Open AccessCalculation of esophagogastric junction vector volume using three‐dimensional high‐resolution manometry
Author(s) -
Nicodème F.,
Soper N. J.,
Lin Z.,
Pandolfino J. E.,
Kahrilas P. J.
Publication year - 2015
Publication title -
diseases of the esophagus
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 63
eISSN - 1442-2050
pISSN - 1120-8694
DOI - 10.1111/dote.12262
Subject(s) - medicine , supine position , high resolution manometry , esophagogastric junction , asymptomatic , position (finance) , esophageal sphincter , nuclear medicine , reflux , anatomy , surgery , esophagus , achalasia , adenocarcinoma , finance , cancer , disease , economics
Summary Lower esophageal sphincter vector volume ( V ‐ V ) was developed in the late 1980s by B ombeck, 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 (3 D ‐ HRM ) assembly ( G iven I maging, D uluth, 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 3 D ‐ HRM assembly and to compare measures of its value using real‐time 3 D ‐ HRM to simulated analogous measures. Eight asymptomatic controls (4 F , ages 26–49) were studied in a supine position with a solid‐state 3 D ‐ HRM assembly positioned across the esophagogastric junction ( EGJ ). The 9‐cm 3 D 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 3 D ‐ HRM segment in a stationary position across the EGJ ; and (ii) during a station pull‐through of the 3 D ‐ HRM segment withdrawing it across the EGJ at 5‐mm increments with each position held for 30 seconds. EGJ cross‐sectional vector areas ( CSVA s) were computed using the irregular polygon area formula: C S V A = (sin (360 n ) 2 ) × ( P 1 × P 2 + P 2 × P 3 … P n × P 1 ) , and n = 8 radial sensors. V ‐ V was computed as the sum of CSVA s at inspiration and end‐expiration by three methods: real‐time 3 D ‐ 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 3 D ‐ 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.