Esophagus

2020 ◽  
pp. 91-109
Author(s):  
Jad M. Abdelsattar ◽  
Moustafa M. El Khatib ◽  
T. K. Pandian ◽  
Samuel J. Allen ◽  
David R. Farley
Keyword(s):  
Anastomotic Leak ◽  
Lower Esophageal Sphincter ◽  
Thoracic Duct ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Gastroesophageal Junction ◽  
Esophageal Surgery ◽  
Gastric Cardia ◽  
Iatrogenic Perforation ◽  
Cricopharyngeus Muscle

The esophagus is a hollow muscular tube approximately 25 cm in length, extending from the cricopharyngeus muscle to the gastroesophageal junction at the gastric cardia. It is the only organ that uses peristalsis. Achalasia is defined as failure of lower esophageal sphincter relaxation with concurrent esophageal aperistalsis. Esophageal manometry is the standard for diagnosing achalasia and DES. Achalasia is managed surgically with a Heller myotomy. Esophageal surgery may result in an iatrogenic perforation, thoracic duct injury, or anastomotic leak.

Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 798-805
Author(s):  
William E. Berquist ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
Eric W. Fonkalsrud ◽  
Arthur R. Euler
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
School Aged Children ◽  
Retrosternal Pain ◽  
Esophageal Sphincter

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.

scholarly journals Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

2020 ◽  
Vol 14 (1) ◽  
pp. 48-55
Author(s):  
Muhammad Miftahussurur ◽  
Manu Tandan ◽  
Dadang Makmun ◽  
Zaheer Nabi
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Gastroesophageal Junction ◽  
Barium Swallow ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Eckardt Score ◽  
Heller's Myotomy ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller’s myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for achalasia due to persistent symptoms after Heller’s myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller’s myotomy was performed 2 years ago. Barium swallow showed achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an achalasia patient who received POEM after unsuccessful Heller’s myotomy and showed clinical improvement.

Esophageal manometry in the opossum.

1977 ◽  
Vol 233 (3) ◽  
pp. E152
Author(s):  
K Schulze ◽  
W J Dodds ◽  
J Christensen ◽  
J D Wood
Keyword(s):  
Animal Model ◽  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Lower Esophageal Sphincter Pressure ◽  
Upper Esophageal Sphincter ◽  
Sphincter Pressure ◽  
Coronal Section ◽  
Esophageal Sphincter ◽  
Human Esophagus

The opossum esophagus is commonly used as an animal model of the human esophagus. We used esophageal manometry in normal animals to provide basal data about normal esophageal motor functions in vivo in this species. At rest, separate and distinct high pressure zones can be recorded at the level of the lower esophageal sphincter, diaphragmatic hiatus, aortic arch, and upper esophageal sphincter. Each zone demonstrates a characteristic pattern of pressures in the radii of the coronal section and a characteristic response to swallowing. The hiatal and aortic zones can be mistaken for the esophageal sphincters. Pressures in the sphincters fall with swallowing. Peristalsis is not bolus-dependent and occurs with 98% of swallows. Pressures generated by peristalsis are greater in the middle of the esophagus than at the ends. Values for resting lower esophageal sphincter pressure and the characteristics of peristalsis were reproducible between different studies in the same animals.

scholarly journals P-87 Thoracic duct embolization for high-output chylothorax after esophageal surgery

2020 ◽  
Vol 31 ◽  
pp. S118
Author(s):  
T. Michiura ◽  
H. Miki ◽  
H. Mukaide ◽  
K. Inoue ◽  
M. Hamada ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Esophageal Surgery ◽  
High Output

Diaphragmatic contribution to gastroesophageal competence and reflux in dogs

1992 ◽  
Vol 263 (4) ◽  
pp. G551-G557 ◽  
Author(s):  
C. J. Martin ◽  
W. J. Dodds ◽  
H. H. Liem ◽  
R. O. Dantas ◽  
R. D. layman ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Short Duration ◽  
Gastroesophageal Junction ◽  
Selective Inhibition ◽  
High Amplitude ◽  
Gastric Distension ◽  
Esophageal Body ◽  
Esophageal Sphincter ◽  
Crural Diaphragm

