The AFS Textbook of Foregut Disease

Description

The AFS Textbook of Foregut Disease serves as a comprehensive guide of information covering the fast-evolving field of foregut disease. This textbook is designed as a partnership between gastroenterologists & gastrointestinal surgeons with an understanding that an essential component of moving forward in this field is through collaboration. This AFS textbook has been developed by the American Foregut Society, a premier society for foregut disease and all chapters are written by experts in the field. Readership is intended for gastroenterologists, GI and thoracic surgeons, gastroenterology and general surgery residents and fellows, medical students, and integrated health members that manage foregut disease. All chapters follow an organized format that contains many graphs, tables, intraoperative photographs, and illustrations of techniques. This textbook provides the most up-to-date scientific information and will be the definitive resource to guide both the diagnosis and management of foregut disease for years to come. Preface Contents Part I: Basic Considerations 1: History of AFS Part II: GERD and Eosinoplhilic Esophagitis 2: GERD Pathophysiology: The Role of the Sphincter and Crural Diaphragm Gastroesophageal Reflux Mechanisms Bibliography 3: Gastroesophageal Reflux Disorders: Diagnostic Approach Symptomatology Clinical Questionnaires Empiric Acid Suppression Trial Upper Endoscopy Ambulatory Reflux Monitoring Catheter-Based Impedance-pH Monitoring On Versus Off-Therapy Testing Wireless pH Monitoring High-Resolution Esophageal Manometry Barium Esophagram Endoscopic Functional Luminal Imaging Probe Gastric Emptying Study Bibliography 4: Medical Therapy for GERD Introduction Goals of Treatment Lifestyle and Diet Changes Diet and Weight Sleep Antacids and Alginates H2 Receptor Antagonists (H2RAs) Proton Pump Inhibitors Other Pharmacologic Options Future Medications Long-Term Management Refractory Disease Conclusions/Summary Points Bibliography 5: Phenotypes of Gastroesophageal Reflux Disease and Personalized Management Introduction Concept of Personalization in GERD Management GERD Phenotypes (Table 5.1) Erosive Esophagitis Nonerosive Reflux Disease Functional Reflux Syndromes Barrett’s Esophagus Reflux Chest Pain Syndrome Regurgitation-Dominant Reflux Disease Extra-Esophageal Syndromes Assessing GERD Phenotype (Fig. 5.1) Clinical Presentation Endoscopic Evaluation Ambulatory Reflux Monitoring Esophageal Motility and Esophageal Function Evaluation Personalized Approach to GERD Therapy (Table 5.3) Role of Acid Suppression in GERD Therapy Role of Endoscopic and Surgical Therapy Lifestyle Modifications Alternative Therapies Conclusions Bibliography 6: Laryngopharyngeal Reflux and Pulmonary Manifestations Introduction Pathophysiology Laryngopharyngeal and Pulmonary Symptoms The Challenge of Establishing the Diagnosis Ambulatory pH Monitoring Novel Biomarkers Medical Therapy of Patients with LPR Explanations for Limited Effect of Medical Treatment Surgical Therapy for LPR Results of Surgery for LPR and Pulmonary Symptoms Factor Influencing the Outcome of Surgery in Patients with LPR Explanations for Suboptimal Outcome of Surgery Other Surgical Options Conclusion Bibliography 7: The Spectrum of Eosinophilic Esophagitis Definition, Epidemiology, and Incidence/Prevalence Pathophysiology/Mechanism Diagnosis Treatment Anti-Inflammatory Treatment and Technical Considerations PPIs Swallowed Topical Steroids Diet Elimination Dupilumab Dilation and Technical Considerations Future Directions Bibliography 8: Esophageal Hypersensitivity and Functional Dyspepsia Esophageal Hypersensitivity Introduction Epidemiology Pathophysiology Peripheral Sensitization Central Sensitization Viscero-Visceral Hyperalgesia Stress and Esophageal Hypersensitivity Clinical Evaluation Functional Chest Pain Functional Heartburn and Reflux Hypersensitivity Globus Functional Dysphagia Management Functional Chest Pain Functional Heartburn Reflux Hypersensitivity Globus Functional Dysphagia Conclusion Functional Dyspepsia Introduction Epidemiology Pathophysiology Diagnosis Management Helicobacter pylori Eradication Acid Suppression Antidepressants Prokinetic Agents 5-Hydroxytryptamine (5-HT)1A Receptor Agonist Phytotherapy Psychological Therapy Dietary Modification Conclusion