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ERCP and its Applications

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ERCP and its Applications. Edited by Jacobson IM. (Pp 288; illustrated; $110.00.) Philadelphia: Lippincott-Raven Publishers, 1997. ISBN 0-397-51664-9.

In 1998 at least three new books entirely devoted to ERCP were published, and this is the most comprehensive of them. It is a multi-author textbook from the United States and in fact from the Eastern part of that country with only one author hailing from Canada and one group from Amsterdam. British readers will recognise a few well known exiles, however. The book is largely a very practical and up to date (many chapters contain references from 1997) review of ERCP in all or nearly all of its manifestations at the end of the 20th Century. The book is accompanied by x ray films, colour plates and line drawings which are adequate in number and well labelled but I was disappointed in the quality of many of thex ray images compared with similar publications. In addition, three of the first four colour plates have a problem with legend or orientation, the latter being a notorious problem with ERCP articles. In the chapter on interventional radiology arrows referred to in the text were missing from the pictures. Moving on to the text, that chapter was very uncontroversial with helpful data, especially on intrahepatic duct anomalies and failed to give the impression sometimes left by such chapters that interventional radiologists and endoscopists live in parallel but unconnected universes.

There are one or two clear transatlantic biases such as the assertion that prolonged patency of metal stents outweighs their additional high cost as further procedures are reduced. This may be true in North America where staff and procedure costs are high but may not be the case in other countries. One chapter which covers the topic of ERCP in patients undergoing cholecystectomy, written by the editor, offers a full, in fact somewhat overfull, discussion of this admittedly contentious area but the English style is curious in that the last noun before the verb always seems to be the one that agrees, rather than the subject of the sentence. As in “alternative imaging techniques that might substitute for ERCP is reviewed”. This idiosyncrasy, also found in other parts of the book, leads to a lot of re-reading which detracts from the otherwise excellent treatment of the subject. The US-centric approach is also apparent, however, when the causes of acute cholangitis ignore hydatid, ascaris, clonorchis, opisthorchis or fasciola.

There is an excellent critical analysis of sphincter of Oddi dysfunction and strictures from Rai and Kalloo from Johns Hopkins, while my admiration for Dutch patients, already considerable, was increased by the statement that balloon dilatation in the bile duct “can be uncomfortable”. This is not quite the word I would choose. A chapter on pseudocyst drainage by Drs Parsons and Howell from Chicago and Portland, Maine, respectively, was excellent and very practical. They did not use the latest needle with which needle knife diathermy and the consequent risks of bleeding are avoided but there was a good balanced review of the literature. Incidentally, in the techniques of stone extraction it was suggested that one technique for applying traction was “torquing” with the up down lever. This is not, to this reviewer’s mind, torquing, which is the technique of applying a clockwise twist to the endoscope shaft, and advancing the scope which becomes moderately rigid by virtue of the wires torqued within it. It is also suggested that a “through the scope” lithotripter cannot be used if a standard basket is impacted with a stone. I assure the authors that this is not the case.

These minor irritations/amusements aside, the book is an excellent read, a good source of references and with some excellent illustrations. I can recommend it to any gastroenterologist who spends a significant amount of time performing this challenging and absorbing technique.

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