48 - Preparation for Pancreaticobiliary Endoscopy

Abstract

Pancreaticobiliary endoscopy focuses on the diagnosis and therapy of conditions involving the pancreas and biliary tree, and distinguishes itself from luminal endoscopy by a greater use of side-viewing endoscopes and echoendoscopes and the use of fluoroscopy. With advances in endoscopic equipment and growing experience, pancreaticobiliary endoscopy has evolved to encompass a wide range of diagnostic and therapeutic procedures of increasing complexity. Accordingly, the practice of pancreaticobiliary endoscopy requires meticulous preparation and training. This chapter reviews the various aspects of preparation for pancreaticobiliary endoscopy. These aspects are conveniently organized under patient-, physician-, and endoscopy unit–related preparation, with an emphasis on existing guidelines and published evidence. Preprocedure visits, the role of open-access endoscopy, informed consent, and interdisciplinary communication are discussed in the patient-related preparation section. Physician training, credentialing, and guidelines for the acquisition and adoption of new techniques are highlighted in the provider preparation section. Suggestions for unit layout, ergonomics, fluoroscopy, staff training, and postprocedure care are provided in the endoscopy unit–related preparation section. Attention to these often-overlooked details before and after the procedure increases the chance of a successful endoscopy and an excellent outcome for the patient.