Table Of ContentThe SAGES University Masters Program Series
Editor-in-Chief: Brian Jacob
The SAGES Manual
of Flexible Endoscopy
Peter Nau
Eric M. Pauli
Bryan J. Sandler
Thadeus L. Trus
Editors
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The SAGES Manual of
Flexible Endoscopy
The SAGES University Masters Program Series
Editor-in-Chief: Brian Jacob
Peter Nau • Eric M. Pauli
Bryan J. Sandler • Thadeus L. Trus
Editors
The SAGES Manual of
Flexible Endoscopy
Editors
Peter Nau Eric M. Pauli
University of Iowa Penn State Milton S. Hershey
Iowa City, IA Medical Cen
USA Hershey, PA
USA
Bryan J. Sandler Thadeus L. Trus
University of California Dartmouth–Hitchcock Medical
San Diego Center
La Jolla, CA Lebanon, NH
USA USA
ISBN 978-3-030-23589-5 ISBN 978-3-030-23590-1 (eBook)
https://doi.org/10.1007/978-3-030-23590-1
© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020
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To Kayla and our children for keeping me
grounded. To my many mentors who have taught
me the importance of clinical excellence as well as
the value of balance.
Peter Nau
I owe my career as a surgical endoscopist to a
number of individuals. I fell in love with flexible
endoscopy during my residency research years at
Penn State working with Drs. Abraham Mathew and
Matthew Moyer, two gastroenterologists with whom
I collaborated on natural orifice surgery projects.
Leaving the lab, Drs. George Maish and Kenneth
Graf let me essentially run the endoscopy lab at our
local VA. They never once made me go to the OR to
operate when I wanted to be scoping and performing
endoscopic interventions. I finished residency with
almost 600 endoscopies on the books, largely due to
their willingness to let me follow my passion. I took
my basic endoscopy skillset to Cleveland, where Drs.
Jeffrey Marks and Jeffrey Ponsky elevated it to a new
level. They helped me understand the full potential
of the flexible endoscopic surgeon, they taught me to
think outside the standard boxes most surgeons are
comfortable in, and they promoted me on a national
level. When I returned to Penn State, my chairman,
Dr. Peter Dillon, instructed the OR to equip me with
what I needed to be successful. I opened an Olympus
endoscope catalogue and circled everything, and
they purchased it all. My senior partners Drs. Randy
Haluck, Ann Rogers, and Jerome Lyn-Sue sent
me every patient they had who needed endoscopy,
trusting my capabilities from day one. What more
could I ask for? There are other individuals as
well: GI colleagues, surgical partners, fellows,
and residents who have made it possible. Special
recognition goes to my friend Mr. Christopher
Ramsay, whose dedication in promoting the surgeon-
endoscopist deserves much more recognition than it
will likely ever receive. Finally, immense amounts of
love and thanks go to my wife, Dr. Jaimey Pauli, and
our daughter, Rory, for letting me make an academic
career out of my passion.
Eric M. Pauli
I’d like to dedicate this manual to the surgical
trainees at UC San Diego and elsewhere in their
pursuit of surgical endoscopy excellence as well
as to the mentors I’ve had during my training to
whom I owe much: thank you all.
Bryan J. Sandler
Thanks to family, friends, students, residents, and
fellows.
Thadeus L. Trus
Preface
Flexible endoscopy is a critical component in the delivery of
high-quality, comprehensive surgical care. While gastroenter-
ologists serve a vital role in this regard, for many patients,
flexible endoscopy is only available in the hands of a surgeon.
Perhaps more importantly, surgeons are uniquely able to uti-
lize endoscopy in the preoperative, intraoperative, and post-
operative setting and are able to approach endoscopy with a
robust understanding of surgical anatomy. Surgeons facile in
flexible endoscopy can assure an accurate diagnosis warrant-
ing intervention, can assess of the quality of their operation
in real time, and can manage their own postoperative
complications.
The history of modern surgery is that of operative inter-
ventions being replaced by therapy delivered via a flexible
endoscope. The ability of surgeons to identify the faults of
current therapy and to witness first-hand the morbidity of
their own operations has driven them to innovate endoscopi-
cally. Endoscopic illumination, colonoscopic polypectomy,
endoscopic retrograde cholangiopancreatography, percutane-
ous endoscopic gastrostomy, esophageal variceal banding,
per-oral endoscopic myotomy, and endoscopic therapies for
obesity, bleeding, gastroesophageal reflux, and dysplastic tis-
sues all have been developed by or with surgeons. There is
little doubt that these trends will continue in the future, as
increasingly more procedures are being offered via an endo-
scopic platform.
vii
viii Preface
The SAGES Manual of Flexible Endoscopy is written for
surgeons of all training and skill levels. For residents, we hope
this text inspires you to see the value-added proposition that
endoscopy can bring to your practice as a gastrointestinal
surgeon. For fellows, the manual was designed to serve as the
backbone of your flexible endoscopy curriculum and was
built around the Entrustable Professional Activity model of
education. For practicing surgeons, the text will provide you
with an overview of modern endoscopy practice and (we
hope) motivate you to seek education and training opportu-
nities to expand the offerings of endoscopy in your practice.
Iowa City, IA, USA Peter Nau, MD, MS, FACS
Hershey, PA, USA Eric M. Pauli, MD, FACS, FASGE
La Jolla, CA, USA Bryan J. Sandler, MD, FACS
Lebanon, NH, USA Thadeus L. Trus, MD
Contents
Part I S AGES Masters Program
1 SAGES University Masters Program: Flexible
Endoscopy Pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Daniel B. Jones, Linda Schultz, and Brian P. Jacob
2 Masters Program Flexible Endoscopy Pathway:
Diagnostic Esophagogastroduodenoscopy . . . . . . . . . 15
Consandre P. Romain, Robert Joshua Bowles,
and Jose M. Martinez
3 Masters Program Flexible Endoscopy Pathway:
Diagnostic Colonoscopy . . . . . . . . . . . . . . . . . . . . . . . . 29
Emily Huang and Syed G. Husain
4 Masters Program Flexible Endoscopy Pathway:
Percutaneous Endoscopic Gastrotomy (PEG) . . . . . . 51
Daniel Davila, Ramona Ilie, and Edward Lin
5 Masters Program Flexible Endoscopy Pathway:
Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Wanda Lam, Ian Greenwalt, and Jeffrey Marks
6 Masters Program Flexible Endoscopy Pathway:
Balloon Dilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Jordan D. Bohnen and Ozanan R. Meireles
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