The contribution of the sling fibers to lower esophageal sphincter asymmetry

Abstract

THE CONTRIBUTION OF THE SLING FIBERS TO LOWER ESOPHAGEAL SPHINCTER ASYMMETRY. JH Schneider, PF Crookes, H Thomas, CG Bremner, TR DeMeester. Department of Surgery, University of Southern California, Los Angeles, California. The sling fibers are located on the left lateral quadrant of the cardia. The significance of this muscle layer for normal and pathologic function of the lower esophageal sphincter (LES) is still controversial and the evaluation of it’s pressure contribution to the LES has not previously been possible. A new circular four channel water-perfused sleeve catheter was developed to quantify this pressure. Materials and Method: The basal pressure of the LES (LESP) was detected in 2 groups. 1: controls (n=34), 2: refluxers (n=51). The patients underwent gastroscopy, x-ray examination and 24-hr monitoring before long-term manometry. All subjects were measured with the circular sleeve (size 5Ox4mm) in the supine position. Each channel was perfused with O.Sml/min water. The station pull-through technique (SPT) was used to measure the LESP. The circular sleeve was validated with the Dent sleeve and a conventional four side hole catheter. The left lateral position of channel III, which measured the sling fiber pressure contribution, was confiied radiologically. Pressures were compared during various body position changes in controls. The students T-test and Mann-Whitney-U test were utilized to compare the results (Table). LESP mmHg(xfSW