title: Calculation of esophagogastric junction vector volume using three-dimensional high-resolution manometry.
abstract: Lower esophageal sphincter vector volume (V-V) was developed in the late 1980s by Bombeck, as a quantification of sphincter integrity used to select reflux patients with a defective valve who may benefit from surgery. Its calculation required motorized pull-through of an 8-lumen water perfused manometry catheter with subsequent computerized reconstruction of sphincter morphology. Recently, a three-dimensional high-resolution manometry (3D-HRM) assembly (Given Imaging, Duluth, GA, USA) has been developed with the potential to assess real-time V-V. The aim of this study was to assess the feasibility of the calculation of V-V using the 3D-HRM assembly and to compare measures of its value using real-time 3D-HRM to simulated analogous measures. Eight asymptomatic controls (4F, ages 26-49) were studied in a supine position with a solid-state 3D-HRM assembly positioned across the esophagogastric junction (EGJ). The 9-cm 3D segment comprised 12 rings of 8 radially dispersed pressure sensors, each 2.5 mm long and spaced 7.5 mm apart on center. Recordings were done during normal respiration: (i) with the 3D-HRM segment in a stationary position across the EGJ; and (ii) during a station pull-through of the 3D-HRM segment withdrawing it across the EGJ at 5-mm increments with each position held for 30 seconds. EGJ cross-sectional vector areas (CSVAs) were computed using the irregular polygon area formula: [Formula in text], and n = 8 radial sensors. V-V was computed as the sum of CSVAs at inspiration and end-expiration by three methods: real-time 3D-HRM, three-station composite, and single-sensor ring measurements. There were no statistic differences among the methods, and all methods showed significant differences between inspiration and expiration. Calculation of real-time V-V is feasible using the 3D-HRM. Moreover, the results of this study highlighted the potential primary role of the diaphragmatic hiatus in the pathophysiology of gastroesophageal reflux disease and the underrecognized but crucial role of the crural repair during the antireflux surgery.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.|Department of Thoracic Surgery, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Nicodème
authors.affiliation: Department ofSurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Soper
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D000328:Adult; D000465:Algorithms; D003964:Diaphragm / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D004943:Esophagogastric Junction / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011312:Pressure; D012119:Respiration
keywords: esophageal pressure topography; esophagogastric junction; gastroesophageal reflux disease; lower esophageal sphincter; three-dimensional-high resolution manometry; vector volume
references.citation: Surg Gynecol Obstet. 1951 Apr;92(4):419-31
references.pmid: 14835197
references.citation: World J Surg. 1992 Mar-Apr;16(2):313-9
references.pmid: 1561816
references.citation: Cleve Clin J Med. 2003 Nov;70 Suppl 5:S4-19
references.pmid: 14705378
references.citation: Ann Surg. 1991 Oct;214(4):374-83; discussion 383-4
references.pmid: 1953093
references.citation: Dis Esophagus. 2006;19(1):31-5
references.pmid: 16364041
references.citation: Aliment Pharmacol Ther. 2009 Nov 15;30(10):1030-8
references.pmid: 19737151
references.citation: Neurogastroenterol Motil. 2013 Sep;25(9):e591-8
references.pmid: 23734788
references.citation: Dis Esophagus. 2001;14(1):54-6
references.pmid: 11422307
references.citation: Ann Surg. 1987 Oct;206(4):465-72
references.pmid: 3662658
references.citation: Dig Dis Sci. 1996 Dec;41(12):2377-82
references.pmid: 9011446
references.citation: Ann Chir Gynaecol. 1995;84(2):151-8
references.pmid: 7574373
references.citation: Am J Gastroenterol. 2007 May;102(5):1056-63
references.pmid: 17319930
references.citation: Neurogastroenterol Motil. 2011 Nov;23(11):e461-9
references.pmid: 21595803
references.citation: Gastroenterology. 1993 Nov;105(5):1362-9
references.pmid: 8224640
references.citation: Am J Physiol Gastrointest Liver Physiol. 2012 Aug 1;303(3):G275-80
references.pmid: 22628033
references.citation: Neurogastroenterol Motil. 2012 Mar;24 Suppl 1:57-65
references.pmid: 22248109
references.citation: Aliment Pharmacol Ther. 2007 Jul 15;26(2):149-60
references.pmid: 17593062
references.citation: Gastroenterology. 1976 Jan;70(1):117-23
references.pmid: 1245272