Oesophagus

Mr Andrew Murphy and Dr Henry Knipe et al.

The oesophagus is a muscular tube that conveys food and fluids from the pharynx to the stomach.

The oesophagus is 23-37 cm long with a diameter of 1-2 cm and is divided into three parts:

It begins at the upper oesophageal sphincter, which is formed by the cricopharyngeus muscle 7.

The lower oesophageal sphincter, also known as the phrenic ampulla or the oesophageal vestibule, represents a 2-4 cm long dilatation between the A-ring and B-ring 7.

The oesophagus courses inferiorly to the left of the midline in the neck and superior mediastinum returning to the midline at T5 before coursing to the left again of the midline in the posterior mediastinum and in its inferior aspect curving anteriorly to pass through the diaphragm into the abdominal cavity. 

There are three normal oesophageal constrictions that should not be confused for pathological constrictions:

  • cervical constriction: due to cricoid cartilage at the level of C5/6
  • thoracic constriction: due to aortic arch at the level of T4/5
  • abdominal constriction: at oesophageal hiatus at T10/11
Relations

Follows arterial supply:

  • upper third: deep cervical lymph nodes
  • middle third: posterior mediastinal lymph nodes
  • lower third: left gastric and coeliac group lymph nodes
  • sympathetic trunk (sympathetic fibres)
  • vagal plexus (parasympathetic fibres)

The oesophagus is made up of five layers noting there is no serosal layer:

  • outer longitudinal muscularis propria
  • inner circular muscularis propria (in the upper 1/3 of the oesophagus this layer is composed of striated (voluntary) muscle while the lower 2/3 is smooth muscle)
  • submucosa
  • muscularis mucosae
  • mucosa
    • stratified squamous epithelium that abruptly changes to columnar epithelium in the lower oesophagus
Barium swallow
  • modified barium swallow used to evaluate pharyngeal motility during swallowing, the procedure utilizes barium of varying consistencies given by mouth with video recording of swallowing
  • barium swallow is the main radiological method of assessing the oesophagus. Double contrast oesophagogram using gas forming crystals and barium contrast are used to distend the oesophagus and coat the mucosa
Endoscopic ultrasonography

Endoscopic ultrasonography is used for evaluation of the depth of the oesophageal tumor.

CT
  • 80% will contain air allowing for appreciation of wall if there is enough surrounding mediastinal fat
  • if collapsed will appear as round or ovoid
MRI
  • T1: isointense to muscle
  • T2: hyperintense to muscle
PET/CT

Useful for the staging of oesophageal cancer.

Abdominal and pelvic anatomy
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Article information

rID: 27314
Section: Anatomy
Synonyms or Alternate Spellings:
  • Esophagus
  • Oesophagus - anatomy

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