio
Thiruvengadam Muniraj, MD, MRCP, PhD
Assistant Professor, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
V. Raman Muthusamy, MD
Professor, Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los
Angeles, California
Jose M. Nieto, DO, AGAF, FACP, FACG, FASGE
Staff Physician, Borland Groover, Jacksonville, Florida
Makoto Nishimura, MD
Staff Physician, Division of Gastroenterology, Hepatology and Nutrition Services, Memorial Sloan Kettering Cancer Center,
New York, New York
Keith L. Obstein, MD, MPH, FASGE, FACG, AGAF
Associate Professor, Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center,
Nashville, Tennessee
Endashaw Omer, MD
Assistant Professor, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky
