ASGE Clinical Update

Pancreatic cancer is the second most frequent gastrointestinal malignancy with approximately 29,000 new cases occurring annually in the United States. Almost all of these patients will die from the disease, making pancreatic cancer the fourth leading cause of cancer death for both men and women. Since surgical resection of the tumor offers the only chance for a cure, modalities for early diagnosis and accurate preoperative staging have continued to evolve. In this review, Drs. Mallery and Baron discuss the role of new diagnostic modalities including helical or multi-detector CT scan, endoscopic ultrasound (EUS), EUS-guided fine needle aspirate, and MRI, MRCP, and MR angiography. ERCP is now primarily relegated to a therapeutic palliative role in inoperable patients. A clinical management algorithm for patients with suspected pancreatic cancer is provided.

Todd H Baron

Shawn Mallery

Grace Elta

Clinical Update

The role of endoscopy in the evaluation and management of patients with suspected pancreatic malignancy

内镜在疑似胰腺恶性肿瘤患者评估和管理中的作用

Irritable bowel syndrome (IBS) is the most common condition encountered in general gastroenterology practice. IBS has protean manifestations but is typically characterized by abdominal pain, bloating, and disturbed defecation. The prevalence of IBS is estimated to be between 14% and 24% in women and 5% and 19% in men in the United States and Britain and is responsible for 2.4 to 3.5 million physician visits per year. The estimated total direct cost associated with IBS was $1.6 billion in 1998 with medication costs and the costs associated with diagnostic testing comprising the largest components of this estimate. Drs Cash and Chey focus on the role of endoscopy in a cost-effective diagnostic evaluation of IBS. Grace Elta, MD Editor

Brooks D. Cash

William D. Chey

The role of endoscopy in irritable bowel syndrome

内镜在肠易激综合征中的作用

Dysphagia is a common esophageal symptom with nearly 1 in 5 subjects older than 50 years describing this symptom in epidemiologic surveys. It is the second most common indication for upper endoscopy in the United States. There is a myriad list of possible etiologies for dysphagia. Consequently, a systematic approach to the differential diagnosis resulting in a well planned investigation is important. As described by Drs. Katzka and Kochman, a carefully obtained medical history is the initial step. Upper endoscopy is almost always indicated as part of the evaluation and treatment. Grace Elta, MD Editor

David A. Katzka

Michael L. Kochman

Diagnostic approach for dysphagia

吞咽困难的诊断方法

A cause for acute pancreatitis is not identified in 10% to 30% of patients after careful history, physical examination, laboratory testing, and radiologic evaluation. These patients are conventionally classified as having idiopathic acute pancreatitis (IAP). Patients with recurrent episodes of IAP are diagnosed with idiopathic acute recurrent pancreatitis (IARP). IAP and IARP are challenging clinical problems for the physician and often frustrating for the patient. Dr. Stuart Sherman has reviewed the role of ERCP and ancillary endoscopic techniques in the evaluation and therapy of these patients. Grace Elta, MD Editor

Stuart Sherman

Idiopathic acute pancreatitis: role of ERCP in diagnosis and therapy

特发性急性胰腺炎：ERCP在诊断和治疗中的作用

GERD is the third most common GI disorder in the United States, affects 19 million US adults, and accounts annually for 4,590,000 outpatient visits and 96,000 hospitalizations, amounting to $19 billion in annual costs. The majority of patients have complete relief of symptoms on long-term medical therapy with proton pump inhibitors. However, as much as 20% continue to have a detriment in quality of life scores caused by GERD symptoms. These refractory patients, or patients who do not want to take long-term medications, may benefit from the plethora of new endoscopic therapies for GERD. Although long-term follow-up and sham-controlled studies are, in general, not yet available, Dr. Triadafilopoulos reviews the currently available techniques and offers a unique perspective on their potential role in GERD therapy. Grace Elta, MD Editor

George Triadafilopoulos

Ten frequently asked questions about endoscopic therapy for gastroesophageal reflux disease

关于胃食管反流病内镜治疗的十大常见问题

Commentary: There now are a wide variety of self-expandable metal stents (SEMS) available to the endoscopist for treatment of biliary obstruction. Furthermore, there is increasing availability of stents with different designs and configurations; stents that are fully covered, uncovered, or partially covered; and several methods of stent deployment. Also, the clinical indications for use of SEMS are expanding to potentially include benign biliary tract disease as well as preoperative usage in potentially resectable malignant disease. In this Clinical Update, Dr Todd H. Baron reviews this topic, focusing on comparative clinical outcome studies of metal vs plastic stents for treatment of biliary obstruction. In addition, Dr Baron discusses possible complications of SEMS and how to manage them. – Richard C. K. Wong, MD, FASGE, Editor University Hospitals Case Medical Center, Cleveland, OH

Todd H. Baron

Biliary self-expandable metal stents

胆道自膨式金属支架

Commentary: Rectal bleeding from internal hemorrhoids occurs commonly and is a frequent indication to visit a physician. Some patients may present with severe bleeding and anemia that require hospital admission and/or blood transfusion. Although medical therapy is usually effective for the majority of outpatients, some patients with frequent and/or severe bleeding may require therapy by endoscopy or surgery. In this Clinical Update, Dr Rome Jutabha reviews the indications and contraindications to endoscopic therapy of symptomatic internal hemorrhoids. In addition, Dr Jutabha discusses the relative risks and benefits of the various commercially available endoscopic treatments. – Richard C. K. Wong, MD, FASGE, Editor University Hospitals Case Medical Center, Cleveland, OH

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ASGE Clinical Update

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The role of endoscopy in the evaluation and management of patients with suspected pancreatic malignancy

The role of endoscopy in irritable bowel syndrome

Diagnostic approach for dysphagia

Idiopathic acute pancreatitis: role of ERCP in diagnosis and therapy

Ten frequently asked questions about endoscopic therapy for gastroesophageal reflux disease

Biliary self-expandable metal stents

Endoscopy for Internal Hemorrhoids

Image-Enhanced Endoscopy

Endoscopic Management of Barrett's Esophagus

The role of endoscopy in the evaluation of suspected pancreatic malignancy