References 9: Endoscopic GERD Therapies Introduction Pre-Procedure Evaluation Transoral Incisionless Fundoplication TIF Mechanism of Action TIF Patient Selection TIF Technical Considerations TIF Outcomes Concomitant Laparoscopic Hernia Repair and TIF (cTIF) Emerging Applications for TIF TIF Summary Endoscopic Anti-Reflux Gastroesophageal Junction Augmentation Mechanism of Action Patient Selection Anti-Reflux Mucosectomy (ARMS) Anti-Reflux Mucosal Ablation (ARMA) and Cardia Ligation Endoscopic Anti-Reflux (CLEAR) Procedure Novel Applications of Endoscopic GEJ Augmentation GEJ Augmentation Summary Conclusion Suggested Readings Tif EGJ Augmentation 10: Understanding the Optimal Gastroesophageal Flap Valve: The Omega Flap Valve Introduction Collaboration of Gastroenterology and GI Surgery Concomitant Transoral Incisionless Fundoplication (cTIF) The Optimal Antireflux Valve Understanding the Omega Gastroesophageal Flap Valve Understanding the Outcome and Geometric Limitations of the Surgical Fundoplication Techniques Proposal of the Omega Fundoplication Conclusion References 11: Laparoscopic Fundoplication Introduction Indications and Workup Physiology of Surgical Fundoplication: How Does it Work? Brief History of Fundoplication Technique Patient’s Position Port Placement Esophageal Mobilization Cruroplasty Division of Short Gastrics Geometry of the Fundoplication Fixation Other Technical Considerations Tailoring the Fundoplication Complications Postoperative Care Outcomes: What Can we Expect? Comparison to Other Antireflux Procedures Conclusions References 12: Comprehensive Review of the Anti-Reflux Mechanism and Fundoplication Introduction Principles of the Anti-Reflux Mechanism Lower Esophageal Sphincter Gastric Sling Fibers Angle of His Gastroesophageal Flap Valve Crural Diaphragm Phrenoesophageal Ligament Mechanism of the Fundoplication Lower Esophageal Sphincter Augmentation/Fundoplication Intra-Abdominal Esophageal Length GEJ Flap Valve and Recreation of the Angle of his Crural Repair Creation of the Fundoplication Nissen Fundoplication Nissen-Rossetti Fundoplication Toupet Fundoplication Dor Fundoplication Watson Fundoplication Belsey-Mark IV Fundoplication Lind Fundoplication Transoral Incisionless Fundoplication (TIF) Fundoplication Outcomes Watson Fundoplication Dor Fundoplication Toupet Fundoplication Belsey Mark IV Fundoplication Lind Fundoplication Transoral Incisionless Fundoplication Conclusion References 13: Laparoscopic Magnetic Sphincter Augmentation Introduction Device and Mechanism Concept Development and Early Trials Indications and Patient Selection Preoperative Evaluation Technical Considerations Surgical Technique Device Sizing and Implantation Postoperative Management Complications Intra- and Perioperative Complications Postoperative Dysphagia Explantation and Migration Erosion Outcomes Prospective Single-Arm Studies Comparison with Proton Pump Inhibitors Comparison with Fundoplication MSA in Patients with Hiatal Hernias Greater than 3 Cm Obesity Motility Disorders Barrett’s Esophagus Post Bariatric Surgery Conclusion References 14: Diagnosis and Management of Paraesophageal Hiatal Hernia Introduction, Definition, Incidence, and Prevalence History of Paraesophageal Hernia Classification Indications for Surgery Surgical Anatomy Technical Considerations Open Vs Laparoscopic Vs Robotic Dissection of the Hiatus Excision of the Hernia Sac Esophageal Mobilization Repairing the Hiatus Mesh Vs No Mesh Mesh Complications Fundoplication Gastropexy Postoperative Consideration Healthcare Costs Bibliography 15: Reoperative Anti-Reflux Surgery Introduction Preoperative Evaluation and Workup Operative Approaches Redo Hiatal Hernia Repair and Fundoplication Roux-en-Y Reconstruction Multiple Previous Fundoplications Short Esophagus Esophageal Dysmotility Damaged Gastroesophageal Junction or Fundus Delayed Gastric Emptying Non-tissue Redo ARS Conclusion Bibliography Part III: Barrett’s Esophagus and Esophageal Neoplasm 16: Screening for Barrett’s Esophagus Introduction Why Screen for BE? Whom to Screen? Risk Factors for BE BE Risk Assessment Tools Special Populations When to Stop Screening? How to Screen? Endoscopic Screening Conventional Esophagogastroduodenoscopy (cEGD) Unsedated Transnasal Endoscopy Swallowable Imaging Capsules Video Capsule Endomicroscopy Swallowable