Motility Studies of the Esophagus in a Case of Esophageal Atresia Before Primary Anastomosis and in Experimental Models

Esophageal motility was assessed in a case of long-gap esophageal atresia (EA) without tracheoesophageal fistula before primary anastomosis, in addition esophageal manometrical studies were also experimentally performed in mongrel dogs to investigate the pathogenesis of the motility disorders in successfully repaired EA. Coordinated peristaltic contractions were observed between the proximal and distal esophageal pouch when swallowing before primary anastomosis in EA. In addition, these contractions induced a reflex relaxation of the lower esophageal sphincter (LES) as seen in the normal esophagus at the age of 8 months. At the age of 28 days, however, the LES showed an unstable pressure profile and the absence of a reflex relaxation in response to the contractions of the proximal esophageal pouch. On the other hand, experimental studies were carried out on six mongrel dogs weighing 12-15 kg. In group 1 (n = 3), the esophagus was divided at the level of the tracheal carina and both the proximal and distal pouches were closed separately. In group II (n = 3), the esophageal branches of the vagal nerves were divided between the level of the aortic arch and the esophageal diaphragmatic hiatus. Postoperatively, coordinated peristaltic contractions were shown between the proximal and distal esophageal pouches in group I, although the vagotomized esophagus showed abnormal simultaneous contractions in group II. These results suggested that even if the esophageal continuity is disrupted, the coordinated peristaltic contractions are propagated between the proximal and distal esophagus before primary anastomosis in EA, and thus postoperative esophageal motility disorders may result from the surgical damage to the vagus during operative procedures.