Document Detail


3D-high resolution manometry of the esophagogastric junction.
MedLine Citation:
PMID:  21595803     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The esophagogastric junction (EGJ) is a complex structure that challenges accurate manometric recording. This study aimed to define EGJ pressure morphology relative to the squamocolumnar junction (SCJ) during respiration with 3D-high resolution manometry (3D-HRM).
METHODS: A 7.5-cm long 3D-HRM array with 96 independent solid-state pressure sensors (axial spacing 0.75 cm, radial spacing 45°) was used to record EGJ pressure in 15 normal subjects. Concurrent videofluoroscopy was used to localize the SCJ marked with an endoclip. Ex vivo experiments were done on the effect of bending the probe to match that seen fluoroscopically.
KEY RESULTS: 3D-high resolution manometry EGJ pressure recordings were dominated by an asymmetric pressure peak superimposed on the lower esophageal sphincter (LES) attributable to the crural diaphragm (CD). Median peak CD pressure at expiration and inspiration (51 and 119 mmHg, respectively) was much greater in 3D-HRM than evident in HRM with circumferential pressure averaging. Esophagogastric junction length, defined as the zone of circumferential pressure exceeding that of adjacent esophagus or stomach was also substantially shorter (2.4 cm) than evident in conventional HRM. No consistent circumferential EGJ pressure was evident distal to the SCJ in 3D-HRM recordings and ex vivo experiments suggested that the intra-gastric pressure peak seen contralateral to the CD related to bending the assembly rather than the sphincter per se.
CONCLUSIONS & INFERENCES: 3D-high resolution manometry demonstrated a profoundly asymmetric and vigorous CD component to EGJ pressure superimposed on the LES. Esophagogastric junction length was shorter than evident with conventional HRM and the distal margin of the EGJ sphincteric zone closely correlated with the SCJ.
Authors:
M A Kwiatek; J E Pandolfino; P J Kahrilas
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural     Date:  2011-05-20
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  23     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-10     Completed Date:  2012-02-13     Revised Date:  2014-09-14    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e461-9     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adult
Esophagogastric Junction / anatomy & histology*
Female
Fluoroscopy / methods
Humans
Imaging, Three-Dimensional / instrumentation,  methods*
Male
Manometry / instrumentation,  methods*
Middle Aged
Pressure
Respiration*
Video Recording / methods
Young Adult
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK056033-09/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902-03/DK/NIDDK NIH HHS
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