Cell Sampling Devices Combined with Biomarkers Biomarkers Used for BE Detection in Combination with Swallowable Esophageal Sampling Devices Trefoil Factor 3 Methylated DNA Markers MicroRNAs Volatile Organic Compounds [52] Alterations in Esophageal Microbiome [52] Challenges with BE Screening References 17: Understanding the Histopathology of GERD and Barrett’s Esophagus Introduction Present Understanding of the Histopathology of GERD Nonerosive and Erosive Reflux Esophagitis Barrett’s Esophagus Esophageal Adenocarcinoma (Fig. 17.1) Present Understanding of the Normal State A New Understanding of the Normal State A New Understanding of the Histopathology of GERD Normal → Early GERD with No Visible CLE at Endoscopy Progression of GERD with No Visible CLE at Endoscopy The Pathological Anatomy of Early GERD: The Dilated Distal Esophagus Pathophysiology of the Dilated Distal Esophagus (Lower Esophageal Sphincter Damage) Late (Severe) GERD with Visible CLE The Second Metaplasia: IM in Cardiac Mucosa (Barrett’s Esophagus) The Third Histological Change: Neoplastic Mutations in Barrett’s Esophagus (Fig. 17.1) Progression of GERD Defined by Abdominal LES Damage and Correlative Histology Conclusion References 18: Management of Nondysplastic Barrett’s Esophagus Defining Barrett’s Esophagus Risks Associated with Barrett’s Esophagus Minimizing Risk of Dysplastic Progression: Medical Therapy Minimizing Risk of Dysplastic Progression: Anatomic Intervention The Rationale for Endoscopic Surveillance of Nondysplastic Barrett’s Esophagus Assessment for Dysplasia within Barrett’s Mucosa Evaluating a Nondysplastic Barrett’s Segment for Risk of Progression to Dysplasia The Argument for Endoscopic Eradication Therapy to Treat Nondysplastic Barrett’s Esophagus Conclusion References 19: Management of Dysplastic Barrett’s Esophagus Introduction Epidemiology Definitions and Terminology Identification of Dysplasia Management Indications for EET Endoscopic Resection Endoscopic Mucosal Resection (EMR) Endoscopic Submucosal Dissection (ESD) Ablation Radiofrequency Ablation (RFA) Cryoablation (CA) Argon Plasma Coagulation (APC) Photodynamic Therapy (PDT) Conclusion Bibliography 20: Management of Early Esophageal Cancer Introduction Current Status of Endotherapy in the United States Owning a Hammer Does Not Make you a Contractor Patient Selection and Pretreatment Evaluation T1b Cancer Endotherapy Techniques Endoscopic Resection Endoscopic Ablation Staging Surveillance Post-Endotherapy Endotherapy Failure Post-Endotherapy Reflux Management Conclusion References 21: Cancer of the Esophagus: Epidemiology and Genetics Introduction Epidemiology Incidence Survival Etiology Squamous Cell Carcinoma Nonmodifiable Risk Factors Modifiable Risk Factors Adenocarcinoma Nonmodifiable Risk Factors Modifiable Risk Factors Genetics Conclusions Bibliography 22: Screening Technologies for Barrett’s Esophagus and Esophageal Adenocarcinoma Introduction Rationale for Screening for Barrett’s Esophagus Risk Factors for Barrett’s Esophagus and Who to Screen Conventional (Video-Based) Screening Techniques Esophagogastroduodenoscopy Transnasal Endoscopy Emerging Screening Techniques Swallowable Tissue Sampling Devices Trefoil Factor 3 Methylated DNA Biomarkers MicroRNA Tethered Capsule Endomicroscopy Exhaled Volatile Organic Compounds Cost-Effectiveness of Screening Conclusions and Future Directions References 23: Staging Endoscopic Ultrasound Introduction Esophageal Cancer Epidemiology and Risk Factors Classification Pretreatment Evaluation Pretreatment Staging EUS in Staging EUS Examination Technique T-Staging N-Staging M-Staging Comparison Among Different Modalities for Staging Esophageal Cancer EUS in Restaging After Therapy Special Considerations Stenotic Lesions Outcomes Impact on Patient Management and Survival Cost-Effectiveness and Economic Impact Gastric Cancer Epidemiology and Risk Factors Classification Pretreatment Evaluation Pretreatment Staging EUS in Staging EUS Examination Technique T-Stage N-Staging M-Staging EUS Accuracy Early Gastric Cancer (EGC) M-Staging Comparison with Other Modalities EUS After Neoadjuvant Chemotherapy Special Considerations Linitis Plastica Limitations of Staging EUS Conclusion References Further Reading 24: Minimally Invasive Esophagectomy Introduction Indications Preoperative Evaluation