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TheSAGES
Manual
ofPhysiologic
Evaluation
ofForegut
Diseases
AnkitD.Patel· AmirAryaie·
JayleenGrams·
LeenaKhaitanEditors
123

The SAGES Manual of Physiologic
Evaluation of Foregut Diseases

Ankit D. Patel • Amir Aryaie
https://t.me/medicina_free
Jayleen Grams • Leena Khaitan
Editors
The SAGES Manual
of Physiologic
Evaluation
of Foregut Diseases

Editors
https://t.me/medicina_free
Ankit D. Patel
Department of Surgery
Emory University School of
Amir Aryaie
BMI Surgical Institute
Atlanta, GA, USA
Medicine
Atlanta, GA, USA
Leena Khaitan
Department of Surgery
Jayleen Grams
Department of Surgery
University of Alabama at
University Hospitals, Cleveland
Medical Center
Cleveland, OH, USA
Birmingham and Birmingham VA
Health Care System
Birmingham, AL, USA
ISBN 978-3-031-39198-9 ISBN 978-3-031-39199-6 (eBook)
https://doi.org/10.1007/978-3-031-39199-6
© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2023
This work is subject to copyright. All rights are reserved by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microlms or in any other physical way, and transmission or information storage
and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specic
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of
publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with
regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature
Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable.

Contents
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Part I Understanding Anatomy and Physiology
1 Anatomy and Physiology of the Esophagus . . . . . . . . 3
Jeffrey Thomas and James Kurtz
2 Anatomy and Physiology of the Stomach . . . . . . . . . . 13
Jenna Borys and James Kurtz
3 Effect of Obesity on Foregut Physiology . . . . . . . . . . . 25
Ryan Lamm and Francesco Palazzo
Part II Diagnostic Testing: Diagnostic Imaging
4 Esophagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Elisa J. Furay, Stephanie Doggett,
and Francis P. Buckley III
5 The Upper GI Series . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Emily Adams and Anna Ibele
6 Timed Barium Swallow in Foregut Disease . . . . . . . . 71
Joseph Sujka, Joel Richter, and Christopher DuCoin
7 Role of CT Imaging in Foregut Physiology
and Benign Pathology
Maggie L. Diller and Daniel Shouhed
8 3D Modeling with CT . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Angela M. Kao and Paul D. Colavita
. . . . . . . . . . . . . . . . . . . . . . . . . . 81
v

vi
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Contents
9 Role of the Gastric Emptying Study . . . . . . . . . . . . . . 107
Michael L. Williford and S. Scott Davis Jr.
10 Endoscopic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . 115
Lindsey C. Shipley and Ali M. Ahmed
Part III Diagnostic Testing
11 High-Resolution Esophageal Manometry with
and without Impedance: Understanding
the “Chicago Classification” . . . . . . . . . . . . . . . . . . . . 129
Mohanad R. Youssef, Meredith Freeman,
Natacha Wathieu, Danuel Laan, and Carlos Galvani
12 Impedance Planimetry: EndoFLIP . . . . . . . . . . . . . . . 173
Michelle Campbell and Michael Ujiki
13 Catheter-Based pH Testing. . . . . . . . . . . . . . . . . . . . . . 183
Fermin Fontan, Oscar Talledo, and Peter Nau
14 Wireless pH Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Jennwood Chen and Kyle A. Perry
15 Proximal pH Testing for Laryngopharyngeal
Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Umashankkar Kannan, Krzystof M. Nowak,
and Subhash Kini
16 Endoscopic Evaluation of the Bariatric Surgery
Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Soane El Djouzi
Part IV Foregut Motility Disorders
17 Achalasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Luis Serrano, Joel Richter, Christopher DuCoin,
and Abdul- Rahman Fadi Diab
18 Minor Disorders of Esophageal Motility . . . . . . . . . . 253
Amy Banks-Venegoni, Justin Hsu, and Gregory Fritz

