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2007 Program and Abstracts | 2007 Posters
High Resolution Manometry Findings in Patients with Intrathoracic Stomach
Fernando a. M. Herbella*, Oliver Gellersen, Valerie a. Williams, Daniel Raymond, Carolyn Jones, Thomas Watson, Jeffrey H. Peters
Department of Surgery, Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY

Using conventional manometry, the majority of patients with massive paraesophageal hiatal hernias will present with a hypotensive lower esophageal sphincter (LES) and hypotensive peristalsis in the distal esophageal body; however, there are no reports on the use of high resolution manometry (HRM) in patients with an intrathoracic stomach.
Aim: This study aims to evaluate the manometric pattern found in patients with an intrathoracic stomach using HRM.
Methods: We reviewed 10 patients (9 females, median age 62 years) who were found to have an intrathoracic stomach, as defined by a large paraesophageal hernia with more than 50% of the stomach in the mediastinum on barium esophagography. Nine patients had a type III hernia and one patient had a type IV hernia. All patients underwent HRM in our laboratory.
Results: Results are expressed in the table below.The LES was hypotensive (<6mmHg) in 1 (10%) patient and hypertensive (>28mmHg) in 2 (20%) patients. Distal esophageal amplitude was hypotensive in 1 (10%) patient. Proximal esophageal amplitude was hypotensive (<30mmHg) in 3 (30%) patients.
Conclusion: Most patients with an intrathoracic stomach have normal manometric findings on HRM.

Median Range
LES length (cm) 2.4 2.3-3.3
LES midrespiratory pressure (mmHg) 19.5 1.6-45.9
Distal esophageal amplitude (mmHg) 70.9 26.2-162.7
Proximal esophageal amplitude (mmHg) 35.9 23.9-65.7
Peristaltic waves (%) 100 80-100
Upper sphincter pressure (mmHg) 44.1 21.6-105.6
Esophageal length (cm) 18.5 15.5-22.7


2007 Program and Abstracts | 2007 Posters
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