Endoscopic ultrasound has revolutionized the approach to lesions inside and outside the gastrointestinal tract. It has opened the door for gastroenterologists to explore organs outside of the GI lumen, such as the lymph nodes, lung, pancreas, and liver. Endoscopic Ultrasound covers all aspects of endoscopic ultrasound, from the basics to the interventional indications. Richly detailed chapters describe the utility of EUS in different parts of the body and are organized based on body site Pioneers in the field summarize new studies, and the direction of EUS in practice. Endoscopic Ultrasound provides a ready reference that will help physicians and support staff that are beginning EUS, as well as trained ultrasonographers who wish to arm themselves with a comprehensive reference and explore the future of the field.

Recent clinical trials of adjuvant therapy for gastric cancer in Japan have shown improved survival benefits, but the results have been considered controversial and have been viewed with some skepticism in the West. Until now, the efforts of Japanese surgical oncologists in multimodality therapy have not been fully understood because they have not been adequately reported in English. This volume now presents the experience and expertise of Japanese surgeons who utilize preoperative or intraoperative chemotherapy, or a combination of systemic and regional chemotherapy. Their collected work provides valuable insight in the Japanese perspective and success in treating gastric cancer. Included in the appendix is an extensive tabular analysis of the gastric cancer database at the Cancer Institute Hospital of Tokyo. Probably the largest such database in the world from a single institution, the analyses present the state of the art in treatment of gastric cancer.

A distinguished panel of world authorities reviews the current state of today's understanding, diagnosis, and treatment of pancreatic cancer. Their cutting-edge reviews discuss both medical and surgical modalities and include numerous insights into the basic molecular processes underlying the disease. Among the key topics covered are the prospects for early diagnosis using molecular techniques, the latest diagnostic and therapeutic methods, the role of laparoscopy (diagnostic and therapeutic), and nonsurgical treatment. The reviewers also address the future possibilities for clinical advances, quality of life concerns, and the value of the Japanese "extended Whipple resection." Pancreatic Cancer will become the new standard reference for all clinicians who diagnose and treat this disease, as well as for basic scientists needing a summary of the many recent advances.
i

Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisti cated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disor ders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic infor mation. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofIowa College of Medicine GI Motility Symposia."

Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy.

A concise, practical guide to the diagnosis and treatment of liver disease. Authoritative and practical, this important new book not only spells out the advantages and limitations of the latest diagnostic tests, but also provides numerous algorithms for evaluating patients and treating the liver problems commonly encountered by primary care physicians. Here, too, the reader will find described the nuances of serological tests for the detection of viral infections and how best to use invasive and noninvasive radiological tests in specific circumstances. Common complications are fully discussed and detailed practical information is given on how to recognize the patient's immediate problems and deal with them effectively. This book's numerous diagrams, clinical "pearls", and cost comparisons will clarify the often complex and bewildering array of conditions associated with liver disease and make it a definitive and indispensable guide for primary care physicians, medical students, and residents.

Gout: Basic Science and Clinical Practice is a thoroughly researched comprehensive text which covers all important aspects of gout, including its genetics, pathophysiology, diagnosis, and management. Gout is probably the most common rheumatic disease after osteoarthritis and is becoming more common with the prevalence of the metabolic syndrome in the US, and in many other countries. Only about 10% of patients with gout are treated by rheumatologists and this often leads to inadequate diagnosis and treatment in general medical practice. Written by an expert in the field this book is valuable reference for rheumatologists and others in the medical profession who are interested in understanding and managing this important disease.

Hiatus hernia affects 1 in 3 people over 50, but it doesn't have to limit or significantly impact your health and wellbeing. Most symptoms can be very easily prevented, or managed, at home with some simple and easy to manage changes to your diet and lifestyle. In his career as a GP, Dr Tom Smith has helped hundreds of people to manage their hiatus hernia, eliminating and significantly improving such symptoms as heartburn, reflux or bloating. This book sets out, step-by-step, some basic strategies you can use not just to feel better but also to improve your general health, including a better diet, less stress and more physical activity. Including the very latest insight, research and advice from top consultant gastroenterologists, the book will explain what medications are available for those who reach that stage, and also discuss surgical management for those who might need it. Simple, supportive, practical and designed for anyone who thinks they might have a hernia - regardless of age, weight or lifestyle - Coping Successfully with Hiatus Hernia will accompany you on the path back to physical health, free of digestive distress or discomfort.

