Novel Developments in ERCP and EUS

This thesis focuses on the diagnostic and therapeutic role of endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic ultrasonography (EUS) in benign and malignant pancreaticobiliary disease. Since the first practical applications of ERCP and EUS were developed in the first half of the nineteen-seventies and nineteen-eighties, respectively, both techniques have evolved in concurrence with the general trend in endoscopy from being merely diagnostic tools to full-fledged therapeutic procedures during which complex diseases can be treated and invasive surgical procedures can be avoided. In a way the pancreas and, to a lesser extent, the biliary system are orphan organs. Due to their relative inaccessibility both for physicians and surgeons and the poor prognosis of malignant pancreaticobiliary disease, the quantity and quality of research in this field traditionally has not been up to par compared with standards in some other areas of research in the medical field. Fortunately times have changed and the pancreas, bile ducts and its associated diseases are now one of the most actively researched topics in basic, translational and clinical research. The aim of this thesis is to investigate the role of EUS in the diagnosis of benign, premalignant and malignant pancreatic disease, to evaluate a novel method of tissue acquisition through EUS and summarize the latest developments of therapeutic endosonography. Furthermore the role of the endoscopic treatment of chronic pancreatitis and benign biliary strictures are evaluated.