Operative Technique Laparoscopic Phase Positioning Port Placement Diagnostic Laparoscopy Hiatal Dissection and Lymph Node Dissection Gastric Mobilization Conduit Creation Pyloric Drainage Procedure Placement of Feeding Jejunostomy Tube Mediastinal Dissection Conclusion of Laparoscopic Component Thoracoscopic Phase Positioning and Port Placement Esophageal Dissection Thoracic Anastomosis Variations of Minimally Invasive Esophagectomy Minimally Invasive Ivor Lewis Esophagectomy Minimally Invasive Three-Field McKeown Esophagectomy Minimally Invasive Transhiatal Esophagectomy Two-Stage Procedures Special Considerations Postoperative Management Complications Outcomes Conclusions References 25: Endoscopic Management of Anastomotic Leaks Introduction Indications Patient Selection and Preoperative Evaluation General Principles Specific Techniques and Outcomes Endoscopic Dilation Endoscopic Stents Endoluminal Vacuum Therapy (EVAC) Endoscopic Clips and Suturing Postoperative Considerations Conclusions Bibliography 26: Palliative Therapy in Esophageal Cancer Introduction Disease Staging Endoscopic Mechanical Interventions Stenting Dilation Endoscopic Ablation Therapy for Esophageal Cancer Photodynamic Therapy (PDT) Cryoablation Argon Plasma Coagulation (APC) Endoscopic Laser Ablation Endoscopic Oncological Therapies External Beam Radiation Therapy (EBRT) Endoluminal Brachytherapy Endoscopic Chemotherapy Endoscopic Chemical Administration Nonendoscopic Palliation and Palliation of Nondysphagia Symptoms Systemic Chemotherapy and Chemoradiation Management of Bleeding: Hemostatic Powder, Argon Plasma Coagulation, Angiography Malnutrition Perforation Surgical Approaches Conclusions Bibliography Part IV: Esophageal Motility Disorders, Esophageal Injury, and Benign Disease of the Esophagus 27: Pathophysiology of Esophageal Motility Disorders Pathophysiology of Esophageal Motility Disorders Disorders of Esophagogastric Junction Outflow Achalasia Esophagogastric Junction Outflow Obstruction Disorders of Peristalsis Absent Contractility Ineffective Esophageal Motility (IEM) Distal Esophageal Spasm (DES) Hypercontractile Esophagus Summary References 28: Diagnostic Testing for Esophageal Motility Disorders: Barium Radiography, High-Resolution Manometry, and the Functional Lumen Imaging Probe (FLIP) Introduction Barium Radiography Introduction Indications and Patient Selection Protocol and Technical Considerations Outcomes and Interpretation Healthcare Costs Esophageal High-Resolution Manometry (HRM) Introduction Indications and Patient Selection Equipment and Patient Preparation Protocol and Technical Considerations Outcomes and Interpretation Healthcare Costs Functional Lumen Imaging Probe (FLIP) Introduction Indications and Patient Selection Equipment Protocol and Technical Considerations Outcomes and Interpretation Healthcare Costs Conclusions Bibliography 29: The Chicago Classification of Esophageal Motor Disorders Introduction The First Chicago Classification—Version 1.0 Updates in the Chicago Classification—Versions 2.0 and 3.0 The Current Chicago Classification—Version 4.0 (Fig. 29.2) Standardized HRM Protocol (Fig. 29.3) Chicago Classification Version 4.0 of Esophageal Motility Disorders Disorders of EGJ Outflow (Table 29.2) Achalasia (Fig. 29.4) EGJ Outflow Obstruction Disorders of Peristalsis (Table 29.3) Absent Contractility (Fig. 29.5a) Distal Esophageal Spasm (Fig. 29.6a) Hypercontractile Esophagus (Fig. 29.6b–d) Ineffective Esophageal Motility (Fig. 29.5) EGJ Barrier Metrics Conclusion Bibliography 30: Cricopharyngeal Disorders, Endoscopic, Stapled, and Open Cricomyotomy and Adjuncts for Zenker’s Diverticulum Introduction Background Relevant Anatomy Pathophysiology Clinical Presentation Evaluation Treatment Considerations Treatment Modalities and Technical Considerations Botulinum Toxin Dilation Myotomy Open Approach Rigid Endoscopy Flexible Endoscopy Outcomes Cricopharyngeal Achalasia Open Surgery Open vs. Endoscopic Surgery Comparison of Endoscopic Techniques Conclusions References 31: Minimally Invasive Management of Epiphrenic Diverticulum Introduction Epidemiology/Pathophysiology Clinical Presentation Diagnostic Evaluation Management Strategies Non-Operative Management Endoscopic Therapy Surgical Therapy Thoracotomy Minimally Invasive Approaches Trans-Hiatal Minimally Invasive Approach