Esophageal Function Testing An Issue Of Gastrointestinal Endoscopy Clinics

This issue reviews the various techniques and uses of esophageal function testing, including the Bernstein Test, Esophageal Acid Perfusion Test, Esophageal Acidity Test, Esophageal Function Studies, Esophageal Manometry, and Esophageal pH Monitoring. These tests are often used to help determine the cause of frequent heartburn or trouble swallowing and to determine whether chest pain is being caused by a problem with the esophagus.

This issue devoted to Esophageal Function Testing highlights these tests that are complimentary to endoscopy and should be considered after endoscopy is performed. In fact, a prerequisite for performing many of these studies is a negative endoscopy and thus, the endoscopist should be well-informed regarding the indication and utility of these tests. Additionally, some of these newer technologies require endoscopy to be performed during the study as the placement or positioning of the measurement tool will require endoscopic landmarks or direct placement. There have been major advances in most of these older techniques, and new novel measurement paradigms have been created that allow for a more visual and accurate depiction of physiologic and anatomic data. These technologies have evolved to be more akin to an imaging technique and thus, the visual display and data acquisition is much more intuitive and easier to teach to trainees. This review would be of the utmost importance to readers of GI Endoscospy Clinics.

This issue devoted to Esophageal Function Testing highlights these tests that are complimentary to endoscopy and should be considered after endoscopy is performed. In fact, a prerequisite for performing many of these studies is a negative endoscopy and thus, the endoscopist should be well-informed regarding the indication and utility of these tests. Additionally, some of these newer technologies require endoscopy to be performed during the study as the placement or positioning of the measurement tool will require endoscopic landmarks or direct placement. There have been major advances in most of these older techniques, and new novel measurement paradigms have been created that allow for a more visual and accurate depiction of physiologic and anatomic data. These technologies have evolved to be more akin to an imaging technique and thus, the visual display and data acquisition is much more intuitive and easier to teach to trainees. This review would be of the utmost importance to readers of GI Endoscospy Clinics.

Dr. Shaheen's issue of Gastrointestinal Endoscopy Clinics of North America addresses the current thinking and clinical decision making surrounding endoscopy for Barrett's Esophagus. Expert authors have contributed articles on the following topics: The Troublesome Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma; Who Deserves Endoscopic Screening for Esophageal Neoplasia; Alternatives to Traditional per oral Endoscopy for Screening; Effectiveness and Cost-Effectiveness of Endoscopic Screening and Surveillance; The Role of Adjunct Imaging in Endoscopic Detection of Dysplasia; Beyond Dysplasia Grade: The Role of Biomarkers in Stratifying Risk; Management of Nodular Neoplasia in Barrett’s Esophagus: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection; EUS and Management of Superficial Esophageal Neoplasia; Radiofrequency Ablation of Barrett’s Esophagus: Patient Selection, Preparation, and Performance; Radiofrequency Ablation of Barrett’s Esophagus: Efficacy, Complications, and Durability; Cryotherapy of Barrett’s Esophagus; Care of the Post-Ablation Patient: Surveillance, Acid Suppression and Treatment of Recurrence; and Surgical Management of Superficial Esophageal Neoplasia. Readers will come away with the knowledge to diagnose and treat neoplasia and Barrett's Esophagus using the latest techniques.

In collaboration with Consulting Editor, Dr. Charles J. Lightdale, Guest Editor Dr. Sachin Wani has put together a state-of-the art issue that presents the latest advances in Barrett’s Esophagus. He has secured expert authors who have contributed clinical reviews on the following topics: The epidemiology of Barrett’s esophagus and esophageal adenocarcinoma – implications for screening and surveillance; Endoscopic screening for Barrett’s esophagus and esophageal adenocarcinoma: rationale, candidates and challenges; Progress in screening for Barrett’s esophagus: beyond standard upper endoscopy; Best practices in surveillance for Barrett’s esophagus; Pathologic assessment of Barrett’s esophagus and Barrett’s related neoplasia: Do we need quality indicators; Cost effectiveness of screening, surveillance and endoscopic eradication therapies in Barrett’s esophagus and early esophageal cancer; Advanced imaging and sampling in Barrett’s esophagus: Artificial intelligence to the rescue; Advances in biomarkers for risk stratification in Barrett’s esophagus; Current status of chemoprevention in Barrett’s esophagus; Optimizing outcomes with radiofrequency frequency ablation of Barrett’s esophagus: candidates, efficacy and durability; Updates in cryotherapy for Barrett’s esophagus; Role of endoscopic mucosal resection and endoscopic submucosal dissection in the management of Barrett’s related neoplasia; Practical approach to refractory and recurrent Barrett’s esophagus; Surgical management of Barrett’s related neoplasia; and Measuring Quality in Barrett’s esophagus: Time to embrace quality indicators. Endoscopists will come away with the information they need to screen, diagnose, and treat patients with Barrett’s Esophagus.

In consultation with Consulting Editor, Dr. Charles Lightdale, Dr. Kenneth Chang has assembled top authors to provide a current update on the management of GERD. Clinical review articles provide updates on the these important topics: Mechanism and Pathophysiology of GERD; Personalized Approach in the work-up and management of GERD; Proton Pump Inhibitors; Radiofrequency Treatment for GERD; Trans-oral Incisionless Fundoplication (TIF); Innovations in Endoscopic Therapy for GERD; Laparoscopic Hernia Repair and Fundoplication, Failed Nissen; Laparoscopic Sphincter Augmentation (LINX); Refractory GERD and Functional Heartburn; and Extra-esophageal GERD and LPR. Readers will come away with the latest techniques and clinical applications to improve patient outcomes.

In consultation with Dr. Charles Lightdale, Dr. DiMaio has assembled a list of articles devoted to endoscopy in hepatology with the most current and clinically relevant content. Dr. DiMaio invited top experts from well-known institutions to contribute reviews on the following topics: EUS in the evaluation of unexplained biliary dilation and liver function test abnormalities; EUS-guided liver biopsy; Advances in endoscopic imaging of the biliary tree; Expert evaluation of indeterminate biliary strictures; Stenting for benign and malignant biliary strictures; Endoscopic management of biliary issues in the liver transplant patient; Endoscopic management of complex biliary stone disease; EUS-guided biliary drainage; ERCP and EUS-guided drainage of the gallbladder; EUS-guided interventions for the measurement and treatment of portal hypertension; Endoscopic management of portal hypertension-related bleeding; EUS for diagnosis and staging of liver tumors; ERCP-guided ablation for cholangiocarcinoma; and EUS-guided ablation of liver tumors. Readers will come away with the most current clinical information they need to improve outcomes in patients with liver disease.

Upper gastrointestinal bleeding is the leading emergency leading to hospitalization and urgent endoscopy. The field of gastrointestinal bleeding is rapidly evolving. The epidemiology is changing with more complex older patients on anticoagulant and antithrombotic agents presenting with upper gastrointestinal bleeding. The initial management has rapidly evolved with new transfusion thresholds, the use of risk stratification scores and no more nasogastric tubes. There is new data and recommendations on optimal timing of endoscopy. Medical therapies have also evolved with changes in proton pump inhibitor administration and the use of prokinetics to improve endoscopic visualization. Many modifications in endoscopic therapy have recently been advanced including the use of endoscopic ultrasound guided angiotherapy, topical sprays (i.e. Hemospray) and over-the-scope clips. In order to give optimal care to patients, it is critical that practicing gastroenterologists are aware of the many recent advances in management of patients with upper gastrointestinal bleeding.