The SAGES Manual of Physiologic Evaluation of Foregut Diseases

Contents
Contributors
Part I: Understanding Anatomy and Physiology
	1: Anatomy and Physiology of the Esophagus
		Anatomy
			Topography of the Cervical, Thoracic, and Abdominal Esophageal Segments
		Physiology
			The Normal Swallowing Mechanism
			Swallowing: Oral Phase
			Swallowing: Pharyngeal Phase and Function of the Upper Esophageal Sphincter
			Swallowing: Esophageal Phase and the Lower Esophageal Sphincter
			Complex Innervation and Neuronal Control of the Esophagus and Esophageal Peristalsis
		References
	2: Anatomy and Physiology of the Stomach
		Anatomy
		Blood Supply, Lymphatics, and Innervation
			Blood Supply
			Lymphatics
			Innervation
		Physiology
		References
	3: Effect of Obesity on Foregut Physiology
		Introduction
		Esophagus
			Esophageal Dysmotility
			Integrity of the Lower Esophageal Sphincter (LES)
			Integrity of the Hiatal Crura
		Stomach
			Regulation of Appetite
			Gastric Size and Motility
		Obesity as a Risk Factor for Defined Pathologic States
			Gastroesophageal Reflux Disease (GERD)
			Barrett’s Esophagus (BE)
			Esophageal Adenocarcinoma (EAC)
		Conclusion
		References
			Further Reading
Part II: Diagnostic Testing: Diagnostic Imaging
	4: Esophagram
		Introduction
		How to Perform an Esophagram and Variations in Technique
		Diagnostic Implications
			GERD
			Mucosal Irregularities
			Hiatal Hernias
			Esophageal Diverticula
			Neoplasms
			Perforation
			Motility Disorders
		Utilization in Pre- and Post-surgical Management
		Conclusion
		References
	5: The Upper GI Series
		UGIS in Conventional Anti-Reflux Surgery
		UGIS in Conventional Bariatric Surgery
		References
	6: Timed Barium Swallow in Foregut Disease
		Case Presentation
		Introduction
		Use as a Diagnostic Tool
		Achalasia
		The Use of TBS in Non-achalasia
		TBS Uses in Evaluating Treatment Efficacy
		Conclusion
		References
	7: Role of CT Imaging in Foregut Physiology and Benign Pathology
		Introduction
		CT Technique
		Gastroesophageal Reflux Disease (GERD) and Hiatal Hernias
		CT Imaging Pre- and Post-fundoplication
		Achalasia
		CT Imaging Post-myotomy
		CT Imaging Versus UGI in the Postoperative Setting
		Conclusions
		References
	8: 3D Modeling with CT
		Introduction
		Esophageal Injuries
		Achalasia
		Hiatal Hernia
		Esophageal Stenosis
		Esophageal Malignancy
		Esophageal Atresia
		Gastric Diseases
		Gastric Cancer
		Gastric Lymphoma
		Gastrointestinal Stromal Tumors (GISTs)
		Gastrectomy: Preoperative and Postoperative Evaluation
		References
	9: Role of the Gastric Emptying Study
		Role of a Gastric Emptying Study
		Interpretation of Results
			Normal Gastric Emptying
			Rapid Gastric Emptying
			Delayed Gastric Emptying
			Borderline Delayed Gastric Emptying
		Clinical Applications
		Conclusion
		References
	10: Endoscopic Ultrasound
		Introduction to EUS
		Application for Foregut Anatomy and Physiology
		Role of EUS in Evaluation and Diagnosis of Foregut Pathology
			Pretreatment Staging for Esophageal, Gastric, and Pancreatic Cancer
				Esophageal Cancer
				Gastric Cancer
				Pancreatic Cancer
			Evaluation and Diagnosis of Foregut Submucosal Nodules
			Evaluation of Duplication Cysts and Childhood Congenital Abnormalities of the Esophagus
			Walled-Off Pancreatic Necrosis
			Evaluation and Diagnosis of the Liver
		Role of EUS in Foregut Treatment
			Treatment of Esophageal, Gastric, and Pancreatic Cancer
			Treatment of Duplications Cysts and Childhood Congenital Abnormalities of the Esophagus
			Treatment of Walled-Off Pancreatic Necrosis
		Conclusion
		References
Part III: Diagnostic Testing
	11: High-Resolution Esophageal Manometry with and without Impedance: Understanding the “Chicago Classification”
		Introduction to High-Resolution Manometry (HRM) without Impedance
			How Does HRM Work?
