This text provides a comprehensive review of the ethical issues involved with the development, evaluation, and introduction of new treatments of gastrointestinal diseases. How several landmark surgical innovations were developed are described to show the challenges faced, and the ethical dilemmas these innovators dealt with. The challenges of dealing with regulatory issues, and how to work with industry partners, and investors when working on a new therapy is described. Once a new technology has been brought to the market, standards need to be developed regarding the training, credentialing and adoption of the new technology. There are insufficient standards of how to balance the desire to provide patients the latest therapy with the obligation that patients receive informed consent about the new technology, and the relationship that the physician may have had with product development. The book describes the national perspective of paying for new technology, and provides one insurance company's approach to the introduction of innovative therapy. The Sages Manual Ethics of Surgical Innovation will be a resource for surgeons, researchers and health policy personnel to understand the ethical issues related to the development, introduction and adoption of innovative therapies for gastrointestinal diseases. Although the context for discussion is the application of innovation to gastrointestinal disease, the ethical issues are applicable to any discussion of innovative medical or procedural therapies.

Gastrointestinal bleeding is an age-old problem. The original description of g- trointestinalbleedingmayhavebeenfromGalenandhisworkconnectingdyspepsia andmelanoticstool. Thechangesinourmanagementofgastrointestinalbleeding overthecenturieshavebeendrivenbynaturalalterationsinthespectrumofdiseases, expanding our understanding of these diseases and the never ending advances in technologyandpharmacologythathaveoccurredrelativetoGIdiseases. Academic interestingastrointestinalbleedingpeakedinthelasthalfofthetwentiethcentury withtheexpandingroleofsurgery,thediscoveryofacid-basedpepticulcerthe- pies,andtheriseof?exibleendoscopyandculminatedinthedescriptionofh. pylori as a causative agent for ulcer disease. More recently there has been a decrease incidenceinbleedingdiseasesofthegutandthereforeadecreasinginterestinthe scholarlywritingaboutthesediseases. Therehasnotbeenamajortextbookwritten aboutgutbleedinginover10yearsandthereforetheintentionofthistextbookisto ?llthatvoidbyprovidingareviewofacomprehensiveapproachtouppergut,mid, andlowergutbleeding. CliniciansatDukeUniversitywhohaveacommoninterestinthegastrointes- naltracthavecollaboratedintheconstructionofthistext. Thisefforthasbrought together surgeons, gastroenterologists, and radiologists, to carefully chronicle the presentation, diagnosis, and management of modern day causes of gastrointes- nal bleeding. These co-authors concentrate on some of the latest innovations in the endoluminal and minimally invasive techniques that characterize the current approaches to these diseases. Emphasis has been placed on capsule endoscopy, double-balloon endoscopy, laparoscopic peptic ulcer surgery, and angiographic diagnosis and management techniques. The text has been written in such a way thatthereadercanquicklyreviewaspeci?ccauseofGIbleedingpriortomanaging ofsuchapatient. Weexpectthistextwillbeusedwiththesameimmediacyasthe diseasespresent. Wehopethatthistextprovidesafoundationforlearningformedicalstudents, interns,residents,andpractitionerswhoencounterthesecriticallyillanddif?cultto managepatients. Durham,NC,USA AuroraD. Pryor Durham,NC,USA TheodoreN. Pappas Durham,NC,USA MalcolmStanleyBranch v Acknowledgment TheeditorswouldliketothankMs. VirginiaCashforherhelpinthepreparation andcoordinationofthetext. vii Contents Part I Upper GI Bleeding Stabilization of Patients Presenting with Upper Gastrointestinal Bleeding. ..3 ErrolL. BushandMarkL. Shapiro Urgent Workup for Upper Gastrointestinal Bleeding...13 LorettaErhunmwunseeandSandhyaA. Lagoo-Deenadayalan Management of Esophageal Variceal Bleeding ...23 KekiBalsaraandLisaPickett Management of Dieulafoy's Lesions ...31 SerainaK. Faes,BrianR. Untch,ClaireEdwards,JohnTurner, MartinPoleski,andDouglasS. Tyler Management of Bleeding Peptic Ulcer Disease ...39 JamesC. PadussisandTheodoreN. Pappas Management of Unusual Sources of Upper GI Bleeding...65 ElisabethTracyandJanetTuttle-Newhall Mallory-Weiss Syndrome...79 JacobN. SchroderandMalcolmS. Branch Management of Bleeding Small Bowel Tumors...85 KeriE. LunsfordandAuroraD. Pryor Management of Bleeding from the Bile Duct ...103 CarlosE. MarroquinandBridgetM. Marroquin Management of Bleeding from the Pancreas...

The diagnosis and management of gastrointestinal bleeding is multidisciplinary by nature involving surgeons, gastroenterologist and radiologists. Due to various pathologies, it involves upper gut, lower gut and occult bleeding. Gastrointestinal Bleeding: A Practical Approach to Diagnosis and Management covers all aspects of bleeding in a systemic approach organized by the site of bleeding. Elective and emergent bleeding is also covered. This volume provides a practical text for the practitioner in addressing patient issues in their practice, with a step by step approach through appropriate diagnosis and management strategies including surgical, endoscopic, medical and angiographic techniques, making this a truly multidisciplinary and disease based text.. Specific sections in the book are crafted by experts in each topic.

Gastrointestinal Bleeding: A Practical Approach to Diagnosis and Management provides a ready reference that will help physicians understand and work through diagnostic and therapeutic dilemmas and will be of great value to full range of practitioners that manage patients with bleeding including surgeons, gastroenterologist and radiologists as well as residents and fellows in these subspecialties.

This atlas is composed of 31 chapters with authoritative commentaries and illustrations in a number of surgical procedures amenable to laparoscopic techniques. The Atlas is a tool that will simplify and organize surgical thought for the advanced laparoscopist.