Abstract
Studies to date have failed to reveal the anatomical counterpart of the lower esophageal sphincter (LES). We assessed the LES and esophageal hiatus morphology using a block containing the human LES and crural diaphragm, serially sectioned at 50 μm intervals and imaged at 8.2 μm/pixel resolution. A 3D reconstruction of the tissue block was reconstructed in which each of the 652 cross sectional images were also segmented to identify the boundaries of longitudinal (LM) and circular muscle (CM) layers. The CM fascicles on the ventral surface of LES are arranged in a helical/spiral fashion. On the other hand, the CM fascicles from the two sides cross midline on dorsal surface and continue as sling/oblique muscle on the stomach. Some of the LM fascicles of the esophagus leave the esophagus to enter into the crural diaphragm and the remainder terminate into the sling fibers of the stomach. The muscle fascicles of the right crus of diaphragm which form the esophageal hiatus are arranged like a “noose” around the esophagus. We propose that circumferential squeeze of the LES and crural diaphragm is generated by a unique myo-architectural design, each of which forms a “noose” around the esophagus.
Highlights
In 2010, Yassi et al.[14] made a novel attempt to study the microscopic myoarchitecture of the lower esophageal sphincter (LES) and CD
Our major and novel finding is that the circular muscle fibers at the lower end of the esophagus cross on its dorsal surface, close to the angle of His and continue as oblique muscle fibers on the anterior and posterior surface of the stomach
In the cranial part of the specimen, the circular muscle fibers are arranged in a spiral fashion
Summary
In 2010, Yassi et al.[14] made a novel attempt to study the microscopic myoarchitecture of the LES and CD. Lack of a powerful, central and graphical processing unit impeded the reconstruction of the 3D anatomy of the EGJ at the micro resolution. In this follow up study, we use the same specimen to report on an actual 3D reconstruction of the myoarchitecture of the EGJ at the microscopic level.
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