Preoperative Considerations Minimally Invasive Trans-Hiatal Operative Technique Surgical Pearls/Pitfalls Postoperative Care Per-Oral Endoscopic Myotomy (POEM) Surgical Outcomes and Complications Conclusions References 32: Disorders of Esophagogastric Junction Outflow and Peristalsis Disorders of Esophagogastric Junction Outflow Achalasia EGJ Outflow Obstruction Epidemiology Pathophysiology Clinical Features Diagnosis Manometric Testing Imaging Endoscopy FLIP Disorders of Peristalsis Absent Contractility Distal Esophageal Spasm Introduction Epidemiology Pathophysiology Clinical Features Diagnosis Manometric Testing Imaging Endoscopy FLIP Hypercontractile Esophagus Introduction Epidemiology Pathophysiology Clinical Features and Presentation Diagnosis Manometric Testing Endoscopy FLIP Esophagogastric Junction Outflow Obstruction Introduction Epidemiology Pathophysiology Clinical Features and Presentation Diagnosis Manometric Testing Imaging Endoscopy FLIP Ineffective Esophageal Motility Introduction Epidemiology Pathophysiology Clinical Presentation Diagnosis Manometric Testing FLIP References 33: Therapies for Spastic Esophageal Motor Disorders Introduction Approach to Management Pharmacologic Therapy Calcium Channel Blockers Nitrates and Phosphodiesterase (PDE-5) Inhibitors Peppermint Oil Proton Pump Inhibitors Neuromodulators Endoscopic Therapy for Spastic Esophageal Motility Disorders Dilation Botulinum Toxin Injection Surgical/Endosurgical Therapy for Spastic Esophageal Motility Disorders Patient Selection for Surgical/Endosurgical Management Procedures: Laparoscopic Heller’s Myotomy (LHM) and Peroral Endoscopic Myotomy (POEM) Risks and Considerations Outcomes Cost Considerations Concerns Conclusion: Surgical/Endosurgical Therapy for Spastic Esophageal Motility Disorders Conclusions Bibliography 34: Pneumatic Dilation for the Treatment of Achalasia Introduction Definition, Incidence/Prevalence, Epidemiology, Pathophysiology/Mechanism Indications Patient Selection Preoperative Evaluation Technique Outcomes Healthcare Costs References 35: Minimally Invasive Heller Myotomy Introduction Common Indications for Myotomy Achalasia Esophagogastric Junction Outflow Obstruction (EGJOO) Epiphrenic Diverticulum Preoperative Evaluation Specific Considerations Patient Preparation Laparoscopic Heller Myotomy with Partial Fundoplication Technical Procedure Myotomy Partial Fundoplication Robot-Assisted Heller Myotomy Benefit Compared to Laparoscopic Approach Technical Procedure Intraoperative Functional Assessment Postoperative Care Complications Outcomes Conclusions References 36: Per-Oral Endoscopic Myotomy (POEM) Introduction, Background of POEM Procedure Current Indications and Outcomes for POEM Achalasia (Types 1, 2, 3) and Spastic Esophageal Disorders Clinical Outcomes—Relief of Dysphagia Outcomes by Achalasia Subtypes Outcomes of Other Spastic Esophageal Disorders (Jackhammer, DES, EGJOO) Long-Term Outcomes Post-POEM GERD POEM vs LHM: Clinical Outcomes Indications for LHM vs POEM Failed Prior Interventions (Heller, Botox, Pneumatic Dilation, POEM) Pre-procedure Evaluation Technical Considerations (Fig. 36.3) Anterior vs Posterior Approach Vertical vs Horizontal Mucosal Incision Extent of Tunnel/Myotomy Full Thickness vs Circular Myotomy Managing Esophageal Diverticulum Reflux Prevention Strategies Post-procedural Complications Conclusions References 37: Scleroderma Introduction Pathophysiology Clinical Manifestations Oropharyngeal Cavity Esophagus Stomach Diagnostic Evaluation Esophagus Stomach Treatment Considerations Esophagus Stomach Conclusion Bibliography 38: Benign Lesions of the Esophagus Introduction Epithelial Lesions Glycogenic Acanthosis Inlet Patch (Heterotopic Gastric Mucosa) Squamous Papilloma Hyperplastic (Inflammatory) Polyp Fibrovascular Polyp Inflammatory Fibroid Polyp Hamartoma Polypoid Bacillary Angiomatosis Pyogenic Granuloma Ectopic Sebaceous Glands Esophagitis Dissecans Superficialis Schatzki Ring Subepithelial Lesions Duplication Cyst Pancreatic Rest Xanthoma Lipoma Leiomyoma Granular Cell Tumor Schwannoma Lymphangioma Glomus Tumor Gastrointestinal Stromal Tumor References 39: Management of Caustic Injury and Esophageal Stricture Caustic Injury Clinical Features Epidemiology Pathophysiology and Mechanism of Injury Classification of Injury Initial Management