Biliary endoscopy.

Highlighting this year was the National Institutes of Health (NIH) State-of-the-Science Conference on endoscopic retrograde cholangiopancreatography. The panel addressed controversies in biliary endoscopy and set the framework for future funding for clinical research endeavors. With respect to biliary endoscopy, the literature addressed therapy for malignant biliary obstruction, choledocholithiasis, and biliary complications post-liver transplant.

Clinical impact of endoscopic ultrasonography on the management of malignancies.

Background & Aims: There are limited data evaluating the clinical impact of endoscopic ultrasonography (EUS). We assessed the impact of EUS on management of known or suspected malignancies.

Methods: Physicians requesting EUS were contacted before the examination and asked: "How would you manage this patient if EUS were not available?" Pre-EUS responses were recorded on standardized forms, and compared with management recommendations as determined by the same requesting physician after EUS.

Initial evaluation of a duodenoscope modified to allow guidewire fixation during ERCP.

Background: Catheter/guidewire exchanges during ERCP require the coordinated efforts of an endoscopist and endoscopy assistant. A prototype duodenoscope was developed to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever.

Methods: An initial prototype duodenoscope and a subsequent modification of this instrument were used to perform ERCP in 7 and 10 patients, respectively.