Observations on oesophageal length.

Abstract

Colfis, J. (1976). Thorax, 31,[284][285][286][287][288]. Observations on oesophageal length. The subject of oesophageal length is discussed. The great variations in the length of the oesophagus in individual patients is noted, and the practical use of its recognition in oesophageal surgery is stressed. An appraisal of the various methods available for this measurement is made; this includes the use of external chest measurement, endoscopic measurement, and the measurement of the level of the electrical mucosal potential change.Correlative studies of these various methods are made, and these show a very high degree of significance. These studies involved simultaneous measurement of external and internal oesophageal length in 26 patients without a hiatal hernia or gastro-oesophageal reflux symptoms, 42 patients with sliding type hiatal hernia, and 17 patients with a peptic stricture in association with hiatal hernia.The method of measuring oesophageal length by the use of the external chest measurement, that is, the distance between the lower incisor teeth and the xiphisternum, measured with the neck fully extended and the patient lying supine, is described in detail, its practical application in oesophageal surgery is illustrated, and its validity tested by internal measurements. The findings of this study demonstrate that the external chest measurement provides a means of assessing the true static length of the oesophagus, corrected for the size of the individual.Cunningham (1902) observed that the length of the oesophagus varies in different individuals from 20 to 35 cm, the distance from the upper incisors to the beginning of the oesophagus averages 15 cm, and the breadth varies between 13 mm in the empty contracted state to 30 mm in the fully distended condition. At endoscopy the usual length is 40 cm, measured from the incisor teeth to the point where the mucosal change occurs. Acceptance of the above figures is likely to lead to error if account is not taken of the fact that the length of the oesophagus varies from one person to another. This difficulty is often experienced when trying to reduce sliding type hiatal herniae of similar size; reduction is easy in one and impossible in the other. The length of the oesophagus may be a factor determining whether a hiatal hernia is reducible or not. There is only one real cause of shortening of the oesophagus, that is, shortening of its muscle length. Longitudinal muscle dysfunction can result in permanent shortening of the oesophagus with misplacement of the cardia into the chest. Irreducibility of the hiatal hernia is a characteristic feature in cases of peptic stricture with oesophagitis and shortening ofthe oesophagus. Shortening of the oesophagus is also seen in collagen disorders such as systemic sclerosis and after irradiation for oesophageal carcinoma. Lengthening of the oesophagus is seen classically in advanced cases of achalasia with paralysis and dilatation.Observations have shown great variations in the length of the oesophagus in adults, between 46...

Esophageal body length, lower esophageal sphincter length, position and pressure in health and disease

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