PRACTICAL GASTROENTEROLOGY • JULY 201142

Pediatric Practice Gastroenterology (1st Edition, September 2010)Editor Warren Bishop, MD/McGraw Hill Publishing ISBN-10: 0071633790/ISBN-13: 978-0071633796Hardcover (472 pages): $90/Kindle Edition: $72My first impression of Pediatric Practice Gastroen-terology was how lightweight and colorful it was. Infact, the best part of this book is the layout and for-matting. The chapters are compact (average chapterranges between 15–20 pages) and easy-to-read. Thereare plenty of boxed charts with lists, flow diagrams,color illustrations, and images. These figures break upthe text and reinforce key points. The book is arrangedinto sections: Symptoms and Assessment, DiagnosticTechniques, Disorders of the Stomach and Intestine,Disorders of the Liver, and Disorders of the Pancreas.The target audience is for clinicians—general pedi-atrics, family medicine and pediatric GI. It provides anexcellent overview of most GI diseases in pediatrics,with current therapies and treatments. There is anemphasis on algorithms and practice guidelines,although these tend to be very simple. While the chap-ters are fairly encompassing, there is not enough depthfor this to be a full resource. Some of the topics areadequately served with one chapter (i.e., surgical dis-eases, motility, or pH and impedance monitoring), andothers are only presented in broad strokes. For exam-ple, a huge topic like inflammatory bowel disease isreviewed in the same amount of space.

This book serves as a solid basic clinical text andshould be on all first-year pediatric GI fellows’required reading. There is plenty of good, practicalinformation in an attractive format. Highlighting note-worthy chapters include: “Gastroesophageal RefluxDisease” (B. Gold) with its key concepts and conclu-sions clearly outlined and detailed explanations (but329 references!). Also, “Biliary Atresia” (M. Leyva-Vega and B. Haber) covers the topic in a thorough yetsuccinct manner, starting with definitions and epi-demiology, pathogenesis, clinical presentation, hugedifferential diagnosis, diagnosis algorithm, treatment,and prognosis. The authors utilize clear anatomic

drawings, photos of infant stool color cards and give atiered approach to the evaluation of an infant with con-jugated hyperbilirubinemia.

When I left the book out in our multi-use confer-ence room, more than one person commented theywould like to purchase the book themselves. It willprobably become a staple pediatric GI textbook. Allpediatric GI offices should have at least one copy.

Pros: • Lots of images (radiographs, histology) in the hard-

cover edition (cannot say what the Kindle editionlooks like)

• Color photos, generous tables and charts, easy-to-read, concise

• References at end of each chapter

Cons: • Not enough depth for experienced pediatric GIs• No case presentations or clinical questions (for a

clinically-focused text)

Who would I recommend this for? • Pediatric providers (physicians, nurse practitioners,

PAs, GI nurses)• First-year GI fellows• Pediatric residents, medical students interested in GI

Kathy D. Chen, M.D.Assistant Professor of Pediatrics

Drexel University College of MedicineSt. Christopher’s Hospital for Children

Philadelphia, PA

Endoscopic UltrasoundShami and Kahaleh, eds.Humana Press, 2010ISBN 978-1-60327-479-1; $ 219Endoscopic Ultrasound edited by Dr s. Vanessa Shamiand Michel Kahaleh from the University of Virginia isa hard-cover book that aims to offer a comprehensive,updated review of the instrumentation, technique, andfuture of endoscopic ultrasound. This book is a usefulreference for both gastroenterologists in their earlyyears of EUS training and for those in practice who

BOOK REVIEWS

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BOOK REVIEWS

desire an updated resource to enhance their skills inEUS application. Endoscopic Ultrasound is toolengthy and dense for the general gastroenterologist,general GI fellows-in-training, or EUS nurses who areinterested in a cursory view of the technology.

The editor’s compilation of contributors should beapplauded. The 42 authors are prominent endosonog-raphers internationally, have been successful at estab-lishing high-volume EUS programs for performanceand training, and are well-published in their field ofexpertise. The book is logically divided into 4 sec-tions: EUS for Starters, EUS by Location, Interven-tional EUS, and Innovations in EUS.

