Three‐dimensional imaging of upper esophageal sphincter resting pressure

Abstract

ObjectiveHigh‐resolution manometry (HRM) is used to analyze upper esophageal sphincter (UES) physiology. Conventional HRM can yield imprecise measurements of UES resting pressure given its unidirectional sensors and averaging of circumferential pressure. In contrast, three‐dimensional (3D) measurements can yield precise UES resting pressure data over the entire length of the UES. This study conducted a detailed analysis of UES resting pressure as evaluated by 3D‐HRM.MethodsSeventeen young, healthy adult participants (7 females and 10 males) were recruited. The 3D‐HRM system used includes a pressure sensor catheter (outer diameter, 4 mm) and eight‐channel transducers arranged circumferentially to acquire pressure data at 45° intervals. The catheter was inserted transnasally into the esophagus and automatically retracted at a speed of 1 mm/s. Participants performed the following tasks: maintain resting breathing, perform breath holding, and perform the Valsalva maneuver. Data were obtained and compared per millimeter over the longitudinal UES length.ResultsClear 3D waveforms were identified, with greater mean UES pressures in anterior‐posterior directions than in lateral directions (P < .05). The anterior distribution was located superior to the posterior portion. Significant differences were observed in mean UES pressures and UES resting integrals between resting breathing and the Valsalva maneuver (P < 0.05). No differences in functional UES length were observed.ConclusionsThe normal UES resting pressure was not directionally uniform in the luminal structure. 3D‐HRM imaging of UES resting pressure can help deepen our understanding of UES physiology.Level of Evidence4

Variables influencing manometric parameters of deglutitive and non‐deglutitive upper esophageal sphincter: A study of 89 asymptomatic participants

“…With the introduction of circumferentially recording pressure sensors spaced at one‐centimeter intervals, the above‐mentioned technical shortcomings can be overcome, which presents the opportunity to systematically include the manometric evaluation of the UES in clinically performed manometry. Data in this regard are emerging 74–76 and the present study contributes to the fundamental information in this field.…”

Relationship between Swallowing Pressure and Saliva Residue on Endoscopic Evaluation in Pharyngeal Dysphagia

“…On the other hand, piriform sinus residue is usually interpreted as the result of impaired pharyngeal contraction and/or hyolaryngeal elevation 2,3 . In addition, residue in the post‐cricoid region, which included the piriform sinuses in the present study, is usually interpreted as an impairment resulting from UES dysfunction and/or proximal esophageal obstruction 31,32 . The hypopharyngeal site is susceptible to complex dysfunction, obstruction, and salivary retention.…”

“…2,3 In addition, residue in the postcricoid region, which included the piriform sinuses in the present study, is usually interpreted as an impairment resulting from UES dysfunction and/or proximal esophageal obstruction. 31,32 The hypopharyngeal site is susceptible to complex dysfunction, obstruction, and salivary retention. From our results, it is also reasonable to conclude that the amount of SR is higher in the piriform sinuses (i.e., the post-cricoid region) than in the valleculae.…”

Differences in upper esophageal sphincter function and clinical characteristics among the three subtypes of Japanese patients with esophageal achalasia

“…Fifth, the method used in this study was not completely equivalent to previous studies. For instance, unlike our method, 3D catheter [21], water perfused method, and pull-through technique [25] were used in the previous studies. The difference made it harder to directly compare the results; however, we could discuss the tendency in each research, not the actual value itself.…”

“…The calculated parameters in this study were the UES length, 4 s-integrated relaxation pressure (IRP), resting UES pressure, UES residual pressure (nadir UES pressure during relaxation), UES relaxation time, and distal contractile integral (DCI) as a parameter to esophageal body pressurization [11]. Resting UES pressure was defined as the average pressure of the UES between deglutition with resting breathing and without swallowing activity where we could observe stable UES pressure [21]. We assessed the pressure three times in each patient, and the average pressure was adopted as the resting UES pressure.…”