Therapeutic Endoscopy: Color Atlas of Operative Techniques

Abstract

Therapeutic endoscopy is a diverse and complicated field that is difficult to master. This second edition is an update from 1998 and demonstrates therapeutic endoscopic techniques. A color atlas illustrative format is used, an approach which is more commonly used in surgical textbooks and atlases. The stated aim of this book is to portray the realistic therapeutic capabilities of endoscopy in day-to-day practice. Each of the 17 chapters is divided into the following sections: general information, indications, prerequisites, instruments, techniques, procedural limitations, and complications. The endoscopic techniques are illustrated exclusively using anatomic endoscopic drawings, almost all of which are in color. A wide range of endoscopic techniques in the upper and lower GI tract are shown. These include upper endoscopic techniques of foreign body extraction, esophageal dilation, esophageal stent placement, PEG and enteral tube placement, management of variceal and nonvariceal bleeding, and mucosectomy. ERCP techniques include sphincterotomy, stone extraction, biliary stent placement, pancreatic ductal therapy, pseudocyst drainage and stenting, and snare papillectomy. Colonic techniques include polypectomy and mucosectomy. There is a separate chapter on the endoscopic treatment of Zenker’s diverticulum. The main strengths of the book are the succinct text with excellent reference to the figures and well-written descriptive figure legends. The figures are outstanding in their quality and ability to convey complicated anatomy and techniques in 3 dimensions. This is an excellent teaching technique that can be more effective than the use of endoscopic photographs. This superiority is best exemplified in the ERCP chapter where different postoperative (eg, Billroth II) anatomies are illustrated. Modifications since the first edition include the inclusion of metal stents to the esophageal stent and biliary drainage chapters, the addition of enteral stent placement, the removal of some basic aspects of ERCP, and the addition of necrosectomy techniques to the pseudocyst drainage chapter. Minor changes in illustrations and techniques are seen scattered throughout the book including the addition of the use of retrieval nets to the foreign body removal section, updated illustrations to endoscopic variceal band ligation, the addition of a new hemostatic clipping device, and new material on mucosectomy. Although most of the already high-quality illustrations are the same, the contrast and crispness has been improved. This multi-authored book has uniformity of style. There continue to be some drawbacks to the textbook. As in the previous edition, the chapter on treatment of nonvariceal upper GI bleeding is almost completely dedicated to the use of hemoclips; although other hemostasis techniques (thermal and injection methods) are mentioned in bulleted form as endoscopic treatment options, none of these are expounded on in the text or are illustrated. The text is written without reference to scientific data and reflects the experience and practice of the authors. For example, in the chapter on treatment of acute variceal bleeding it is stated “the treatment of choice for profuse acute esophageal bleeding is the intravariceal injection of cyanoacrylate tissue adhesive.” In addition, the authors demonstrate techniques that, while useful, are not accepted as standard of care or performed by most therapeutic endoscopists. These include sealing of pancreatic fistulae and bile leaks using cyanoacrylate glues, removal of solid debris from necrotic pancreatic collections, and endoscopic treatment of Zenker’s diverticula. Some techniques that would be useful to add to the book include: transnasal endoscopy for to facilitating nasojejunal feeding tube placement, direct percutaneous jejunostomy, cold snare removal of colonic polyps, and band ligation-snare resection for mucosectomy. It appears that the authors’ have achieved half of their stated aim. They certainly have portrayed the realistic therapeutic capabilities of endoscopy. However, for nearly all endoscopists in the United States, much of what is demonstrated would not be included in their day-to-day practice. Nonetheless, the authors have provided therapeutic endoscopists with an excellent and exciting color atlas, the strength of which lies in combining endoscopy with illustrative anatomy in order to provide a conceptual understanding of many therapeutic endoscopic techniques. This book will be most useful for those interested in learning advanced therapeutic endoscopy or to assist in teaching advanced therapeutic endoscopic techniques. The illustrations are especially useful to include in visual presentations to illustrate these procedures. The therapeutic techniques in this book are not intended to be interpreted as doctrine, but rather to demonstrate useful practices and concepts within the field of therapeutic endoscopy. In addition, it should not be considered a comprehensive endoscopic reference, but complementary to other therapeutic endoscopy textbooks. I strongly recommend it be added to the library of aspiring and active therapeutic endoscopists. Bottom Line: A well-illustrated guide to therapeutic endoscopy.