Events associated with gastroesophageal reflux have been determined by concurrent diaphragmatic and esophageal body electromyography, video radiography, and manometry in four conscious dogs. Three characteristic phenomena occurred in parallel immediately before and during gastroesophageal reflux: 1) transient lower esophageal sphincter relaxation, 2) profound (99.5%) and selective inhibition of crural diaphragmatic activity, and 3) a previously unrecognized dorsal movement of the gastroesophageal junction (mean 1.3 cm) demonstrated by implanted radiological markers. The patterns associated with spontaneous acid and gas reflux were indistinguishable from those induced by gastric distension. Costolumbar diaphragmatic activity was stable up until the instant of sphincter opening, when there was a single costolumbar contraction of short duration and high amplitude. Esophageal shortening did not occur before reflux. Reflux that occurred after atropine-induced inhibition of lower esophageal sphincter tone to < 2 mmHg was intermittent and coincided with selective crural inhibition. These studies demonstrated that selective crural inhibition is a prerequisite for gastroesophageal reflux and suggest that the crural diaphragm is an important factor for the maintenance of gastroesophageal competence.

scholarly journals Laparoscopic Removal of Angelchik Prosthesis Followed by Interval Sleeve Gastrectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Faryal G. Afridi ◽  
Morgan Johnson ◽  
Kelsey A. Musgrove ◽  
Salim Abunnaja ◽  
Lawrence E. Tabone ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Gastroesophageal Junction ◽  
Antireflux Procedure ◽  
Bariatric Clinic ◽  
Work Up ◽  
Laparoscopic Removal

Introduction. The Angelchik prosthesis (AP) is a historic antireflux device which consists of a C-shaped silicone ring placed around the gastroesophageal junction (GEJ) and secured by Dacron tape. We present a rare experience with an AP and its impact on bariatric surgical outcomes. Case. Our patient is a 66-year-old woman who had an open antireflux procedure with an AP in 1987. She presented to a bariatric clinic for consideration of bariatric surgery for the treatment of morbid obesity and associated comorbidities. She also reported significant problems with reflux and dysphagia. After an appropriate work-up, an AP was identified at her GEJ. She was taken to the operating room for laparoscopic removal with planned interval laparoscopic sleeve gastrectomy. Intraoperatively, the AP was identified around the GEJ; after extensive adhesiolysis, the prosthesis was removed. Postoperatively, in order to determine if the AP had caused any lasting esophageal motility problems, the patient underwent a high-resolution esophageal manometry which demonstrated normal esophageal motility. Interval laparoscopic sleeve gastrectomy was performed safely 9 weeks later. Conclusion. Although rarely used, it is still possible to encounter an Angelchik prosthesis in practice. General and bariatric surgeons need to be aware of this rare device and understand how to manage its related complications.

The effect of eating on lower esophageal sphincter electrical activity

2009 ◽  
Vol 296 (4) ◽  
pp. G793-G797
Author(s):  
Claudia P. Sanmiguel ◽  
Yuichiro Ito ◽  
Masanobu Hagiike ◽  
Jeffrey L. Conklin ◽  
David Lalezari ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Longitudinal Axis ◽  
Implantable Device ◽  
Solid Food ◽  
Standard Meal ◽  
Esophageal Sphincter