"Principles of Deglutition" is the first in class comprehensive multidisciplinary textbook to encompass the entire field of normal and disordered deglutition. It is designed as the definitive text for all those who desire to further their knowledge of the dynamic and expanding field of deglutology. The text is created to serve as a treasured reference for clinicians, educators and trainees from such diverse backgrounds as gastroenterology, speech language pathology, otolaryngology, rehabilitation medicine, radiology and others.

"Principles of Deglutition" brings together the state-of-knowledge from 12 disciplines involved in dysphagia through contributions of over one hundred thought leaders and master clinicians for the benefit of patients and providers alike. It concisely organizes the wealth of knowledge that exists in each of the contributing disciplines into one comprehensive information platform.

"Principles of Deglutition" provides a one-stop destination for members of all specialties to obtain state-of-the-art and critically reviewed information regarding deglutition physiology, pathophysiology, diagnosis and management. It delivers a comprehensive and in depth review of deglutition related cerebral cortical, brainstem, peripheral nerves, and neuromuscular mechanisms, advanced diagnostic modalities and standard of care and cutting edge medical, rehabilitative and surgical treatments. It is an essential reference for all deglutologists.

As the population ages, clinicians are facing an increasing number of elderly patients with colorectal cancer. These patients pose unique challenges as they have more comorbidities and lower functional reserves. In addition, the treatment goals may differ from those in younger patients. This book discusses in depth the different aspects of management of colorectal cancer in the elderly. After the provision of pertinent background information on the normal physiology of aging, screening and diagnosis are discussed. Subsequent chapters focus on a range of issues associated with the surgical and perioperative care of these patients and with adjuvant treatment and palliative care. Each chapter provides helpful take-home messages in bullet point form, and numerous informative figures and tables are also included. The authors are surgeons, physicians, anesthetists, geriatricians, oncologists, and allied health professionals with extensive experience in the field.

The Scientification of Gastroenterology During the 20th Century * Science contributes to medicine in three ways: It provides a body of relatively secure knowl edge. Some of that knowledge has been applied to develop technologies which have had a major impact upon the practice and effectiveness of medicine. Last, science offers to medicine a way of thinking. - 1. McCormick [(1993) The Contribution of Science to Medicine. Perspect. Bioi. Med. 16,315.] Awareness of the digestive system began with the dawn of civilization, when man, observing the feeding habits of animals in the surrounding environment, experimented with foods, edible and inedible. Identity came with discoveries of the digestive organs during the 16th and 17th centuries. Function was revealed by physiologic studies of digestion, absorp tion and secretion, metabolism, and motility during the 18th and 19th centuries. Diagnostic access improved with the technological advances of the 20th century. Understanding of gas trointestinal (GI) disease followed the growth of the basic sciences and gastroenterology's involvement in scientific research during the latter half of the 20th century. Early in the 20th century, gastroenterology was yet an undefined activity without clinical or scientific guidelines. Diagnostic approach to the digestive tract was minimal. Valid con cepts of disease were lacking. Visceroptosis, sitophobia, and "colonic autointoxication" were common "diagnoses." Therapeutic resources were scarce.

Endoscopic ultrasonography (EUS) has evolved from an obscure method of investigation in the 1980s to a distinct endoscopy subspecialty with interventional and therapeutic capabilities. The art of interpreting EUS images is a skill every endoscopist needs to master. This book helps to meet that need as it is concise, simple to read, and amply illustrated, and describes the technique in a step-by-step manner. Many high-resolution EUS images of diseases are included, and literature reviews are kept short and concise while separate discussions and illustrations are devoted to radial and linear techniques. The book can be used as a reference handbook in the endoscopy room, yet contains all of the relevant information required to perform EUS, interpret images, and reach a diagnosis. Important pathological conditions are thoroughly discussed using representative EUS images, pointing out salient differentiating features, and relevant literature reviews are included. The section on interventional EUS deals with advanced interventional or therapeutic procedures, and potential complications and methods to avoid them are discussed. For the novice, the book is designed to teach EUS using a step-by-step approach, and for the seasoned endosonographer it is a practical reference tool for use while performing EUS and may also serve in the differentiation of various pathologies.

