Sa1435 Sonographic Antomy of the Gastroesohageal Junction High Pressure Zone (GEJHPZ) Using Endoluminal Ultrasound, Manometry and High Resolution CT Scan

Abstract

ents of the HPZ. From prior anatomic studies using simultaneous high resolution manometry and high frequency ultrasound with pharmacologic manipulation, these HPZ components represent a proximal lower esophageal circular muscle sphincter (LEC), a mid crural diaphragm (CD) and a distal gastric sling and clasp muscle fiber complex. The average pressure in each of these components was 24.7+/10.7mmHg in the LEC, 33.2+/-17.2mmHg in the crural diaphragm and 15.83+/-8.03 in the clasp sling muscle fiber complex. The width of the LEC, crural diaphragm and gastric sling clasp fiber complex was 1.01 +/0.25cm, 1.29 +/0.37cm and 0.76 +/0.3 cm respectively. The total length of the high-pressure zone was 4.08 +/0.61 cm. The distance between the peak pressure within the gastric sling and clasp muscle fiber complex and the crural diaphragm was 1.7 +/0.53cm and the distance between the crural diaphragm and the LEC was 1.4 +/-0.48. CONCLUSIONUsing high spatial resolution manometry within the high-pressure zone of the gastroesophageal junction, it is possible to resolve the high-pressure zone into 3 distinct and separate components. These components represent the gastric sling and clasp fiber muscle complex in the proximal stomach, the crural diaphragm measured in the distal esophagus and the LEC muscle proximal to the CD. The average pressure, width and distance between these components were measured.