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Part 1 book “Endoscopy in liver disease” has contents: Equipment, patient safety, and training, sedation and analgesia in endoscopy of the patient with liver disease, endoscopy in the setting of coagulation abnormalities in the patient with liver disease, endoscopic management of acute variceal bleeding,… àn other contents.
Endoscopy in Liver Disease Endoscopy in Liver Disease Edited by John N Plevris Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh University of Edinburgh Edinburgh, Scotland, UK Peter C Hayes Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh University of Edinburgh Edinburgh, Scotland, UK Patrick S Kamath Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota, USA Louis M Wong Kee Song Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota, USA This edition first published 2018 © 2018 by John Wiley & Sons Ltd All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions The right of John N Plevris, Peter C Hayes, Patrick S Kamath, and Louis M Wong Kee Song to be identified as the authors of the editorial material in this work has been asserted in accordance with law Registered Offices John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand Some content that appears in standard print versions of this book may not be available in other formats Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by 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website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make This work is sold with the understanding that the publisher is not engaged in rendering professional services The advice and strategies contained herein may not be suitable for your situation You should consult with a specialist where appropriate Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages Library of Congress Cataloging‐in‐Publication Data Names: Plevris, John N., editor | Hayes, Peter C., editor | Kamath, Patrick S., editor | Wong Kee Song, Louis M., editor Title: Endoscopy in liver disease / edited by John N Plevris, Peter C Hayes, Patrick Kamath, Louis-Michel Wong Kee Song Description: First edition | Hoboken, NJ : Wiley, 2018 | Includes bibliographical references and index | Identifiers: LCCN 2017026560 (print) | LCCN 2017027059 (ebook) | ISBN 9781118660850 (pdf ) | ISBN 9781118660843 (epub) | ISBN 9781118660874 (cloth) Subjects: | MESH: Liver Diseases–diagnostic imaging | Endoscopy, Digestive System–methods Classification: LCC RC847.5.I42 (ebook) | LCC RC847.5.I42 (print) | NLM WI 700 | DDC 616.3/6207545–dc23 LC record available at https://lccn.loc.gov/2017026560 Cover image: Courtesy of Louis-Michel Wong Kee Song Cover design by Wiley Set in 10/12pt Warnock by SPi Global, Pondicherry, India 10 9 8 7 6 5 4 3 2 1 v Contents List of Contributors vii Preface xi About the Companion Website xii Equipment, Patient Safety, and Training John N Plevris and Scott Inglis Sedation and Analgesia in Endoscopy of the Patient with Liver Disease 19 Rohit Sinha, Anastasios Koulaouzidis, and John N Plevris Endoscopy in the Setting of Coagulation Abnormalities in the Patient with Liver Disease 29 Bezawit Tekola and Stephen Caldwell Varices: Screening, Staging, and Primary Prophylaxis 43 Alan Bonder, Ignacio Alfaro, and Andres Cardenas Endoscopic Management of Acute Variceal Bleeding 55 Marcus C Robertson and Peter C Hayes Prevention of Recurrent Bleeding from Esophageal Varices 97 Annalisa Berzigotti, Fanny Turon, and Jaime Bosch Refractory Variceal Bleeding: When First Endoscopy Fails, What Next? 111 Virginia Hernández‐Gea, Fanny Turon, and Juan Carlos García‐Pagán Portal Hypertensive Gastropathy and Gastric Vascular Ectasia 119 Cristina Ripoll and Louis M Wong Kee Song Portal Hypertensive Enteropathy and Obscure Gastrointestinal Bleeding 143 Anastasios Koulaouzidis, Emanuele Rondonotti, and Roberto de Franchis 10 Endoscopic Management of Upper Gastrointestinal Pathology in the Patient with Liver Disease 155 Selina Lamont and Adrian Stanley vi Contents 11 Colonoscopic Screening and Surveillance in the Patient with Liver Disease (Including Post‐Transplant) 173 William M Tierney and Khadija Chaudrey 12 Endoscopic Retrograde Cholangiopancreatography and Cholangioscopy in Hepatobiliary Disease 195 Klaus Mönkemüller, Giovani E Schwingel, Alvaro Martinez‐Alcala, and Ivan Jovanovic 13 Endoscopic Ultrasound in the Diagnosis of Hepatobiliary Malignancy 229 Michael J Levy , Larissa Fujii‐Lau, Julie K Heimbach, and Gregory J Gores 14 Endoscopic Ultrasound Guided Biliary Drainage 245 Mouen A Khashab, Shyam Varadarajulu, and Robert H Hawes 15 Hepatobiliary Endoscopy in the Patient with Liver Disease and Altered Anatomy 259 Stuart K Amateau and Raj J Shah 16 Management of Post‐Liver Transplant Hepatobiliary Complications 279 Ryan Law, Larissa Fujii‐Lau, and Todd H Baron 17 Endoscopic Confocal and Molecular Imaging in Hepatobiliary Disease 295 Michael S Hoetker and Martin Goetz 18 Laparoscopy in Patients with Hepatobiliary Disease 305 Tom K