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Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study.

Abstract：

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Hernandez LV,Dua KS,Surapaneni SN,Rittman T,Shaker R

doi

10.1016/j.gie.2010.04.029

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

587-92

issue

3

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01557-9

journal_volume

72

pub_type

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