Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study - 24/08/11
Reprint requests: Reza Shaker, MD, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 Wisconsin Avenue, Milwaukee, WI 53226Riassunto |
Background |
The pharyngoesophageal segment commonly referred to as the upper esophageal sphincter (UES) generates a high-pressure zone (HPZ) between the pharynx and the esophagus. However, the exact anatomical components of the UES-HPZ remain incompletely determined.
Objective |
To systematically define the US signature of various components of the pharyngoesophageal junction and to determine how these structures contribute to the development of the UES-HPZ.
Design |
Prospective, experimental study.
Setting |
Tertiary Academic Medical Center.
Patients |
This study involved 18 healthy volunteers.
Intervention |
We studied 5 participants by using a high-frequency US miniprobe (US-MP) and concurrent fluoroscopy and another 13 participants by using the US-MP and concurrent manometry.
Main Outcome Measurements |
Relative contribution of various muscles in the UES-HPZ.
Results |
Manometrically, the UES-HPZ had a median length of 4.0 cm (range 3.0-4.5 cm). A C-shaped muscle, believed to represent the cricopharyngeus muscle, was observed for a median length of 3.5 cm (range 2.0-4.0 cm). The oval configuration representing the esophageal contribution to the UES was seen in 10 of 13 participants (77%) at the distal HPZ (esophagus to UES transition zone). The flat configuration of the inferior constrictor muscle was noted in 7 of 13 participants (54%) at the proximal HPZ (UES to pharynx transition zone). There were 4 to 5 wall layers versus 3 layers in the distal and proximal HPZ, respectively. The mean (± SD) muscle thickness was relatively constant along the length of the UES-HPZ.
Limitations |
Air artifacts in the UES-HPZ.
Conclusion |
The configuration and layers of the UES-HPZ vary along its length. The upper esophagus is a significant contributor to the distal UES-HPZ.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : HPZ, MMMT, UES, US-MP
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| DISCLOSURE: Drs Shaker, Dua, and Surapaneni were supported by National Institutes of Health grants 5P01DK068051 and 5R01DK025731. All other authors disclosed no other financial relationships relevant to this publication. |
Vol 72 - N° 3
P. 587-592 - settembre 2010 Ritorno al numero
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