Manometric Studies of the Upper Esophageal Sphincter

Abstract

The pharyngoesophageal sphincter (PES) has been studied extensively using the standard three lumen esophageal catheter. Studies using this catheter are nonreproduciible because intraluminal pressure in the PES is dependent on the orientation of the catheter. This difficulty was overcome when a multiluminal catheter was developed by Winans. In this work we used a modification of this multiluminal catheter to study the PES in 6 normal patients and in 13 patients who had undergone partial laryngeal surgery. Pressure profiles in the six normal patients revealed a marked increase in intraluminal pressure in the anterior-posterior direction. This is explained by the anatomy of the cricopharyngeal muscle which does not insert in a median raphe. These readings were reliable and reproducible. The operative patients included nine subtotal supraglottic laryngectomies and four partial laryngopharyngectomies. Eight patients had a cricopharyngeal myotomy and five did not. Pre- and postoperative measurements in this series revealed a marked decrease in PES pressure in those patients who had a myotomy; however, all patients were decannulated and swallowed postoperatively without clinical evidence of aspiration. All future manometric studies of the PES should employ a multilumined catheter in order that the differential pressures in the upper esophagus are recorded.