Overview

The patient on the table is bleeding, the guidewire keeps slipping into the pancreatic duct, and the next decision determines whether they leave with cleared stones or post-ERCP pancreatitis. Apply yesterday's reflexes to today's complexity and you get the perforation closed three hours late, the stricture left undilated, the dysplasia missed at withdrawal, the leak that becomes a sepsis admission. This handbook delivers point-of-care procedural reasoning across luminal, pancreaticobiliary, and interventional endoscopy - what to do, when to do it, and what to do when it does not work. Inside this book: - Wire-guided cannulation under pressure - execute the double-wire technique, deploy a prophylactic pancreatic stent, and avoid the precut you do not actually need - Forrest classification with intent - stratify ulcer bleeding by stigmata, deploy combination therapy, and time the second-look that prevents the rebleed - Optical diagnosis at the polyp - apply NICE and JNET in real time to choose cold-snare, hot-snare, EMR, or referral for ESD before the snare even opens - Step-up therapy for walled-off necrosis - deploy a lumen-apposing metal stent, sequence necrosectomy sessions, and avoid the open surgery - POEM technique end-to-end - execute mucosotomy, submucosal tunnel, selective myotomy, and closure across all three Chicago Classification subtypes of achalasia - Cholangioscopy for indeterminate strictures - direct visualization, targeted SpyBite biopsy, and the management decision the brushings could not deliver - Perforation closure under pressure - choose between TTSC, OTSC, suturing, or stent across the GI tract before peritonitis develops - EUS-guided biliary drainage - perform choledochoduodenostomy or hepaticogastrostomy when ERCP has failed and percutaneous drainage is the wrong answer For gastroenterologists, advanced endoscopists, hepatobiliary surgeons, fellows in advanced endoscopy training, and the GI nurses and technologists who staff the procedure room. Open the book, sharpen the procedural reasoning, and bring it to the next case.

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