EUS for Starters includes a handy description ofultrasound imaging basics such as the crystals piezo-electric effect. It includes comprehensive tables withthe available consoles and echoendoscopes and a practical description of how to perform an exam usingthe radial and linear instruments. The chapter on endoscopic pitfalls is particularly attractive for thebeginner endosonographer as it provides convenientadvice with simple solutions of commonly encoun-tered EUS problems. Lacking are directions on how tomaximize and improve imaging quality using zoom,magnification, and power-flow that would be helpfulfor the early-stage endosonographer. Cytopathology ofEUS-guided FNA is a worthy contribution discussingprinciples of slide/cell block preparation techniquesand cytological features of diseases frequently encoun-tered in EUS.

EUS by Location contains well-written chapters,such as EUS in mediastinal lesions, cystic lesions ofthe pancreas, esophageal and gastric cancer, rectal can-cer and incontinence. The chapters are comprehensiveand extensively referenced, and they contain practicalinformation (such as changes in most recent 2010TNM classification of gastric, ampullary, and rectalcancer) and the latest evidence on limitations of EUSin specific clinical situations. A weakness of the sec-tion is the omission of the role of EUS in suspectedchronic pancreatitis, a common EUS indication in aca-demic centers.

Interventional EUS is summarizes newer applica-tions of EUS such as EUS–guided cholangiopancre-atography, drainage of pancreatic fluid collections, andceliac plexus block in a concise manner. The strengths

of Innovations in EUS include fine-needle injectiontherapy discussing injectables, implantables, andenergy delivery devices and endosurgical applications.Future research in these techniques will define theirtrue efficacy.

Overall, this book successfully combines basicinformation as well as updated evidence on the practi-cal applicability and future directions of endoscopicultrasound. It would be a nice companion to Hawes/Fockens book and DVD, Endosonography 2nd Edi-tion, 2009. Endoscopic Ultrasound is well-written,organized and easy to read. It is a valuable addition tothe library of the beginner endosonographer and tophysicians who perform EUS as part of their generalgastroenterology practice.

Letitia Luz, M.D. (EUS Fellow)Lee McHenry, M.D.

Professor of MedicineDivision of Gastroenterology

Indiana UniversityIndianapolis, Indiana

John Pohl, M.D., Book Editor, is on the Editorial Boardof Practical Gastroenterology.

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PPRRAACCTTIICCAALL GGAASSTTRROOEENNTTEERROOLLOOGGYY

R E P R I N T SR E P R I N T S

Practical Gastroenterology reprints are valuable,

authoritative, and informative. Special rates

are available for quantities of 100 or more.

For further details on rates or to place an order: visit our website at:

www.practicalgastro.com

PRACTICAL GASTROENTEROLOGY • JULY 2011 47

MEDICAL BULLETIN BOARD

Nebraska Cultures Launches Four Dr. Shahani’s® Legacy BlendsNebraska Cultures Inc., the creator and exclusive sup-plier of Dr. Shahani’s® L. acidophilus, announcedtoday the launch Dr. Shahani’s® Legacy Blends; fournew probiotics blends called Pro-Traveler™, Healthy-Defense™, Kid-Kare™ and Digestion-Plus™. 

Dr. Shahani’s® Legacy Blends are a part ofNebraska Cultures custom blending service for bulkprobiotic customers who are looking for viable, strongand effective strains. Nebraska Cultures formulationsare supplied in raw material form, including bulk pow-der, bulk capsules or their exclusive chewable tablets. 

“All of these blends were recommended by Dr.Shahani in his book,  Cultivate Health fromWithin,” explained Michael Shahani, director of oper-ations for Nebraska Cultures. “He was certainly aheadof his time when it came to customizing probioticblends to address certain health challenges. That’s whyit’s so fitting that these are Dr. Shahani’s® LegacyBlends.  We are excited to introduce the new blends toour clients who can share them with consumers.”

The Pro-Traveler™ Probiotic Blend combines thetwo most popular and researched strains of probioticbacteria, Lactobacillus acidophilus DDS-1 and  Bifi-dobacterium bifidum, which are particularly helpful forcombating common food-poisoning bacteria.

