Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer-a regional cohort study.

PURPOSE: Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). METHODS: Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. RESULTS: One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3-T4 ≤ 10 cm from the anal verge were analysed. Thirty (8.7%) patients with MRI-positive LLN were identified. Synchronous distant metastases were associated with MRI-positive LLN (p-value 0.019). Long-course chemoradiotherapy was clinical practice in cases of MRI-positive LLN. No differences in local (p-value 0.154) or distant (p-value 0.343) recurrence rates between MRI-positive LLN patients and MRI-negative patients were detected. Only four patients underwent lateral lymph node dissection (LLND). There was no significant difference in overall survival during follow-up between the MRI-negative (CI at 95%; 99-109 months) and MRI-positive group (CI at 95%; 69-108 months; p-value 0.14). CONCLUSION: Lateral lymph node metastases present a challenging clinical situation. The present study shows that combination of neoadjuvant therapy and selective LLND is an applicable strategy in cases of MRI-positive LLN.

A Device that Models Human Swallowing.

The pharynx is critical for correct swallowing, facilitating the transport of both air and food transport in a highly coordinated manner, and aberrant co-ordination causes swallowing disorders (dysphagia). In this work, an in vitro model of swallowing was designed to investigate the role of rheology in swallowing and for use as a pre-clinical tool for simulation of different routes to dysphagia. The model is based on the geometry of the human pharynx. Manometry is used for pressure measurements and ultrasonic analysis is performed to analyze the flow profiles and determine shear rate in the bolus, the latter being vital information largely missing in literature. In the fully automated model, bolus injection, epiglottis/nasopharynx movement, and ultrasound transducer positioning can be controlled. Simulation of closing of the airways and nasal cavity is modulated by the software, as is a clamping valve that simulates the upper esophageal sphincter. The actions can be timed and valves opened to different degrees, resembling pathologic swallowing conditions. To validate measurements of the velocity profile and manometry, continuous and bolus flow was performed. The respective velocity profiles demonstrated the accuracy and validity of the flow characterization necessary for determining bolus flow. A maximum bolus shear rate of 80 s-1 was noted for syrup-consistency fluids. Similarly, the manometry data acquired compared very well with clinical studies.

Improved Prognosis and Low Failure Rate with Anticoagulation as First-Line Therapy in Mesenteric Venous Thrombosis.

BACKGROUND: Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed. METHODS: Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015. RESULTS: The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000-2007) and 3.2% in the latter (2008-2015) part of the study period (p = 0.006). Age ≥75 years (OR 12.4, 95% CI [2.5-60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3-54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2-51.6]) were independently associated with increased mortality in multivariable analysis. CONCLUSIONS: Short-term prognosis in patients with MVT has improved. Contemporary data show that monotherapy with anticoagulation is an effective first choice in MVT patients.

Clinical implications of CT findings in mesenteric venous thrombosis at admission.

PURPOSE: The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. METHODS: Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). RESULTS: We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p < 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2-77.2]). Successful thrombus recanalization was achieved in 66% of patients. CONCLUSION: The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.

One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction.

BACKGROUND: Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure. METHODS: A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted. RESULTS: The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia. CONCLUSIONS: Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past.

CT angiography followed by endovascular intervention for acute superior mesenteric artery occlusion does not increase risk of contrast-induced renal failure.

OBJECTIVES: Acute superior mesenteric artery (SMA) occlusion can be diagnosed in an early phase by computed tomography (CT) angiography, which is also a prerequisite for endovascular intervention. However, the issue of development of postoperative permanent renal failure due to contrast-induced nephropathy has not been evaluated. DESIGN: Retrospective MATERIALS: A total of 55 patients with acute SMA occlusion were retrieved from the in-hospital register during a 4-year period between 2005 and 2009. METHODS: Glomerular filtration rate was calculated as a simplified variant of Modification of Diet in Renal Disease Study Group (MDRD). RESULTS: Preoperative renal insufficiency was found in 52%; advanced state in one patient. Creatinine was lower (p = 0.018) at discharge (median: 71 micromol L(-1)), compared to admission (median: 76 micromol L(-1)), in the 32 survivors exposed to repeated iodinated contrast media (median: 54.7 g iodine). No patient died due to renal failure or needed dialysis after endovascular intervention. Endovascular intervention was associated with a higher survival rate (p = 0.001). CONCLUSION: Serious acute contrast-induced nephropathy was not found in patients diagnosed by CT angiography and treated by endovascular procedures for acute SMA occlusion. Elevated serum creatinine levels should not deter the clinician from ordering a CT angiography in patients with suspicion of acute SMA occlusion.