			How to Perform High-Resolution Esophageal Manometry?
			How Is the Study Interpreted?
				Step 1: Assess the EGJ Anatomy and Function
				Step 2: Assess Esophageal Body Function (Table 11.1) (Fig. 11.7)
				Step 3: Review Pressurization Patterns
		The Chicago Classification v3.0
		High-Resolution Manometry with Impedance (HRIM)
			Indications for HRIM
			Technique
			HRIM Interpretation
		High-Resolution Manometry: Esophageal Disorders Not Addressed by the “Chicago Classification”
		Provocative Tests
		Updates with Chicago Classification v4.0
			Motility Disorders
		Conclusions
		References
	12: Impedance Planimetry: EndoFLIP
		Background
		Definition
			Achalasia and Motility Disorders
			GERD
			Gastroparesis
		Summary
		References
	13: Catheter-Based pH Testing
		Introduction
		Defining GERD
		Catheter-Based pH Testing Device
		Technique
		Indications
		Interpretations
		Conclusion
		References
	14: Wireless pH Testing
		A Brief History of pH Monitoring
		Catheter-Based pH Monitoring
		Wireless pH Monitoring
		Wireless Versus Catheter-Based pH Monitoring
		Conclusion
		References
	15: Proximal pH Testing for Laryngopharyngeal Reflux
		Laryngopharyngeal Reflux
		Oropharyngeal pH Monitoring
		Pepsin
		Multichannel Intraluminal Impedance (MII): pH Testing
		Conclusion
		References
	16: Endoscopic Evaluation of the Bariatric Surgery Patient
		Introduction
		Periprocedural Recommendations
		Technical Considerations
		Sedation
		Procedural Technique
		Timing of Endoscopy Evaluation in the Bariatric Patient
			The Preoperative Period
			The Intraoperative Period
			The Postoperative Period
				GERD
				Adjustable Gastric Band (AGB) Slippage and Erosion
				Marginal Ulcers
				Gastric Leak and Fistulae
				Anastomotic Strictures
				Foreign Body and Bezoars
				Anemia and GI Bleed
				Endoscopic Retrograde Cholangiopancreatography (ERCP) After RYGB
		Conclusion
		Editors’ Note
		References
Part IV: Foregut Motility Disorders
	17: Achalasia
		Case Presentation
		Introduction
		Pathophysiology
		Clinical Presentation
		Diagnostic Workup
		Chicago Classification
		Treatment
		Editors’ Note
		References
	18: Minor Disorders of Esophageal Motility
		Ineffective Esophageal Motility
			Patient Scenarios
		Fragmented Peristalsis
			Patient Scenario
		Editors’ Note
			IEM
		References
	19: Distal Esophageal Spasm
		Introduction
		Symptoms and Diagnosis
		Treatment
		Conclusion
		References
	20: Jackhammer Esophagus
		Introduction
		Epidemiology
		Pathophysiology
		Clinical Features
			Symptoms
			Imaging/Tests
		Differential Diagnosis
		Diagnosis
			Evaluation
			Diagnostic Criteria
		Management
			Initial Management
			Persistent Disease
		Editors’ Note
		References
	21: Secondary Esophageal Motility Disorders: Diagnosis and Management
		Introduction
		Summary
		References
	22: Esophagogastric Junction Outflow Obstruction
		Case Scenario
		Introduction
		Etiology
		Clinical Presentation
		Diagnosis
		Management
		Treatment
		Conclusion
		Further Reading
	23: Gastric Outlet Obstruction
		Introduction
		Diagnostic Workup
			History
			Physical Examination
			Laboratory Values
			Imaging
