Foreword

The pancreatobiliary region has one of the most complicated structures and physiological functions in our body. Endoscopic procedure in the region thus requires rather complicated techniques. This makes it difficult and time-consuming to explain pancreatobiliary diseases or pancreatobiliary endoscopy to patients and their families, or to deliver correct information to medical staff during training.

This book was specifically written to eliminate such difficulties and to increase the understanding and provision of medical information related to pancreatobiliary diseases and pancreatobiliary endoscopy in the shortest time possible.

Much time and effort has been invested in publishing this book so that medical staff specializing in pancreatobiliary diseases, e.g. specialists, fellows, residents, nurses and medical students, will be able to more easily understand the corresponding diseases and a variety of endoscopic treatments in a short period of time, while patients and their families will be able to gain better insights into the pancreatobiliary endoscopy needed by the patients.

My sincere thanks go to Professor Seok Ho Dong, the editor-in-chief, who has made arduous efforts for this book, and to all other editors who have contributed.



Sun-Joo Kim, M.D., Ph.D.

President

The Korean Society of Pancreatobiliary Diseases


Preface

"Seeing is learning"

This is the creed of the authors bore in mind when they came together and agreed to bring out this kind of book. This volume contains illustrated figures of pancreatobiliary diseases as well as relevant ERCP procedures. You will be getting familiar with the anatomy and diseases of the pancreas and biliary tract while looking at the detailed illustrations. Besides, you will be able to understand various ERCP procedures with ease. The authors carried out painstaking search for figures from books or through the web and tried to put as many figures as possible. You can also get some useful information on commercially available accessories for ERCP in the final chapter. All the figures in this volume were modified and redrawn one by one to make the best illustrations.

I would like to express my hearty thanks to all the authors for their exceptional contributions and to the artist who dedicated himself to elaborate computer graphics.

Part I

Normal and Variant Anatomy of Pancreaticobiliary Tract

01 _Overview of bile duct and pancreas 2

02 _ Segments of liver 7

03 _Artery and vein of pancreaticobiliary system 12

04 _Biliary tract 15

05 _ Pancreas 24

06 _Gallbladder and cystic duct 30

Part II

Ampulla of Vater

01 _Major papilla 34

02 _ Histologic structure 36

03 _Y, V, and U type 40

04 _Periampullary diverticulum 42

05 _ Ampulla of Vater cancer 43

Part III

Biliary Tract

01 _Choledochal cyst 46

02 _ Types of choledochocele 47

03 _ Duplication of extrahepatic bile duct 49

04 _Anomalous pancreaticobiliary union (APBU) 50

05 _Stones on biliary tract 55

06 _ Bile duct injury 56

07 _Postsurgical benign biliary stricture 57

08 _ Intrahepatic biliary disease 58

09 _Bile duct cancer 59

10 _Klatskin tumor (Hilar cholangiocarcinoma) 62

11 _ Extrahepatic bile duct stricture 64

12 _ Gallbladder cancer 65

Part IV

Pancreas

01 _Pancreas divisum 68

02 _ Annular pancreas 70

03 _Chronic pancreatitis 72

04 _Pancreas cystic lesion 76

05 _ Pancreatic cancer 79



Part V

Techniques of ERCP

01 _Intubation of duodenoscope 82

02 _ Cannulation 88

03 _ Altered anatomy 106

04 _Precut papillotomy and infundibulotomy 130

05 _Endoscopic sphincterotomy (EST) 143

06 _ Drainage 153

07 _Stone extraction 168

08 _ Papillectomy 184



Part VI

Sphincter of Oddi

01 _Normal anatomy 186

02 _ Relaxation and contraction 187

03 _Stenotic and dysfunctional sphincter of Oddi 188

04 _Sphincter of Oddi manometry 189

Part VII

ERCP Accessories

01 _Catheters 192

02 _ Guide wires 195

03 _Sphincterotomes 197

04 _Needle knives 199

05 _ Dilating balloons 200

06 _Extraction baskets 202

07 _ Extraction balloons 205

08 _Lithotriptors 207

09 _Naso-biliary and naso-pancreatic drainage 208

10 _ Cytology brushes 209

11 _ Plastic stents 210

12 _ Metal stents 213