High-quality images, illustrative diagrams, and coverage of the latest techniques guide you through this complex topic and help you achieve optimal outcomes. Deliver the most ERCP , now in its second edition, is dedicated to simplifying and explaining everything that you need to know to effectively and safely practice endoscopic retrograde cholangiopancreatography. Deliver the most effective therapy with an in-depth review of intricate ERCP procedures, and equip yourself with the latest techniques, therapeutic modalities, and guidelines. Master the latest diagnostic and therapeutic techniques with ERCP - your visual and interactive guide to this increasingly important procedure! Enhance your learning with the help of summaries following each chapter, updated images throughout, and a wealth of illustrative diagrams demonstrating key information.
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Todd H. Baron, E-mail: ude. This article has been cited by other articles in PMC. Those explanations are far too simplistic. One must realize that my career had intersected with EUS many times but never took hold. A small side room was equipped with an early mechanical radial echoendoscope. The images were suboptimal, the cases few and the emphasis at that time including my own was on ERCP. None of us could have predicted then what we are seeing now.
There was no EUS equipment at my center, not uncommon at the time. Interestingly, a young Paul Fockens visited our center in or and nicely demonstrated some diagnostic cases with industry-loaned equipment. However, still, nothing really took hold for me. A radiologist and I tried, unsuccessfully, to slay the EUS training dragon.
Frustration ensued, and the machine and its whereabouts remain unknown to me. After moving on to my next academic destination in , I was again exposed to EUS. Yet another, brief attempt at learning EUS came and went. There appeared no need, as staging and tissue acquisition predominated, and it seemed needless for a therapeutic endoscopist to pursue it further. However, ultimately it became apparent to me that EUS training was necessary for providing more broad therapeutic interventions.
The tools available for therapeutic echo endoscopy were not yet available to provide rapid and seamless interventions. With time, however, the converse was seen. There were no new tools for ERCP-guided puncture and drainage in fact, even less as some available duodenoscope puncture needles were taken off the market. As an interventional endoscopist one cannot ignore what is being done and envision what can be done.
That coupled with the admitted fear of becoming obsolete led me to train in EUS. The training process is now exactly at 1-year and across three continents. It has not been an easy road. Training in EUS is not an age problem.
Training programs are not designed to teach established gastroenterologists. Many programs are already equipped with established endosonographers and do not envision a need to train additional endosonographers. Institutions realize that money is lost when allowing a full-time gastroenterologist to take time away from their practice for additional training. I chose to train mostly outside of the United States as there were willing programs and individuals with high procedural volumes.
There is no standardized approach to training late in career and one need to consider programs based more on diagnostic or therapeutic aspects, depending on ultimate goals and philosophic learning approaches. The mind appears more naturally wired for one or the other. Something obviously clicked and made intuitive sense in that direction.
Endoscopic ultrasound training at this stage in life makes sense to me. Assuming my health remains intact I can foresee another 15 years of performing endoscopy. I believe that EUS training will provide me with career longevity and satisfaction as well as providing unique patient care. I am confident that prior extensive experience in interventional procedures will allow me to expand the field of therapeutic echoendoscopy.
This, of course, remains to be seen. Training at this career stage requires commitment to first understanding the foundation of EUS. Obviously, this takes time. Theoretically the learning curve is slightly less steep given past endoscopic experience. However, as mentioned the brain wiring in one direction means rewiring to another. One must also deal with the fact that all prior success must be put aside and accept the pain and frustration of starting at the bottom all over again.
If nothing else, it allows me to be sympathetic to those young endoscopists in fellowship training. Overall, I took this direction as I have seen the light, or shall I say the echoes — both dark and bright. Can I recommend this approach to endoscopists in a similar situation? The answer is a qualified yes, if one has dedication to training and education and available support system.
This includes institutional support and support at home. Be prepared to immerse yourself in ultrasound textbooks, anatomy books and cadavers, if available , DVDs, simulators live, ex-vivo, virtual, mechanical and online learning resources. It can be done with time and dedication. Look me up in a few years for an update.
Baron TH. Drainage of pancreatic fluid collections: Is EUS really necessary? Gastrointest Endosc. Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: Success and complication rates.
Surg Endosc. Retrograde endoscopic cystgastrostomy for pancreatic pseudocyst drainage after a Prior Roux-en-Y gastric bypass. Obes Surg. Endoscopic drainage of a pancreatic pseudocyst in a symptomatic patient with subtotal gastrectomy and Roux-en-Y anastomosis. Endoscopic transgastric drainage of a postoperative intra-abdominal abscess after colon surgery. Combined endoscopic transgastric and transpapillary drainage of an infected biloma. Endoscopic transrectal drainage of a diverticular abscess.
Successful transgastric drainage of a large mucinous adenocarcinoma of the stomach for palliation of malignant gastric luminal obstruction. Placement of fully covered self-expandable metal stents to control entry-related bleeding during transmural drainage of pancreatic fluid collections with video Gastrointest Endosc.
Endoscopic ultrasonography-guided gallbladder drainage: Actual technical presentations and review of the literature with videos J Hepatobiliary Pancreat Sci. EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Endoscopic ultrasonography-guided pancreatic duct access: Techniques and literature review of pancreatography, transmural drainage and rendezvous techniques.
Todd H. Baron, E-mail: ude. This article has been cited by other articles in PMC. Those explanations are far too simplistic. One must realize that my career had intersected with EUS many times but never took hold.
Mizilkree Withoutabox Submit to Film Festivals. Read more Read less. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices. Share your thoughts with other customers. Try the Kindle edition and experience these great reading features: Uses the clearest, most detailed instructions on performing ERCP produced to date, so you can follow each procedure in-depth.