New diagnostic and treatment modalities involving endoscopic retrograde cholangiopancreatography and esophagogastroduodenoscopy.

Within the past several years, there has been dramatic advances in diagnostic and therapeutic modalities involving EGD and ERCP. Endoscopic sclerotherapy of esophageal varices is effective in controlling acute variceal bleeding in approximately 90% of the patients. Once bleeding is controlled, sclerotherapy may be a useful, long term treatment to prevent recurrent hemorrhage and to improve survival. In the treatment of patients with nonvariceal upper Gl bleeding, endoscopic electrocoagulation and laser photocoagulation does not significantly alter the operative rate or mortality rate. However, a subset of patients with either a visible vessel or angiodysplasia may benefit from endoscopic therapy of upper Gl bleeding. Another innovation, the ultrasonic endoscope has many potential applications, but instrumentation needs to be improved significantly before this diagnostic modality will be of clinical value. In the treatment of biliary tract disease, endoscopic sphincterotomy has revolutionized the therapy of patients with common bile duct stones and sphincter of Oddi disorders. Although sphincter of Oddi manometry is in its infancy, pressure measurements in the sphincter segment appear useful in identifying patients with sphincter of Oddi dysfunction who will benefit from sphincterotomy. Following endoscopic sphincterotomy, transpapillary biliary catheters, endoprosthesis and Gruntzig's balloons can be placed endoscopically into the common bile duct. These techniques are beneficial in the therapy of patients with large common bile duct stones as well as in short or long term management of patients with benign or malignant strictures of the biliary tree.