		Endoscopic Evaluation
			Preparation
			Technique
		Management
			Initial Management
			Medical Management
		Management by Etiology
		Benign Disease
		Endoscopic Dilation
		Endoscopic Steroid Injection
		Self-Expanding Metal Stents
		Surgical Management
		Malignant Disease
		Self-Expanding Metal Stents
		Surgical Bypass
		Special Considerations
			Esophagogastric Junction Outflow Obstruction
			Bariatric Surgery Complications
			Roux-En-Y Gastric Bypass
			Sleeve Gastrectomy
			Gastric Banding
		References
	24: Gastroparesis
		Introduction
		Epidemiology and Etiology
		Clinical Presentation
		Diagnosis
		Clinical Evaluation and Diagnostic Modalities
		Treatment
		Conclusion
		References
	25: Dumping Syndrome
		Introduction
		Pathophysiology
		Epidemiology and Etiology
		Clinical Presentation
		Diagnosis
		Clinical Evaluation and Diagnostic Modalities
		Treatment
		References
	26: Normal Physiology Findings After Hiatal Hernia Repair and Fundoplication
		Introduction
		Upper GI/Esophagram
		Computed Tomography
		Manometry and Motility
		pH Testing
		Endoscopy
		Gastric Emptying
		EndoFLIP
		Discussion
		Editors’ Note
			Reflux/Dysphagia After a Sleeve
			Dysphagia or Cough After Sleeve
		References
	27: K. Normal Foregut Function After Bariatric Surgery
		Introduction
		The Lower Esophageal Sphincter and Esophageal Function in Patients with Obesity
		Normal Physiologic Findings After Bariatric Surgery
			Adjustable Gastric Banding
			Sleeve Gastrectomy
			Roux-En-Y Gastric Bypass
			Duodenal Switch and Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy
		Abnormal Physiologic Findings After Bariatric Surgery
		Conclusion
		Editors’ Note
			Reflux/Dysphagia After a Sleeve Gastrectomy
			Dysphagia or Cough After Sleeve
		References
	28: Normal Physiologic Findings After Esophageal Myotomy
		Introduction
		Normal Physiologic Findings in Diagnostic Tests Post-Myotomy
			Radiological Findings after Myotomy
			Manometric Findings Post-Myotomy
			Esophageal pH Study and Endoscopic Findings Post-Myotomy
		References
Part V: Pathology/Symptom Based
	29: Barrett’s Esophagus: A Review of Current Literature
		Introduction
		History
		Epidemiology/Demographics
		Risk Factors
		Pathogenesis
		Dysplasia
		Diagnosis
		Surveillance
		Medical Treatment
		Endoscopic Management
			Radiofrequency Ablation
			Endoscopic Mucosal Resection
			Phototherapy
			Cryotherapy
			Surgical Management
		References
	30: Diagnostic Tests for Gastroesophageal Reflux Disease
		Introduction
		Evaluation
		Barium Esophagram
		Esophagogastroduodenoscopy (EGD)
		Esophageal Manometry
		pH Monitoring
		Summary
		References
	31: Laryngopharyngeal Reflux
		Introduction
		Epidemiology
		Pathophysiology
		Diagnosis
		Treatment
		Conclusion
		References
	32: Esophagitis
		Introduction
			Endoscopic Features and Classification of Esophagitis
			The Histopathology of Esophagitis
		References
	33: Eosinophilic Esophagitis
		Pathophysiology and Epidemiology
		Presentation
		Diagnosis
		Treatment
		Follow-up
		Conclusion
		References
	34: Paraesophageal Hernias
		Introduction
			Definition, Incidence, Prevalence, and Risk Factors
			Etiology
