Volume 3 Issue 1, January 2006

This Viewpoint discusses the role of combined multichannel intraluminal impedance-pH testing in the evaluation of patients with GERD symptoms that are refractory to proton-pump-inhibitor therapy. The relationship between symptoms and reflux is important as symptoms might not be due to continuing reflux, and these patients therefore might not benefit from surgery.

Bleeding from gastric varices is a life-threatening event that presents a therapeutic challenge for clinicians. This Viewpoint discusses the advance in nonsurgical treatment of gastric fundal varices, including the new radiologic technique of balloon-occluded retrograde transvenous obliteration.

In the past 20 years the management of peptic ulcer bleeding has been revolutionized by effective endoscopic hemostasis and potent acid-suppressing agents. The author of this Review considers the roles that risk stratification, pharmacologic therapy, endoscopic therapy and surgery now have to play in the management of this common and potentially fatal condition.

This Review discusses cholangiocarcinoma, the incidence of which is increasing globally. There are several established risk factors for cholangiocarcinoma, and others are now being recognized. Diagnosis requires the integration of clinical information, imaging studies, tumor markers and histology. Surgery can be curative, but most patients have unresectable disease, in which case palliation can improve quality of life and might also improve survival.

Optimal management of anticoagulant and antiplatelet agents during the periendoscopic period requires consideration, but limited prospective data mean that guidelines have largely relied on expert opinion. This Review summarizes the ASGE guidelines, details the relevant literature on which they are based, considers literature that has become available since their publication, and provides a framework for the management of periendoscopic anticoagulation.