Impact of MDCT with intravenous contrast on the survival in patients with acute superior mesenteric artery occlusion.

Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for intestinal ischemia was associated with trend for a higher rate of correct radiological diagnosis, 18 of 23 (78%), at first evaluation (0.06) but without affecting in-hospital survival (p = 0.27). At re-evaluation, SMA occlusion was found in all cases with MDCTiv, whereas intestinal findings were present in half. In-hospital mortality rate was 42% for patients who underwent MDCTiv, which was significantly lower compared to 90% for the ten patients examined with plain MDCT (p = 0.007) and 71% for patients not examined with MDCTiv or plain MDCT (p = 0.031). Patients that underwent plain MDCT had higher levels of creatinine compared to those examined with MDCTiv (p = 0.005). Patients who underwent intestinal revascularisation, endovascular or open, had higher survival rate (p = 0.001). Examination with MDCTiv in patients with acute SMA occlusion was associated with survival benefit. Hence, MDCTiv seems to be the method of choice in the workup phase. Radiologists should routinely describe the mesenteric vessels in patients with acute abdomen even when the diagnosis is not asked for. Patients with high creatinine levels are at risk to be examined without intravenous contrast, and survival in these patients is poor.

Effect of barium sulfate contrast medium on rheology and sensory texture attributes in a model food.

BACKGROUND: The swallowing process can be visualized using videoradiography, by mixing food with contrast medium, e.g., barium sulfate (BaSO(4)), making it radiopaque. The sensory properties of foods may be affected by adding this medium. PURPOSE: To evaluate if and to what extent sensory and rheological characteristics of mango purée were altered by adding barium sulfate to the food. MATERIAL AND METHODS: This study evaluated four food samples based on mango purée, with no or added barium sulfate contrast medium (0%, 12.5%, 25.0%, and 37.5%), by a radiographic method, and measured sensory texture properties and rheological characteristics. The sensory evaluation was performed by an external trained panel using quantitative descriptive analysis. The ease of swallowing the foods was also evaluated. RESULTS: The sensory texture properties of mango purée were significantly affected by the added barium in all evaluated attributes, as was the perception of particles. Moreover, ease of swallowing was significantly higher in the sample without added contrast medium. All samples decreased in extensional viscosity with increasing extension rate, i.e., all samples were tension thinning. Shear viscosity was not as dependent on the concentration of BaSO(4) as extensional viscosity. CONCLUSION: Addition of barium sulfate to a model food of mango purée has a major impact on perceived sensory texture attributes as well as on rheological parameters.

Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis.

There exists no systematic evaluation on the findings in multi-detector row computed tomography (MDCT) with portal phase enhancement in patients with mesenteric venous thrombosis (MVT). Patients with MVT between 2004 and 2006 were identified at Malmö University Hospital, Sweden. Thirty patients had MVT. Median age was 58 years (interquartile range, 46-72), and 57% (17) were men. MDCT with portal phase enhancement showed MVT in 19 out of 20 investigated patients at first evaluation, even though there was clinical suspicion in only one, and conservative management was possible in 19 (95%). Central and peripheral MVT was seen in 20 (100%) and six (30%) cases, respectively. Extra-hepatic and intra-hepatic portal and splenic vein thrombosis was seen in 17 (85%), nine (45%) and 15 (75%) cases, respectively. Venous collaterals were visible in 12 (60%) cases. The most frequent extra-vascular pathologies were mesenteric oedema (50%), ascites (40%), small bowel wall oedema (25%) and local small bowel wall dilatation (20%). The vascular findings in MVT are more pronounced than the intestinal findings in MDCT with portal phase enhancement, and evaluation of the mesenteric vessels should be included in routine MDCT scans for unclear acute abdomen.