The basis of this book is a ten-lecture course on the control of gastrointesti nal motility given each year to the final year undergraduate students in Physiology at Sheffield University. A naive thought led me to believe that the conversion of my lecture notes into the present book would be a relatively easy task. I now know differently. As there is no equivalent undergraduate course elsewhere that I know of, it would be dishonest of me to claim this book to be an undergraduate text. The comprehensive way in which I have dealt with the subject, together with the inclusion of the most up-to-date material, make the book more relevant to postgraduate students of physiology, medicine and related sciences who require an introduction to the field of gastrointestinal motility and its control. I have, however, attempted to present the current concepts on the physiological mechanisms regulating motility in a way which under graduates, as well as postgraduates, will find readable, informative and, hopefully, enjoyable."

DDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess is on what to do best for the ment and investigations, but the emphasis patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

The much-anticipated revision of the second edition of The SAGES Manual: Fundamentals of Laparoscopy, Thoracoscopy, and GI Endoscopy, has been completely restructured, reorganized, and revised. The Manual has been split into two volumes for better portability. Volume I, Basic Laparoscopy and Endoscopy covers the fundamentals and procedures performed during surgical residency. Volume I will be the first volume used by students, residents, and allied healthcare professional trainees. Material has been added to these fundamentals and procedures that will also be of interest to experienced surgeons. Volume II, Advanced Laparoscopy and Endoscopy covers more advanced procedures, generally taught during fellowship. All of the sections have been reorganized with a critical eye to the needs of the modern minimal access surgeon. Two new editors have been added. Chapters have been revised by both new authors as well as many stalwart authors from previous editions. These portable handbooks cover all of the major laparoscopic and flexible endoscopic procedures in easy-to-read format. Indications, patient preparation, operative techniques, and strategies for avoiding and managing complications are included for the complete spectrum of both "gold standard" and emerging procedures in diagnostic and therapeutic laparoscopy, thoracoscopy, and endoscopy. The scope, detail, and quality of the contributions confirm and demonstrate the SAGES commitment to surgical education. This manual is sure to find a home in the pocket, locker or briefcase of all gastrointestinal endoscopic surgeons and residents.

Most people’s diets are woefully inadequate for providing proper nutrition. Even good diets fail to deliver sufficient levels of nutrients. The Vitamin Cure book series highlights the safe and clinically effective use of vitamin supplements for a variety of illnesses. Research continues to prove the immense value of vitamins for maintaining health and fighting disease. The Vitamin Cure books, written by authors who are recognized experts in their field, deliver authoritative, up-to-date, and practical information on taking vitamins for particular health problems.

Those that think that they are not affected by digestive issues may consider them less serious than many other health problems. This is far from the case, as those who suffer from them can report. And digestive health has a direct impact on many very serious illnesses aside from those directly apparent, such as indigestion, gastroesophageal reflux disease (GERD), and ulcers. Digestive health is critical to your health in general, and has a direct impact on all of the systems and organs in your body.

This readable guidebook will assist anyone suffering from digestive issues or those who just want to make sure that they are providing optimal nutrition to their bodies. It explains the major digestive systems, describes their structure and functions, discusses the health problems that can develop in each system and their causes, and addresses available medical treatments. It covers a wide range of problems from canker sores to GERD, inflammatory bowel disease, Crohn’s disease, gluten allergies, and gallstones, to cancer, and more. The focus is to give readers straightforward, clear explanations on how and when to treat digestive issues with healthy, natural nutrition and vitamin therapies.

Contemporary Coloproctology covers colorectal surgery, as practiced today, in an easily accessible format with emphasis on bringing key facts rapidly into focus. It is ideal reading both for the medical trainee and the practicing colorectal surgeon. As well as a succinct presentation of the current colorectal knowledge base, each chapter contains practical advice and pearls of wisdom from established practicing clinicians. A unique feature of the format is the identification of key references and questions and scenarios that present real life decisions in colorectal surgery. Edited and authored by outstanding surgeons in their fields, this book brings the reader expertise in surgery and management across the various conditions encountered in coloproctology.