		Presentation and Evaluation
			Presentation
			Evaluation
				Radiography
				Endoscopy
				Manometry and pH Monitoring
		Treatment
			Indications for Surgery
			Surgical Technique
			Post-Operative Care
			Robot Vs Laparoscopy
			Mesh
			Antireflux Procedure
			Gastropexy
			Short Esophagus
			Outcomes
			Complications
		Conclusion
		Editors’ Note
		References
	35: Primary Dysphagia: A Case-Based Approach to Diagnosis and Treatment
		Case 1
		Case 2
		Case 3
		References
	36: Persistent Dysphagia After Prior Anti-Reflux Procedure
		Introduction
		Surgical Fundoplication
			Barium Esophagography
			Endoscopy
			Esophageal Manometry
				Esophagogastric Junction Parameters
				Esophageal Body Contraction Parameters/Peristalsis
				Manometry Summary
			Functional Luminal Imaging Probe (FLIP)
		Magnetic Sphincter Augmentation (MSA)
			Barium Esophagography
			Endoscopy
			Manometry
		Editors Note
		References
	37: Persistent Dysphagia After Esophageal Myotomy
		Introduction
		Potential Etiologies of Persistent/Recurrent Dysphagia
		Evaluation of Persistent/Recurrent Dysphagia
		Management Algorithm for Persistent/Recurrent Achalasia
		Operative Approach to Redo Laparoscopic Heller Myotomy
		Outcomes of Intervention for Recurrent/Persistent Dysphagia
		Summary
		References
	38: Recurrent Reflux After Prior Fundoplication
		Introduction
		Diagnostic Work-Up
			EGD
			Barium Esophagram
			Ambulatory pH Monitoring
			High-Resolution Manometry (HRM)
		Management
		Summary
		References
	39: Reflux After Myotomy
		Reflux After Myotomy
		Reflux After Surgical Myotomy
		Choice of Antireflux Procedure (ARP)
		Predictors of Reflux After Heller’s Myotomy
		Reflux After POEM
		Predictors of Reflux After POEM
		References
	40: GERD After Duodenal Switch
		Introduction
		Biliopancreatic Diversion and Duodenal Switch
		Preoperative GERD Workup and Considerations
		GERD Outcomes
		Conclusions
		References
	41: Sleeve Gastrectomy and Gastroesophageal Reflux Disease
		References
	42: Reflux After Gastric Bypass: Roux en-Y and One-Anastomosis Gastric Bypass
		Roux en-Y Gastric Bypass (RYGB)
			Hiatal Hernia
			Marginal Ulcers
			Gastro-Jejunal Stenosis
			Gastro-Gastric Fistula
			Enlarged Pouch
			Candy Cane Syndrome
			Bile Reflux
			Motility Disorders
			Others
		One Anastomosis Gastric Bypass or Mini-Gastric Bypass
			Bile Reflux
			Mechanical Complications
		Editor Note
		References
	43: Pediatric and Adolescent Foregut Motility
		Gross Development of the Foregut
		Challenges Unique to the Pediatric Population
		Approach to the Pediatric Patient with Suspected Motility Disorder, Diagnostic Imaging, and Interventional Studies
			Diagnostic Imaging
			Esophago-Gastro-Duodenoscopy (EGD)
			Gastrointestinal Manometry
			High Resolution Esophageal Manometry (HREM)
			Combined Esophageal pH/Impedance Monitoring
			Antro-duodenal Manometry
			Wireless Motility Capsule (WMC)
		Specific Foregut Motility Disorders in Children
			Esophageal Atresia
			Achalasia
			Eosinophilic Esophagitis
			Gastroesophageal Reflux Disease (GERD)
			Fundoplication and Gastrostomy Feeding Buttons
		Future Advances
		References
Index