Gallagher, Ewen M Harrison, and O James Garden Index 323 vii List of Contributors Ignacio Alfaro, MD Specialist Member Institute of Digestive Diseases and Metabolism Hospital Clinic Barcelona, Spain Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts, USA Jaime Bosch, MD, PhD, FRCP Assistant Professor of Medicine Director of Endoscopy Division of Gastroenterology and Hepatology University of Minnesota Medical Center Minneapolis, Minnesota, USA Professor of Medicine and Senior Consultant Hepatologist Hepatic Hemodynamic Laboratory and Liver Unit Hospital Clinic University of Barcelona Barcelona, Spain; Guest Professor of Hepatology Inselspital, University of Bern Bern, Switzerland Todd H Baron, MD, FASGE Stephen Caldwell, MD, FAASLD Stuart K Amateau, MD, PhD Professor of Medicine Director of Advanced Therapeutic Endoscopy Division of Gastroenterology and Hepatology University of North Carolina Chapel Hill, North Carolina, USA Annalisa Berzigotti, MD, PhD Associate Professor of Medicine (Hepatology) University Clinic for Visceral Surgery and Medicine Inselspital, University of Bern Bern, Switzerland Alan Bonder, MD Assistant Professor of Medicine Division of Gastroenterology and Hepatology Professor of Medicine GI/Hepatology Digestive Health Center University of Virginia Charlottesville, Virginia, USA Andres Cardenas, MD, MMSc, PhD, AGAF, FAASLD Faculty Member/Consultant Institute of Digestive Diseases and Metabolism Hospital Clinic Barcelona, Spain Khadija Chaudrey, MD Gastroenterologist Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota, USA viii List of Contributors Roberto de Franchis, MD Gregory J Gores, MD Professor of Gastroenterology Department of Biomedical and Clinical Sciences University of Milan Milan, Italy Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota, USA Larissa Fujii‐Lau, MD Assistant Professor of Medicine Department of Gastroenterology Queens Medical Center University of Hawaii Honolulu, Hawaii, USA Tom K Gallagher, MCh, FRCSI Consultant Hepatobiliary and Transplant Surgeon St Vincent’s University Hospital Dublin, Ireland Juan Carlos García‐Pagán, MD, PhD Barcelona Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic Barcelona Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) University of Barcelona CIBERehd (Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas) Barcelona, Spain O James Garden, CBE, MD, FRCSEd Regius Professor of Clinical Surgery and Honorary Consultant Surgeon Hepatobiliary and Pancreatic Surgical Services Department of Clinical Surgery Royal Infirmary of Edinburgh Edinburgh, Scotland, UK Martin Goetz, MD Professor of Endoscopy Innere Medizin Universitätsklinikum Tübingen Tübingen, Germany Ewen M Harrison, PhD, FRCSEd Clinical Senior Lecturer and Honorary Consultant Surgeon Hepatobiliary and Pancreatic Surgical Services Department of Clinical Surgery Royal Infirmary of Edinburgh Edinburgh, Scotland, UK Robert H Hawes, MD Professor of Medicine University of Central Florida College of Medicine Medical Director Florida Hospital Institute for Minimally Invasive Therapy Florida Hospital Orlando Orlando, Florida, USA Peter C Hayes, MD, PhD Professor of Hepatology Liver Unit and Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh University of Edinburgh Edinburgh, Scotland, UK Julie K Heimbach, MD Professor of Medicine Department of Surgery Mayo Clinic Rochester, Minnesota, USA Virginia Hernández‐Gea, MD, PhD Barcelona Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic Barcelona Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) University of Barcelona CIBERehd (Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas) Barcelona, Spain List of Contributors Michael S Hoetker, MD Alvaro Martinez‐Alcala, MD Innere Medizin Universitätsklinikum Tübingen Tübingen, Germany Visiting Fellow Therapeutic Endoscopy Basil I Hirschowitz Endoscopic Center of Excellence University of Alabama Birmingham, Alabama, USA Scott Inglis, BSc, MSc, PhD, MIPEM, CSci Senior Clinical Scientist and Honorary Lecturer Medical Physics, NHS Lothian/ University of Edinburgh Royal Infirmary of Edinburgh Edinburgh, Scotland, UK Ivan Jovanovic, MD, PhD Professor of Medicine University of Belgrade Belgrade, Serbia Mouen A Khashab, MD Associate Professor of Medicine Department of Medicine and Division of Gastroenterology and Hepatology The Johns Hopkins Hospital Baltimore, Maryland, USA Anastasios Koulaouzidis, MD, FEBG, FACG, FASGE Associate Specialist Endoscopy Unit, Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh Edinburgh, Scotland, UK Klaus Mönkemüller, MD, PhD, FASGE Professor of Medicine Helios Klinikum Jerichower Land Teaching Hospital of the Otto‐von‐Guericke University Burg, Germany John N Plevris, MD, PhD, FRCPE, FEBGH Professor and Consultant in Gastroenterology Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh University of Edinburgh Edinburgh, Scotland, UK Cristina Ripoll, MD Assistant Professor First Department of Internal Medicine Martin‐Luther‐Universität Halle‐Wittenberg