Evaluation Treatment Subsequent Management and Long-Term Sequelae Medical Management Reconstructive Surgery Management of Esophageal Strictures Clinical Features Etiology Stricture Characterization Management of Benign Esophageal Strictures Endoscopic Dilation Endoscopic Dilation with Steroid or Mitomycin C Injection Endoscopic Incisional Therapy Esophageal Stents Self-Dilation Management of Malignant Esophageal Strictures Esophageal Stents Debulking Endoscopic Therapy Bibliography 40: Management of Esophageal Perforation Introduction Etiology Presentation Diagnosis Guiding Principles for Management Principle #1) Resuscitation and Control of Sepsis Principle #2) Diversion of the Salivary Stream Principle #3) Nutritional Support Management of Esophageal Perforations Conservative Management Interventional Radiology Management Flexible Endoscopic Management Surgical Management of Esophageal Perforations Boerhaave’s Syndrome Conclusion References Part V: Gastric Disorders 41: Pathophysiology of Gastric Neuromuscular Disorders Introduction Epidemiology and Clinical Presentation Epidemiology Disease Prevalence and Patient Characteristics Healthcare Burden Etiologies Pathophysiology of Delayed Gastric Emptying Normal Gastric Motor Function Pathophysiology of Gastroparesis Antral Hypomotility Pyloric Dysfunction Duodenal Dysmotility Autonomic Dysfunction Visceral Hypersensitivity Immune Dysregulation in Delayed Gastric Emptying Pathophysiology of Gastroparesis Syndromes with Non-delayed Gastric Emptying Introduction Further Descriptions of the Concept of GPS Other Aspects of Gastroparetic Syndromes Specific Areas of Gastroparetic Syndromes (GPS) Enteric Aspects of GPS Neuropathic Factors in GPS Inflammatory Aspects in GPS Immune/Genetic Aspects of GPS Serosal/Hormonal Aspects of GPS Additional Factors Involving GPS Gastro-Pyloric Dysfunction Gastroesophageal Dysfunction The Role of Diet Pathophysiology Based on Symptoms Conclusion References 42: Diagnostic Testing and Pharmacotherapy in Gastroparesis Introduction Diagnostic Testing Gastric Emptying Evaluation Small Bowel Radiography Antroduodenal Manometry Electrogastrography Gastric Magnetic Resonance Imaging (MRI) Ultrasound Pharmacotherapy Prokinetic Agents Anti-nausea Neuromodulation Conclusion References 43: Endoscopic Pyloric Therapies for Gastroparesis Introduction Botulinum Toxin Injection into the Pylorus Endoscopic Dilation of the Pylorus Transpyloric Stenting for the Management of Gastroparesis Indications and Patient Selection Technical Aspects Post-procedure Care Outcomes Gastric Peroral Endoscopic Myotomy (G-POEM) Indications and Patient Selection Technical Aspects Post-procedure Care Outcomes Conclusion Bibliography 44: Surgical Treatment of Gastroparesis Introduction, Definition, Incidence/Prevalence: Gastroparesis (GP) Gastric Electrical Stimulation (GES) System Indications for GES Mechanism of Action Patient Selection Preoperative Evaluation Technical Considerations Outcomes GES System-Related Complications Postoperative Considerations Healthcare Costs Specific Considerations Surgical Pyloroplasty Indications for Pyloroplasty Operative Technique Complications Outcomes Simultaneous Pyloroplasty with Gastric Electrical Stimulation Conclusions Further Reading 45: Cyclic Vomiting Syndrome, Dumping, and Marijuana-Induced Hyperemesis Syndrome Cyclic Vomiting Syndrome Introduction Etiology Diagnosis Clinical Features Comorbid Conditions and Impact of CVS Management Conclusion Dumping Syndrome Features of Dumping Syndrome Rapid Gastric Emptying in Cyclic Vomiting Syndrome Epidemiology of Rapid Gastric Emptying Pathogenic Role of Rapid Gastric Emptying Contrast of Gastric Emptying Abnormalities in Cyclic Vomiting Syndrome vs. Cannabinoid Hyperemesis Cannabinoid Hyperemesis Syndrome Introduction Pathophysiology Role of Cannabinoids in CHS and CVS Is CHS a Distinct Disorder? Management Conclusion References Part VI: Gastric Cancer and Other Gastroesophageal Disorders 46: Gastric Cancer Epidemiology, Genetics, and Screening Introduction Epidemiology of Sporadic Gastric Cancer Variations in Incidence and Mortality of Gastric Cancer Familial Gastric Cancer Hereditary Diffuse Gastric Cancer Gastric Adenocarcinoma and Proximal Polyposis of the Stomach Familial Intestinal Gastric Cancer Gastric Cancer Genetics Molecular Classification