Although the first description of patients with what we now call Crohn's disease or ulcerative colitis was published well before 1900, both disorders seem to be diseases of the twentieth century. At the very start of the twenty-first century, it therefore seems appropriate to look back and at the same time look forward and to assess what knowledge has been gained during the last 100 years and in what direction research and thereby clinical practice will go in the future. This book, the proceedings of Falk Symposium No. 111 held in Freiburg, Germany, on June 19-20 1999, contains contributions from experienced senior scientists on the state of the art in pathophysiology, diagnosis and treatment, together with unpublished and new findings from young researchers. Basic scientists and clinicians are thereby involved in an exchange of information which will lead to new directions for future research and clinical management of inflammatory bowel diseases.

This book is a completely up-to-date review of the basic tests available in gastroenterology. It is based on a detailed critical analysis of recently described procedures and the review of more traditional methods; each is as signed its correct place in the modern management of patients. Emphasis is placed on those techniques with which the authors have practical experience. The most useful investigations are indicated in the table of contents by heavy type. Comprehensive references are included to provide information about the selection, performance and interpretation of tests. The book is designed for trainees and clinicians without special expertise in gastroenterology, as well as being a shelf manual for the gastroenterologist and the staff of gastrointestinal investigation units. Special thanks are due to the nursing staff of the Day Ward, Bishop Auck land General Hospital; Mr P. Grencis, Medical Photographer; Dr S. Desai, Radiologist; and Amanda Gallagher who typed the manuscript. Malcolm C. Bateson Ian A. D. Bouchier 1988 xu CHAPTER 1 Intubation The passage of various forms of nasogastric, duodenal and intestinal tubes is basic to many of the diagnostic procedures performed in the gastrointestinal system. Method Whenever possible the patient's fullest co-operation should be obtained. If the patient is taking any drugs which might influence the test to be under taken these should be discontinued."

Despite the fact that the incidence of gastric cancer is declining in the Western world, it remains a significant problem with respect to accurate diagnosis and treatment since it has a high mortality rate. In June 1989 an International Conference was held at the University of Rome "La Sapienza" entitled "New Trends in Gastric Cancer: Background and videosurgery." During this meeting background information on the aetiopathogenesis of gastric cancer was presented together with talks and video presentations on the latest advances in the treatment of gastric carcinoma, both from the European and Japanese experience. Because of the poor prognosis of gastric carcinoma there is increasing pressure for early detection. Some of the problems in the early detection of gastric carcinoma are discussed together with methods of surveillance of high-risk subjects. It is generally accepted that the surgical approach to gastric carcinoma should take into account the site and extent of the lesion and there are chapters on new methods for pre and intraoperative staging of the disease which allow a more logical approach to surgery. A comparison between Japanese and Western rule and results was attempted and reasons for the differences were investigated. Since the field is still evolving not all aspects could be covered, and those angles not approached in this book will be addressed in a second International Conference to be held in Rome in June 1990.

This volume, the sixth of the series, represents the natural counterpart of the previous volume, Ultra structure of the Digestive Tract. Unlike the latter, however, whose contents fell entirely within the domains of gastroenterology, Ultrastructure of the Extraparietal Glands of the Digestive Tract encom passes a few cognate sciences, such as hepatology, pancreatology, and even oral biology, which are usually dealt with separately. This allows, starting from cell biology, embryology, and comparative anatomy, a comprehensive survey of organs that have much in common both structurally and functionally. The chapters of this book have been compiled by well-known experts in the field with the aim not only of reviewing and pointing out the state of the art of the subject covered, but also of giving directions for future work. Furthermore, through the integration of electron microscopy with immunocytochemistry, autoradiography, freeze fracture, maceration, enzymatic digestion, etc., and by providing superb illus trative material, the authors substantiate the pivotal role played by modern morphology in under standing human physiology and pathology. In fact, it must be stressed, that a consistent part of the tissues studied here are from human origin. We believe that this volume should be read, not only by scientists and teachers active in the field, but also by a larger audience of students and professionals interested in knowing the scientific foundations of biomedicine."

