scan, a computer‐aided detection model for VLE [20, 21] is most likely to be the future of this technology.
Summary
The endoscopic evaluation of the esophagus is an extremely important role in the diagnosis of esophageal disease. Most findings are readily apparent with a careful high‐definition white‐light exam, which can be augmented with NBI or BLI to define mucosal and vascular patterns. The value of advanced imaging with acetic acid and laser endomicroscopy has been compared to the random biopsy method in patients with BE in many studies. Overall, the combined data was found to meet the standard criteria set for by the American Society of Gastrointestinal Endoscopy for a new technology designed to reduce or replace mucosal biopsy sampling using the available data and meta‐analysis [22]. In spite of the recommendations, widespread adoption of these advancements has been limited by cost and general consensus among physicians in community and academic settings.
References
1 1 Gupta N, Gaddam S, Wani SB, et al. Longer inspection time is associated with increased detection of high‐grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc 2012; 76(3):531–538.
2 2 di Petro M, Boerwinkel DF, Shariff MK, et al. The combination of autofluorescence endoscopy and molecular biomarkers is a novel diagnostic tool for dysplasia in Barrett’s oesophagus. Gut 2015; 64:49–56.
3 3 Longcroft‐Wheaton G, Brown J, Basford P, et al. Duration of acetowhitening as a novel objective tool for diagnosing high risk neoplasia in Barrett’s esophagus: a prospective cohort trial. Endoscopy 2013; 45(6):426–432.
4 4 Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111:30–50; quiz 51.
5 5 Tholoor S, Bhattacharyya R, Tsagkournis O, Longcroft‐Wheaton G, Bhandari P. Acetic acid chromoendoscopy in Barrett’s esophagus surveillance is superior to the standardized random biopsy protocol results from a large cohort study (with video). Gastrointest Endosc 2014; 80(3):417–424.
6 6 Shimizu Y, Omori T, Yokoyama A, et al. Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining: high‐grade intra‐epithelial neoplasia turns pink within a few minutes. J Gastroenterol Hepatol 2008; 23(4):546–550.
7 7 Kara MA, Peters FP, Rosmolen WD, et al. High‐resolution endoscopy plus chromoendoscopy or narrow‐band imaging in Barrett’s esophagus: a prospective randomized crossover study. Endoscopy 2005; 37:929–936.
8 8 Ngamruengphong S, Sharma VK, Das A. Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett’s esophagus: a meta‐analysis. Gastrointest Endosc 2009; 69:1021–1028.
9 9 Sharma P, Bansal A, Mathur S, et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett’s esophagus. Gastrointest Endosc 2006; 64(2):167–175.
10 10 Sharma P, Bergman JJ, Goda K, et al. Development and validation of a classification system to identify high‐grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow‐band imaging. Gastroenterology 2016; 150(3):591–598.
11 11 Subramaniam S, Kandiah K, Schoon E, et al. Development and validation of the international blue light imaging for Barrett’s neoplasia classification. Gastrointest Endosc 2020; 91:310–320.
12 12 Everson MA, Lovat LB, Graham DG, et al. Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett’s esophagus‐associated neoplasia. Gastrointest Endosc 2019; 89(2):247–256.
13 13 Camus M, Coriat R, Leblanc S, et al. Helpfulness of the combination of acetic acid and FICE in the detection of Barrett’s epithelium and Barrett’s associated neoplasia. World J Gastroenterol 2012; 18(16):1921–1925.
14 14 Canto MI, Anandasabapathy S, Brugge W, et al. in vivo; endomicroscopy improves detection of Barrett’s esophagus‐related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014; 79(2):211–221.
15 15 ASGE Technology Committee, Chauhan SS, Abu Dayyeh BK, Bhat YM, et al. Confocal laser endomicroscopy. Gastrointest Endosc 2014; 80(6):928–38.
16 16 Trindade AJ, George BJ, Berkowitz J, et al. Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett’s esophagus. Endosc Int Open 2016; 4:E318–E322.
17 17 Alshelleh M, Inamdar S, McKinley M, et al. Incremental yield of dysplasia detection in Barrett's esophagus using volumetric laser endomicroscopy with and without laser marking compared with a standardized random biopsy protocol. Gastrointest Endosc 2018; 88:35–42.
18 18 Legett CL, Gorospe EC, Chan DK, et al. Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of Barrett’s esophagus. Gastrointest Endosc 2016; 83:880–888.
19 19 Trindade AJ, McKinley MJ, Fan C. et al. Endoscopic surveillance of Barrett’s esophagus using volumetric laser endomicroscopy with artificial intelligence image enhancement. Gastroenterol 2019; 157:303–305.
20 20 Swager AF, van der Sommen F, Klomp SR, et al. Computer‐aided detection of early Barrett’s neoplasia using volumetric laser endomicroscopy. Gastrointest Endosc 2017; 86:839–846.
21 21 Kahn A, Pai RK, Fukami N. Novel computer‐enhanced visualization of volumetric laser endomicroscopy correlates endoscopic and pathologic images. Clin Gastroenterol Hepatol 2018; 16:xxiii–xxiv.
22 22 ASGE Technology Committee, Thosani N, Abu Dayyeh B, Sharma P, et al. ASGE Technical Committee systematic review and meta‐analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real‐time imaging assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc 2016; 83(4):684–698.
8 High‐Resolution Manometry and Esophageal Pressure Topography
Dustin A. Carlson and Peter J. Kahrilas
Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Acknowledgments
This work was supported by P01 DK117824 (PI: Pandolfino) from the Public Health Service.
Introduction
Esophageal manometry is the primary method to evaluate esophageal motility, done by measuring pressures along the esophagus during test swallows. High‐resolution manometry (HRM) utilizes catheters with pressure sensors spaced 1–2 cm apart spanning from the hypopharynx to the stomach to assess the entire esophagus simultaneously. Sophisticated software algorithms using interpolation between pressure sensors generate esophageal pressure topography (EPT) or Clouse plots that display esophageal motility and sphincter function as color‐coded isobaric contour plots in real time [1, 2]. Analysis of EPT plots is facilitated by analysis software that generates objective metrics of esophageal function that can classify individual swallows and formulate esophageal motility diagnoses [3, 4]. The enhanced pressure resolution, pictorial output, and objective metrics available with HRM/EPT represent a major advancement in technology as compared with the predicate technology in conventional manometry that used pressure sensors spaced 3–5 cm apart displayed as line tracings. As compared with conventional line‐tracing manometry, HRM/EPT provides an increased diagnostic yield for major esophageal motor disorders as well as improved reliability, reproducibility, and accuracy of interpretation [5, 6]. This chapter will discuss the use and interpretation of HRM/EPT.
Indications for esophageal manometry
Esophageal