Contents
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vii
19 Distal Esophageal Spasm . . . . . . . . . . . . . . . . . . . . . . . 267
Sarah Samreen and Dmitry Oleynikov
20 Jackhammer Esophagus . . . . . . . . . . . . . . . . . . . . . . . . 275
Stuart A. Abel and Joseph R. Broucek
21 Secondary Esophageal Motility Disorders:
Diagnosis and Management . . . . . . . . . . . . . . . . . . . . . 291
Meredith A. Harrison, Ronak Modi,
Rodrigo Duarte-Chavez, and Andrew M. Brown
22 Esophagogastric Junction Outflow Obstruction . . . . 309
Kelly M. Herremans, J. Christian Brown,
and Alexander L. Ayzengart
23 Gastric Outlet Obstruction . . . . . . . . . . . . . . . . . . . . . 319
Michael T. Fastiggi and Mujjahid Abbas
24 Gastroparesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Bora Kahramangil, Emanuele Lo Menzo,
Samuel Szomstein, and Raul Rosenthal
25 Dumping Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Bora Kahramangil, Emanuele Lo Menzo,
Samuel Szomstein, and Raul Rosenthal
26 Normal Physiology Findings After Hiatal Hernia
Repair and Fundoplication . . . . . . . . . . . . . . . . . . . . . 359
Ramses A. Saavedra and Edward Auyang
27 K. Normal Foregut Function After Bariatric
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Megan Lundgren and Talar Tatarian
28 Normal Physiologic Findings After Esophageal
Myotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Abdulaziz Ali Karam and Mohammed Al Mahroos

viii
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Contents
Part V Pathology/Symptom Based
29 Barrett’s Esophagus: A Review of Current
Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Justin Eagleston, Lauren Yoder, and Kshitij Kakar
30 Diagnostic Tests for Gastroesophageal Reflux
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Hope T. Jackson and Ivy N. Haskins
31 Laryngopharyngeal Reflux . . . . . . . . . . . . . . . . . . . . . 429
Charles Hill, Stephanie Doggett,
and Francis P. Buckley III
32 Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Federico Serrot
33 Eosinophilic Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . 453
Tayler J. James and Nikolai A. Bildzukewicz
34 Paraesophageal Hernias . . . . . . . . . . . . . . . . . . . . . . . . 463
Isaac R. Kriley, Shaoxu Bing, and Ruchir Puri
35 Primary Dysphagia: A Case- Based Approach
to Diagnosis and Treatment . . . . . . . . . . . . . . . . . . . . . 483
Matthew W. Romine and Abhishek D. Parmar
36 Persistent Dysphagia After Prior Anti-Reflux
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Jennifer F. Preston and Nathaniel J. Soper
37 Persistent Dysphagia After Esophageal Myotomy . . . 515
Alison Y. Haruta and Andrew S. Wright
38 Recurrent Reflux After Prior Fundoplication . . . . . . 529
Tanuja Damani and Justin Henning
39 Reflux After Myotomy . . . . . . . . . . . . . . . . . . . . . . . . . 541
Mohsen Alhashemi, Abdulaziz Karam Ali,
and Mohammed Al Mahroos
40 GERD After Duodenal Switch . . . . . . . . . . . . . . . . . . . 557
Filippo Filicori and D’Artagnan DeBow

Contents
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41 Sleeve Gastrectomy and Gastroesophageal
Reflux Disease
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
Anna Ibele and Emily Adams
42 Reflux After Gastric Bypass: Roux en-Y
and One- Anastomosis Gastric Bypass . . . . . . . . . . . . 573
Gabriel Diaz Del Gobbo and Matthew Kroh
43 Pediatric and Adolescent Foregut Motility . . . . . . . . . 591
Stefan Scholz, Vibha Sood, and Elizabeth Sharbaugh
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
ix

Contributors
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Mujjahid Abbas, MD New Jersey Bariatric Center, Hackettstown, NJ, USA
University Hospitals Cleveland Medical Center, Cleveland, OH,
USA
Case Western University School of Medicine, Cleveland, OH,
USA
StuartA.Abel, MD Division of Upper GI and General Surgery,
Department of Surgery, Keck Medical Center of USC, University
of Southern California, Los Angeles, CA, USA
Emily Adams, MD Department of Surgery, The University of
Utah, Salt Lake City, UT, USA
AliM.Ahmed, MD Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL,
USA
Mohsen Alhashemi, MD, MSc, FRCSC Department of Surgery, College of Health Sciences, Kuwait University, Kuwait, QC,
Kuwait
AbdulazizKaramAli, MD Department of Surgery, McGill University, Montreal, QC, Canada
Montreal General Hospital, Montreal, QC, Canada
Department of Surgery, College of Health Sciences, Kuwait University, Kuwait, QC, Kuwait
xi
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