Halle (Saale), Germany Marcus C Robertson, MBBS (Hons), BSci (Biotechnology) Consultant Gastroenterologist Royal Alexandra Hospital Paisley, Scotland, UK Liver Transplant and Hepatology Fellow Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh Edinburgh, Scotland, UK Ryan Law, DO Emanuele Rondonotti, MD, PhD Clinical Lecturer of Medicine Division of Gastroenterology University of Michigan Ann Arbor, Michigan, USA Gastroenterology Unit Valduce Hospital Como, Italy Michael J Levy, MD Attending Physician, Consultant Cirurgia Aparelho Digestivo Gastroenterologia São Bento Sul Santa Catarina, Brazil Selina Lamont, MBChB, FRCPSGlasg Professor of Medicine Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, USA Giovani E Schwingel, MD ix x List of Contributors Raj J Shah, MD, AGAF William M Tierney, MD, FASGE, AGAF Professor of Medicine Division of Gastroenterology and Hepatology Director, Pancreaticobiliary Endoscopy University of Colorado Anschutz Medical Campus Aurora, Colorado, USA Professor of Medicine Digestive Diseases and Nutrition Section University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA Rohit Sinha, MBBS, MRCP(UK), PgDip(Lon) Barcelona Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic Barcelona, CIBERehd (Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain Clinical Research Fellow in Hepatology Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh University of Edinburgh Edinburgh, Scotland, UK Fanny Turon, MD Shyam Varadarajulu, MD Consultant Gastroenterologist and Honorary Clinical Associate Professor Glasgow Royal Infirmary Glasgow, Scotland, UK Professor of Medicine University of Central Florida College of Medicine Medical Director Center for Interventional Endoscopy Florida Hospital Orlando Orlando, Florida, USA Bezawit Tekola, MD Louis M Wong Kee Song, MD, FASGE Adrian Stanley, MBChB, MD, FRCPEd, FRCPSGlasg Senior Fellow GI/Hepatology Digestive Health Center University of Virginia Charlottesville, Virginia, USA Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota, USA Barrett’s Esophagus with white light endoscopy and NBI as “endoscopic trimodal imaging.” Studies suggest there may be a role for the latter in reducing the number of biopsies required when used in low risk patients; however more studies are required before firm recommendations can be made [12] Although additional data are required, these modalities may be a useful non‐ biopsy approach to assess and carry out surveillance of BE in patients with cirrho sis, with or without portal hypertension or coagulopathy Biomarkers Patients who progress from BE to adeno carcinoma have been shown to have p53 alterations One of the normal p53 alleles is inactivated by mutation and the other is lost by a mechanism called loss of het erozygosity Immunostaining of p53 can be used as an adjunct to histopathological analysis since it may improve the diagnosis of dysplasia [5,13] Another biomarker found to be a predictor of progression is cyclin D1 [14] Aneuploidy, which can be diagnosed from systemic flow cytometry, has been shown to have a 5‐year cumula tive esophageal carcinoma incidence of 28% [15] Apart from p53, no other bio markers have been found useful for the diagnosis of dysplasia However, more robust evidence is required before recom mending the routine use of biomarkers in this situation Management Although the management of BE is problematic in the setting of cirrhosis, it is important to determine its presence in patients being considered for liver trans plantation, because there can be rapid progression of premalignant and malig nant lesions in the setting of immunosup pression Once a patient is diagnosed with BE, it is important to commence proton pump inhibitor (PPI) therapy An observa tional study by Kastelein et al reported a Figure 10.3 Esophageal varices within Barrett esophagus >75% reduction in the risk of neoplastic progression in BE if long term PPIs are prescribed [16] In the BE patient with liver disease, surveillance strategies will depend on the risks of repeated multiple esophageal biopsies In patients with esophageal varices, the risks of biopsy surveillance clearly outweigh the benefits (Figure 10.3) In patients without esophageal varices, surveillance biopsies should be considered on an individual basis Once low grade dysplasia (LGD) has been diagnosed and confirmed by two independent pathologists, the updated BSG guidelines recommend repeat endoscopy every months as long as LGD persists [5] However, a recent randomized trial com paring endoscopic surveillance with radiofrequency ablation (RFA) of BE in patients with LGD suggested a benefit in favor of RFA [17] In this study, 136 patients were randomized to undergo either biopsy surveillance or RFA After years of the planned 3‐year study, 20.6% of patients randomized to the surveillance group progressed to high grade dysplasia (HGD) (n = 9) or esophageal adenocarci noma (n = 5) Only one patient in the RFA group progressed to esophageal adeno carcinoma (p