The  Healthy-Defense™ Probiotic Blend is for-mulated to help fight yeast, fungal and viral infections.This blend is made with 50 percent Lactobacillus aci-dophilus DDS-1, 25 percent Bifidobacterium bifidum,and 25 percent Enterococcus faecium.

The  Kid-Kare™ Probiotic Blend is designed to help replenish the strains most commonly found in healthy children and infants. The blend is 35 per-cent  Lactobacillus acidophilus DDS-1, 35 percent Bifidobacterium bifidum, 15 percent Bifidobacteriumlongum, and 15 percent Bifidobacterium infantis.

The  Digestion-Plus™ Probiotic Blend isdesigned to support a healthy colon by replenishinghealthy bacteria, improving digestion and acidifyingthe colon. It is made with 40 percent Lactobacillus aci-dophilus DDS-1, 30 percent Lactobacillus salivarius,and 30 percent Bifidobacterium bifidum.

About Nebraska CulturesSince 1981, Nebraska Cultures has supplied the nat-ural products industry with the finest probiotic cul-tures—the Dr. Shahani’s® brand—specializing in theDDS-1 strain of Lactobacillus acidophilus. NebraskaCultures remains at the forefront of the probioticindustry by performing new research, increasing con-sumer awareness, growing its business overseas andexpanding into functional foods.

As one of the most influential probiotics scientiststo date, Dr. Khem Shahani began his landmarkresearch on Lactobacillus acidophilus at the Univer-sity of Nebraska in the late 1950s. There he discovereda particular strain of Lactobacillus acidophilus thatshowed superior growth, stability and nutritional via-bility. Dr. Shahani would later name the strain DDS-1for the Department of Dairy Science Number Onestrain and spend the rest of his career unlocking itspotentials for improving overall health.

For more information about the DDS-1 strainof  Lactobacillus acidophilus or Nebraska Cultures,please visit:www.nebraskacultures.com or call toll free1-877-377-4242.

PRACTICAL GASTROENTEROLOGY • JULY 201148

MEDICAL BULLETIN BOARD

Boston Scientific Begins U.S. and International Launch of Expect™ Endoscopic Ultrasound Aspiration NeedleInnovative Fine Needle Aspiration technologyexpands diagnostic capabilities in pancreas and gastrointestinal tractBoston Scientific Corporation today announced the U.S.and international launch of its Expect™ EndoscopicUltrasound Aspiration Needle, used for acquiring tissuesamples for diagnosing and staging malignancies inorgans adjacent to the gastrointestinal tract.  The ExpectNeedle received FDA clearance and CE Mark approvalearlier this year and is being marketed in the U.S.,Europe and other international markets.

Endoscopic ultrasound (EUS) is a non-surgical,less-invasive procedure that uses high-frequency soundwaves to produce detailed images of the gastrointesti-nal tract and adjacent organs, including the pancreas,liver, bile duct and mediastinal space. To complementEUS, Fine Needle Aspiration (FNA) is often used tocollect cytology samples for cancer diagnosis.  Datahave shown that EUS is associated with improved sur-vival rates for pancreatic cancer patients due to moreinformed, stage-appropriate disease management (1).

“Combining EUS with FNA offers powerful diag-nostic capabilities that can help optimize malignancymanagement in the GI tract and inform appropriatetreatment paths for the patient, including surgery,chemotherapy, radiation or palliation,” said Robert H.Hawes, M.D., Professor of Medicine, Division of Gas-troenterology and Hepatology, at the Medical Univer-sity of South Carolina in Charleston.  “The excellentvisibility, sharpness and durability of the Expect Nee-dle help obtain high-quality diagnostic samples easilyand efficiently.”

The Expect Needle features an echogenic patternproviding excellent visibility and precise needle guid-ance within the targeted organ or structure.  The cobaltchromium design is engineered to offer improvedsharpness and pushability, along with deformationresistance, compared to traditional stainless steel nee-dles. As a result, physicians may be able to more eas-ily and accurately obtain a tissue sample whilemaintaining excellent visibility during the procedure.