A series of international symposia on viral hepatitis and liver disease has been held triannially, and called the "Olympics" of this research field. Our book presents the results of the eighth of these "Olympiads" which for the first time, was held in Asia (May 1993, Tokyo). Due to the rapid progress in research on both basic and clinical aspects of viral hepatitis and liver disease, the state of the art in this field is continually being updated, and our book provides a broad and in-depth survey of current work. The major topics in our book include molecular biology of the five known hepatitis viruses (HAV, HBV, HCV, HDV, and HEV), clinical implications of genetic variants of HBV and HCV, interferon treatment of HCV-related liver disease, and worldwide epidemiology and control of viral hepatitis. New subjects not seen in previous books, such as genotypes of HCV, are also covered. Expanding knowledge about the heterogeneity of the HCV genome has revealed a great variety of genotypes as well as their association with host pathogenesis and their varying responsiveness to interferon therapy. The first promising results of efforts to develop a hepatitis C vaccine are also presented. Finally, compared with its predecessors, our book contains many more papers from Asian countries, where the prevalence of viral hepatitis and liver disease is the highest in the world.

The endoscopic use of lasers in the treatment of gastrointestinal d seases began within the last decade and has evolved rapidly. Work is now being done at more than 150 centers in Europe, the United States, Japan and the rest of the world. To date no publi cation has defined the state of the art. This text attempts to fill that void. To disseminate information about therapeutic laser endoscopy, an increasing number of short courses have been sponsored in the United States wherein the attendee hears didactic lectures, views video tapes, and in addition, has the opportunity to have a "hands-on" experience with endoscopic laser therapy in the animal labs. This book is an expansion of the material presented in one such course sponsored by The Cook County Hospital in Chicago, Illinois, in October, 1982. The course was organized by Peter Bright-Asare, M. D., Chairman of Gastroenterology at the time of the course and chaired by Dr. Bright-Asare and myself. Some of the lectures from the course have been broadened and formalized. Other chapters were invited and added. Also included are group discussions about issues that are either controversial or undefined. Attempts were made to secure consensus opinion from experienced investigators in areas where no hard scientific experimental or clinical data exists. The contributors have a wide range of interest and expertise. Dr."

Despite significant progress in modern gastroenterology, the aetiology of inflammatory bowel disease as well as coeliac disease is still to a great extent unknown and poorly understood. The principles of treatment - particularly of IBD - emphasize the importance of a combined medical and surgical approach. This book is the proceedings of an international symposium that brought together workers from many disciplines involved in the treatment of IBD and coeliac disease, and is a useful update on recent advances in paediatric and paediatric-surgical gastroenterology. F. Hadziselimovic, B. Herzog, A. Biirgin-Wolff vii List of Principal Contributors M. BUROELSKI F. HAOZISELIMOVIC Kinderklinik Department of Gastroenterology Medizinische Hochschule Hannover Basler Kinderspital Postfach 61 01 80 Rbmergasse 8 CH-4005 Basel 0-3000 Hannover 61 Switzerland FRG H. K. HARMS A. BURGIN-WOLFF Dr. V. Hauner'sches Kinderspital Basler Kinderspital Lindwurmstrasse 4 Rbmergasse 8 0-8000 Munich 2 CH-4005 Basel FRG Switzerland A. H. CO LOONY W. T. J. HEKKENS Department of Physiology Harvard Medical School Faculty of Medicine Division of Urology The Children's Hospital University of Leiden 300 Longwood Avenue Wassenaarseweg 62 Boston, MA 02115 PO Box 9604 NL-2300 RC Leiden USA The Netherlands C. P. FLIEGEL Department of Radiology B. HERZOG Basler Kinderspital Pediatric Surgery Rbmergasse 8 Basler Kinderspital CH-4005 Basel Rbmergasse 8 Switzerland CH-4005 Basel Switzerland J. -O. GEBBERS Institute of Pathology B. S. KIRSCHNER Kantonsspital Wyler Children's Hospital CH-6000 Luzern 16 5825 S. Maryland Avenue Switzerland Chicago, IL 60637 USA A. M. GRIFFITHS Division of Gastroenterology M. L.