Dig Dis 2006;24:319–341

Use of Endoluminal Ultrasound to Evaluate Gastrointestinal Motility

Miller L. · Dai Q. · Korimilli A. · Levitt B. · Ramzan Z. · Brasseur J.
Temple University Hospital, Gastroenterology Section, Philadelphia, Pa., USA
email Corresponding Author

 goto top of outline Key Words

  • Endoluminal ultrasound
  • Motility
  • Esophageal motility disorders
  • High-frequency ultrasound
  • Three-dimensional ultrasound

 goto top of outline Abstract

The use of high-frequency ultrasound transducers in the gastrointestinal tract (GI) has already yielded remarkable findings concerning the anatomy, physiology and pathophysiology of the GI tract and of various motility disorders. These transducers have made completely invisible portions of the GI tract (the longitudinal smooth muscle, muscles of the upper esophageal sphincter, components of the gastroesophageal junction high-pressure zone, and the muscle of the anal sphincter complex) accessible to investigation. Use of simultaneous ultrasound and manometry has allowed the exploration of the normal physiology of peristaltic contraction. The components of the high-pressure zone of the distal and proximal esophagus have been isolated and the movement of these components has been studied individually and as a group. Various esophageal motility disorders have been investigated including achalasia, scleroderma, Barrett’s esophagus and diffuse esophageal spasm. The possible etiology of the symptoms of esophageal chest pain and heartburn (sustained esophageal contractions of the longitudinal smooth muscle), have been studied. The possible underlying pathophysiology of GERD (the missing gastric clasp and sling fiber pressure profile) has been explored. Three-dimensional high-frequency ultrasound imaging has allowed the peristaltic contraction sequence to be viewed in a completely new and unique manner. The biomechanics of both esophageal contraction and the gastroesophageal junction high-pressure zone have been investigated and the mechanical advantage of esophageal shorting has been studied. The mechanism of action of standard surgical and newer endoscopic therapies for GERD has been defined. Future applications of this technology are limited only by our imagination.

Copyright © 2006 S. Karger AG, Basel

 goto top of outline References
  1. Liu JB, Miller LS, Goldberg BB, et al: Transnasal US of esophagus: preliminary morphologic and function studies. Radiology 1992;184:721–727.
  2. Miller LS, Liu JB, Klenn PJ, et al: High-frequency endoluminal ultrasonography of the esophagus in human autopsy specimens. J Ultrasound Med 1993;12:563–566.
  3. Liu J, Miller LS, Goldberg BB: Endoluminal ultrasound in gastroenterology: Application of new technology. Clin Diagn Ultrasound 1994;29:185–215.
  4. Miller LS, Liu JB, Colizzo FP, et al: Correlation of high frequency esophageal ultrasonography and manometry in the study of esophageal motility. Gastroenterology 1995;105:832–837.

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  5. McCray WH Jr, Chung C, Parkman HP, Miller LS: Use of simultaneous high-resolution endoluminal sonography and manometry to characterize high-pressure zone of distal esophagus. Dig Dis Sci 2000;45:1660–1666.
  6. Wong RF, Bonapace ES Jr, Chung CY, Liu JB, Parkman HP, Miller LS: Simultaneous endoluminal sonography and manometry to assess anal sphincter complex in normal subjects. Dig Dis Sci 1998;43:2363–2372.
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  8. Dai Q, Liu JB, Brasseur JG, Thangada VK, Thomas B, Parkman H, Miller LS: Volume (three-dimensional) space-time reconstruction of esophageal peristaltic contraction by using simultaneous US and manometry. Gastrointestinal Endosc 2003;58:913–919.
  9. Miller LS, Liu JB, Colizzo FP, et al: Correlation of high-frequency esophageal ultrasonography and manometry in the study of esophageal motility. Gastroenterology 1995;105:832–837.

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  10. Nicosia MA, Brasseur JG, Liu JB, Miller LS: Local longitudinal muscle shortening of the human esophagus from high-frequency ultrasonography. Am J Physiol 2000;281:G1022–G1033.
  11. Pal A, Brasseur JG: The mechanical advantage of local longitudinal shortening on peristaltic transport. J Biomech Eng 2002;124:94–100.
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  13. Dai QS, Soliman AS, Dilipkumar P, Thangada V, Brasseur J, Chung C, Ulerich R, Parkman H, Thomas B, Miller LS: Simultaneous ultrasound and manometry during pharmacologic paralysis of the crural diaphragm allows spatial localization of the two components of the intrinsic gastroesophageal junction high-pressure zone. Gastroenterology 2004;126:A636-W1437.
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  18. Schiano TD, Fisher RD, Parkman HP, Cohen S, Dabezier M, Miller LS: Use of high-resolution endoscopic ultrasonography to assess esophageal wall damage after pneumatic dilation and botulinum toxin injection to treat achalasia. Gastrointest Endosc 1996;44:151–157.
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  20. Miller LS, James B, Ulerich R, Thomas B, Thomas A, Dai Q: A new theory to explain the pathophysiology of GERD. Pharmacological separation of the gastroesophageal junction high-pressure zone demonstrates an absent gastric sling fiber pressure profile in patients with GERD. Gastroenterology 2004;126:A503-T1741.
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  22. Miller LS, Dai Q, Dimitriou J, Schiffer B, Brasseur J: Endoscopic plication (EndoCinch) repairs a physiologic defect in patients with gastroesophageal reflux disease: absent pressure profile due to the gastric sling fibers. Gastroenterology 2004;126:A330-M1420.
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  24. Dai Q, Chung CY, Nowrouzzadeh F, Parkman H, Brasseur J, Thangada V, Miller LS: Simultaneous ultrasound and manometry in the evaluation of Nissen fundoplication. Gastroenterology 2003;124:A418-M2113.

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  25. Adrain AL, Ter Han-Chuan, Cassidy MJ, Schiano TD, Liu JB, Miller LS: High-resolution endoluminal sonography is a sensitive modality for the identification of Barrett’s metaplasia. Gastrointest Endosc 1997;46:147–151.
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  30. Schiffner BJ, Miller L, Dai Q, Dimitriou J, Brasseur JG: Opening stiffness and geometry of the esophago-gastric segment in health, with GERD, and after endoscopic surgery (abstract). A 396, M1808, Gastro 2005.
  31. Alexander AA, Miller LS, Liu JB, Feld RI, Goldberg B: High-resolution endoluminal sonography of the anal sphincter complex. J Ultrasound Med 1994;13:281–284.

 goto top of outline Author Contacts

Larry Miller, MD
Temple University Hospital, Gastroenterology Section
8th Floor, Parkinson Pavillion
Philadelphia, PA 19043 (USA)
Tel. +1 215 707 6922, Fax +1 215 707 2684, E-Mail larry.miller@temple.edu

 goto top of outline Article Information

Number of Print Pages : 23
Number of Figures : 33, Number of Tables : 0, Number of References : 31

 goto top of outline Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 24, No. 3-4, Year 2006 (Cover Date: July 2006)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI

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