“The quality of tissue samples is critical to accu-rately assessing malignancies, which in turn impact

treatment algorithms,” said Shyam Varadarajulu,M.D., Director of Endoscopy, University of Alabama,Birmingham. “The Expect Needle yields detailed,high-quality samples that enable rapid evaluation oflesions and abnormalities to determine the specificstage of malignancies.”

“The launch of the Expect Needle broadens ourEndoscopy portfolio and further strengthens our lead-ership position in pancreaticobiliary disease manage-ment,” said David Pierce, President of BostonScientific’s Endoscopy Division.  “Providing physi-cians with an innovative, durable aspiration needle forEUS-FNA procedures highlights our commitment todelivering a full suite of advanced technologies todiagnose gastrointestinal diseases and help improvepatient care.”

About Boston ScientificBoston Scientific is a worldwide developer, manufac-turer and marketer of medical devices whose productsare used in a broad range of interventional medicalspecialties. For more information, please visit:www.bostonscientific.com.  

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PRACTICAL GASTROENTEROLOGY • JULY 201150

Cautionary Statement Regarding Forward-Looking StatementsThis press release contains forward-looking statementswithin the meaning of Section 27A of the SecuritiesAct of 1933 and Section 21E of the SecuritiesExchange Act of 1934. Forward-looking statementsmay be identified by words like “anticipate,” “expect,”“project,” “believe,” “plan,” “estimate,” “intend” andsimilar words. These forward-looking statements arebased on our beliefs, assumptions and estimates usinginformation available to us at the time and are notintended to be guarantees of future events or perfor-mance. These forward-looking statements include,among other things, statements regarding our businessplans, the pancreaticobiliary disease management mar-ket and our share of that market, new product launchesand launch cadence, regulatory approvals, clinical tri-als, studies, product performance and competitiveofferings. If our underlying assumptions turn out to beincorrect, or if certain risks or uncertainties material-ize, actual results could vary materially from theexpectations and projections expressed or implied byour forward-looking statements.  These factors, insome cases, have affected and in the future (togetherwith other factors) could affect our ability to imple-ment our business strategy and may cause actualresults to differ materially from those contemplated bythe statements expressed in this press release.   As aresult, readers are cautioned not to place unduereliance on any of our forward-looking statements.  

Factors that may cause such differences include,among other things: future economic, competitive,reimbursement and regulatory conditions; new productintroductions; new product performance; demographictrends; intellectual property; litigation; financial mar-ket conditions; and future business decisions made byus and our competitors. All of these factors are diffi-cult or impossible to predict accurately and many ofthem are beyond our control. For a further list anddescription of these and other important risks anduncertainties that may affect our future operations, seePart I, Item 1A—Risk Factors in our most recentAnnual Report on Form 10-K filed with the Securitiesand Exchange Commission, which we may update inPart II, Item 1A—Risk Factors in Quarterly Reportson Form 10-Q we have filed or will file hereafter. We

disclaim any intention or obligation to publicly updateor revise any forward-looking statements to reflect anychange in our expectations or in events, conditions orcircumstances on which those expectations may bebased, or that may affect the likelihood that actualresults will differ from those contained in the forward-looking statements. This cautionary statement isapplicable to all forward-looking statements containedin this document.

1. Ngamruengphong, et al. EUS and survival in patients with pan-creatic cancer: a population-based study. GastrointestinalEndoscopy, 2010. 72 (1) 78-83.  

MEDICAL BULLETIN BOARD

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CALL FOR PAPERSANNOUNCING AN EXCITING

NEW DIRECTION FOR PRACTICAL GASTROENTEROLOGY

We are launching a new series on original digestive diseases research. Research can be

prospective or retrospective as well as clinical innature. Outcomes or population based research isalso welcome. Please provide a cover letter thatbriefly summarizes the important aspects of the

manuscript with recommendations for up to threereviewers who are qualified in the field as well as three reviewers who may have a conflict of

interest with your study. Please send manuscriptselectronically to Dr. Uma Sundaram, attention

Cristin Murphy (telephone: 304.293.4123) to thefollowing e-mail address: camurphy@hsc.wvu.edu