Systems Precision Oncology Screening Recommendations Summary Bibliography 47: Diagnosis and Management of Gastric Intestinal Metaplasia Introduction Epidemiology Pathophysiology Histologic Features Diagnosis and Management of GIM Endoscopic Diagnosis Risk Stratification Staging Systems Management Eradication of H. pylori Short-Interval Endoscopic Evaluation Endoscopic Surveillance Healthcare Cost Considerations Conclusion Bibliography 48: Endoscopic Staging and Resection for Early Gastric Cancer Case Presentation Introduction Endoscopic Evaluation of EGC Assessment of Margins Staging: Depth of Invasion and Lymph Node Involvement Indications for Resection of EGC Absolute, Expanded, and Relative Criteria for Endoscopic Resection Absolute Indications for EMR or ESD Absolute Indications for ESD Expanded Indications for ESD Relative Indications Submucosal Invasion Undifferentiated Adenocarcinoma Techniques for Resection Endoscopic Mucosal Resection Endoscopic Submucosal Dissection Technique Surveillance Post-treatment Curative Resection Noncurative Resection Helicobacter pylori (H. pylori) Infection Case Conclusion References 49: Laparoscopic Total and Subtotal Gastrectomy Introduction Definitions and Indications Gastric Adenocarcinoma Preoperative Evaluation Laparoscopic Approach Lymphadenectomy Surgical Technique Patient Positioning and Preoperative Considerations Port Placement and Diagnostic Laparoscopy Omentectomy and Division of the Gastrocolic Ligament Division of the Hepatogastric Ligament Division of the Right Gastroepiploic Pedicle and Gastric Resection Modified D2 Lymphadenectomy Reconstruction Postoperative Considerations Postoperative Management Perioperative Morbidity and Anastomotic Complications Conclusions Bibliography 50: Laparoscopic Resection of Gastric and Esophageal Submucosal Tumors Introduction Epidemiology Diagnosis/Pre-op Evaluation Indications/Patient Selection Contraindications for Minimally Invasive Management Technical Consideration Esophagus Room Step-Up and Port Placement Proximal and Mid-esophageal Tumors Distal Esophageal Tumors Stomach Room Step-Up and Port Placement Gastric Fundus and Greater Curvature Tumors Lesser Gastric Curve and Pre-pyloric Tumors Gastric Cardia-Exophytic GEJ Tumors Gastric Cardia-Endophytic GEJ Tumors Without Esophageal Extension Esophageal Outcomes Gastric Outcomes Postoperative Considerations Conclusion Bibliography 51: Peptic Ulcer Disease Introduction Epidemiology Pathophysiology H. pylori NSAIDs Non-H. pylori/Non-NSAID Causes of PUD Clinical Manifestations Complications of Peptic Ulcer Disease Hemorrhage Perforation Gastric Outlet Obstruction Penetrating/Fistulizing PUD Diagnostic Testing Endoscopic Evaluation of Ulcers Diagnostic Tests for H. pylori Infection Treatment of H. pylori Infection Screen for and Stop NSAIDs in Patients with PUD Acid Suppressive Therapy Other Suggestions to Promote Ulcer Healing Evaluation for Suspected Zollinger-Ellison Syndrome Stress Ulcers Endoscopic, Interventional Radiology, and Surgical Treatments for Complicated PUD Management of Hemorrhage Due to PUD Management of Other Complications of PUD Conclusion Bibliography 52: Primary Gastric Lymphoma Introduction Gastric MALT Gastric Diffuse Large B-Cell Lymphoma Clinical Presentation Diagnosis Staging Treatment Chemotherapy First-Line Chemotherapy for Advanced Stage Disease Second and Subsequent Lines of Chemotherapy Treatment Options for Elderly or Infirm Patients Histologically Transformed or High-Grade Lymphoma Radiation Therapy References Part VII: Obesity and Metabolic Disease 53: Laparoscopic and Robotic Sleeve Gastrectomy Introduction, Definition, Incidence/Prevalence Epidemiology, Pathophysiology/Mechanism Indications and Patient Selection Preoperative Evaluation Technical Considerations Laparoscopic Technique Robotic Concomitant Hiatal Hernia Repair Conversion to Sleeve Gastrectomy Outcomes Postoperative Considerations Healthcare Costs Specific Considerations Conclusions Bibliography 54: Laparoscopic and Robot-Assisted Roux-en-Y Gastric Bypass Introduction Epidemiology Pathophysiology Indications and Patient Selection Indications Patient Selection Contraindications Preoperative Evaluation Multidisciplinary Evaluation and Education Psychiatric Evaluation Medically Supervised Weight Loss Upper Endoscopy Patient Education Technical