Electrical activity of the lower esophageal sphincter (LES) has been recorded mainly in vitro and in anesthetized animals. Swallowing produces relaxation of the LES, followed by its contraction. These changes should be associated with changes in LES electrical activity. To determine whether changes in LES electrical activity can be used to recognize the beginning of a meal, four dogs were implanted with two electrodes in the longitudinal axis of the LES. The electrodes were connected to an implantable device for recording of electrical activity. After recovery, dogs underwent two experiments: 1) combined recordings of LES electrical activity and esophageal manometry to test the effect of dry swallows, water, and solid food swallows on LES electrical activity and 2) telemetric recording of LES electrical activity during a standard meal. All amplitudes were in mV, means ± SD, ANOVA, P < 0.05. In experiment 1, an increase in the amplitude of LES electrical activity was associated with the substance being swallowed, i.e., at rest: 0.31 ± 0.06; dry swallows: 0.6 ± .0.1; water: 0.67 ± 0.12; solid food: 1.06 ± 0.17, P < 0.001. In experiment 2, there was a pronounced and characteristic increase in amplitude of LES electrical activity during feeding, 0.26 ± 0.1; during fasting, 0.99 ± 0.23; while eating, 0.31 ± 0.1 postprandial, P < 0.001. In conclusion, the beginning and duration of a meal are identified by distinct, easily recognizable changes in the amplitude of LES electrical activity. These changes depend on the type of the substance being swallowed and are most prominent with solid food. Changes in LES electrical activity can potentially be used for automatic eating detection.

scholarly journals Mechanism of UES relaxation initiated by gastric air distension

2014 ◽  
Vol 307 (4) ◽  
pp. G452-G458 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Time Delay ◽  
Lower Esophageal Sphincter ◽  
Gastroesophageal Junction ◽  
Esophageal Pressure ◽  
Upper Esophageal Sphincter ◽  
Gastric Fistula ◽  
Esophageal Mucosa ◽  
Rapid Injection ◽  
Free Air ◽  
Esophageal Sphincter

The aim of this study was to determine the mechanism of initiation of transient upper esophageal sphincter relaxation (TUESR) caused by gastric air distension. Cats ( n = 31) were decerebrated, EMG electrodes were placed on the cricopharyngeus, a gastric fistula was formed, and a strain gauge was sewn on the lower esophageal sphincter ( n = 8). Injection of air (114 ± 13 ml) in the stomach caused TUESR ( n = 18) and transient lower esophageal sphincter relaxation (TLESR, n = 6), and this effect was not significantly ( P > 0.05) affected by thoracotomy. Free air or bagged air ( n = 6) activated TLESR, but only free air activated TUESR. Closure of the gastroesophageal junction blocked TUESR (9/9), but not TLESR (4/4), caused by air inflation of the stomach. Venting air from distal esophagus during air inflation of the stomach prevented TUESR ( n = 12) but did not prevent air escape from the stomach to the esophagus ( n = 4). Rapid injection of air on the esophageal mucosa always caused TUESR (9/9) but did not always (7/9) cause an increase in esophageal pressure. The time delay between the TUESR and the rapid air pulse was significantly more variable ( P < 0.05) than the time delay between the rapid air pulse and the rise in esophageal pressure. We concluded that the TUESR caused by gastric air distension is dependent on air escape from the stomach, which stimulates receptors in the esophagus, but is not dependent on distension of the stomach or esophagus, or the TLESR. Therefore, the TUESR caused by gastric air distension is initiated by stimulation of receptors in the esophageal mucosa.

scholarly journals Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

2021 ◽  
Vol 1 (3) ◽  
pp. 216-226
Author(s):  
Shahin Ayazi
Keyword(s):  
Risk Stratification ◽  
Antireflux Surgery ◽  
Esophageal Manometry ◽  
Critical Role ◽  
Gastroesophageal Junction ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Postoperative Dysphagia ◽  
Prognostic Utility

Manometric assessment of the gastroesophageal junction (GEJ) and esophageal body is the key to a better understanding of the mechanics of antireflux surgery (ARS) and maximizing its benefits while minimizing adverse outcomes. However, there is an attitude of uncertainty regarding the necessity of esophageal motility prior to ARS among some surgeons. This evidence-based review highlights the critical role of manometry in the preoperative workup for patients undergoing ARS. It also discusses how manometry can detect findings associated with favorable outcomes or the risk of postoperative dysphagia. Manometric data can be used for risk stratification and the prediction of outcomes, aiding the surgeon in matching an operation to the specific physiology of each individual patient.

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