Consideration Laparoscopic Roux-en-Y Gastric Bypass Patient Positioning Trocar Placement Biliopancreatic Limb Alimentary Limb Jejunojejunostomy Gastric Pouch Creation Gastrojejunostomy Robot-Assisted Roux-en-Y Gastric Bypass Example Video of Laparoscopic Roux-en-Y Gastric Bypass Postoperative Care Outcomes Healthcare Costs and Considerations Conclusion References 55: Endoscopic Gastric Remodeling for Weight Loss Introduction Bariatric Endoscopy Candidates for ESG and POSE Preoperative Evaluation Intraprocedural and Postoperative Protocol Endoscopic Sleeve Gastroplasty Technical Aspects and Procedural Considerations Outcomes Safety Primary Obesity Surgery Endoluminal (POSE) Procedure Technical Aspects and Procedural Considerations Outcomes Safety ESG Versus POSE Endoscopic Revision After Bariatric Surgery Argon Plasma Coagulation Transoral Outlet Reduction Endoscopy (TORe) Restorative Obesity Surgery Endoluminal (ROSE) Revisional Endoscopic Sleeve Gastroplasty of Laparoscopic Sleeve Gastrectomy Training and Program Development Cost of Endobariatric Therapies Conclusion and Future Directions References 56: Strategies in Management of GERD in the Severely Obese Undergoing Bariatric Surgery Current Surgical Options in the Management GERD and Severe Obesity Pathophysiology of GERD Associated with Bariatric Surgery Innovative Strategies in the Management of Patients with GERD and Obesity Staged Procedures: Antireflux Surgery Followed by Bariatric Surgery Single Stage Procedure: Flap Valve Preserving Bariatric Surgery Conclusions References 57: Endoscopic Management of Bariatric Complications Introduction Leaks (RYGB and SG) Overall Clinical Management Diversion/Exclusion Technique SEMS Internal Drainage Techniques Double Pigtail Stents (DPS) Endoscopic Vacuum Therapy (EVT) Septotomy Closure Techniques Clipping Sealants Biomaterial Plug Endoscopic Suturing Septal Occluder Gastrojejunal Anastomosis (GJA) Stricture Marginal Ulcers (RYGB) Isolated Sleeve Gastrectomy Stricture Silastic Ring and Band-Related Complications (Fobi-Capella Procedure) References 58: Bariatric Surgery Complications and Management Introduction Complications of Sleeve Gastrectomy Staple Line Leaks Stenosis/Stricture Bleeding After Laparoscopic Sleeve Gastrectomy Complications of Gastric Bypass Leaks After Gastric Bypass Strictures After Gastric Bypass Marginal Ulceration and Gastrogastric Fistula After Gastric Bypass Obstruction Roux-en-O Bypass Complications After Biliopancreatic Diversion with Duodenal Switch Complications of Laparoscopic Adjustable Gastric Band Conclusions References 59: Post-bariatric Surgery GERD Normal Anti-reflux Mechanism Lower Esophageal Sphincter Crural Diaphragm Mechanisms of Reflux Obesity and GERD Bariatric Surgical Interventions Laparoscopic Sleeve Gastrectomy (LSG) Roux-en-Y Gastric Bypass GERD After Sleeve Clinical Presentation of GERD After RYGB Progression of GERD to Barrett’s Esophagus After Bariatric Surgery Approach to Management of Post-bariatric Surgery GERD Endoscopic Approaches Radiofrequency Ablation Anti-reflux Mucosectomy (ARMS) Surgical Approaches Magnetic Sphincter Augmentation (MSA): LINX Conversion to RYGB Concurrent or Subsequent Treatments of GERD in the Setting of Bariatric Surgery Currently Available Hiatal Hernia Repair Concurrent Fundoplication Concurrent Magnetic Sphincter Augmentation (MSA) References 60: Gastroesophageal Reflux Disease and Metabolic Surgery Introduction Epidemiology Pathophysiology Presentation Workup/Diagnosis GERD Around Metabolic Surgery Management Non-procedural Management Procedural Management Hiatal Hernia Conclusion References Part VIII: Specific Considerations 61: Health Advocacy Introduction Legislative Advocacy Payer Advocacy Physicians as Effective Advocates Conclusion References 62: Robotic Foregut Surgery Robotic Heller Myotomy Introduction Robotic Heller Myotomy Surgical Technique Robotic Antireflux Surgery Introduction Robotic Fundoplication Surgical Technique for Robotic Fundoplication Robotic Paraesophageal Hernia Introduction Robotic Paraesophageal Hernia Repair Surgical Technique for Robotic Paraesophageal Hernia Repair Robotic Revisional Foregut Surgery Introduction Indications and Pre-operative Preparation for Re-operative Foregut Surgery Surgical Technique of Redo Foregut Surgery Outcomes Conclusion Bibliography Index