Epidemiology, risk and prognostic factors in mesenteric venous thrombosis.

BACKGROUND: Epidemiological reports on risk and prognostic factors in patients with mesenteric venous thrombosis (MVT) are scarce. METHODS: Patients with MVT were identified through the inpatient and autopsy registry between 2000 and 2006 at Malmö University Hospital. RESULTS: Fifty-one patients had MVT, diagnosed at autopsy in six. The highest incidence (11.3 per 100,000 person-years) was in the age category 70-79 years. Activated protein C resistance was present in 13 of 29 patients tested. D-dimer at admission was raised in all five patients tested. Multidetector row computed tomography (CT) in the portal venous phase was diagnostic in all 20 patients investigated, of whom 19 were managed conservatively. The median length of resected bowel in 12 patients who had surgery was 0.6 (range 0.1-2.2) m. The overall 30-day mortality rate was 20 percent; intestinal infarction (P = 0.046), treatment on a non-surgical ward (P = 0.001) and CT not done (P = 0.022) were associated with increased mortality. Cancer was independently associated with long-term mortality: hazard ratio 4.03, 95 percent confidence interval 1.03 to 15.85; P = 0.046. CONCLUSION: Portal venous phase CT appeared sensitive in diagnosing MVT. As activated protein C resistance was a strong risk factor, lifelong anticoagulation should be considered.

Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature.

Purpose Ingrowth of fibroblasts in a polypropylene mesh may cause contraction and a later recurrence. We assessed mesh contraction in intraabdominal and retromuscular implantation after incisional hernia repair. METHODS: A cohort of patients within an RCT on laparoscopic (LHR) versus open hernia repair (OHR) had their mesh borders marked with metal clips. X-ray was performed on postoperative day 1 and after 1 year. Total length, width, and dislocation were measured. A tacker fixated large-pore polypropylene mesh was used in LHR, and a retromuscular small-pore heavy-weight mesh was sutured to the midline in OHR. Patient's pain was assessed before surgery and after 1 year. RESULTS: For analysis 37/47 patients remained: 20 LHR and 17 OHR. Hernia defect area was median 41 cm2 in LHR and 25 cm2 in OHR (p < 0.140). Implanted mesh size was 300 cm2 for LHR and 240 cm2 for OHR (p < 0.341). After 1 year the mesh area decreased by 4.4% and 0.5% in LHR and OHR, respectively (p < 0.063). Longitudinal distance decreased by 2.8% in LHR and by 2.6% in OHR (p < 0.269). Transverse distance decreased by 1.6% in LHR but increased by 3.1% in OHR (p < 0.005). Dislocation was seen in four LHR and one OHR. Two recurrent and one port-site hernia were diagnosed after LHR. Measurements between observers were identical in 58% and consensus was made in the remainder. Pain was not correlated to mesh area change. CONCLUSIONS: Mesh contraction after 1 year is not a clinical issue for an intraperitoneal large-pore mesh or a retromuscular small-pore mesh. It is not correlated to postoperative pain.

The normal movements of the hyoid bone during swallow.

The position of the hyoid bone during quiet breathing and its movement during pharyngeal swallow, as well as its relation to the movement of the epiglottis and the elevation of the rima glottidis were studied with cineradiography in 50 nondysphagial volunteers. The movement of the hyoid bone occurred in either a two-step (40 patients) or a one-step (10 patients) fashion. The findings confirm that pharyngeal swallow is executed with precision and with only small variability in measured parameters.

An experimental manometric study simulating upper esophageal sphincter narrowing.

RATIONALE AND OBJECTIVES: Elevated intrabolus pressure above a pharyngeal narrowing has been postulated as an important finding in patients with cricopharyngeal bars. To elucidate the significance of intrabolus pressure around lumen narrowings in the pharynx, intraluminal pressure characteristics were evaluated in a laboratory model simulating upper esophageal sphincter narrowing. METHODS: Intraluminal solid-state manometry was performed in an experimental model in which variable narrowing was created in an expandable balloon simulating the pharyngeal walls. RESULTS: Intrabolus pressure was dependent on the position of the manometric sensor, degree of lumen narrowing, bolus volume, flow rate, and fluid viscosity. CONCLUSIONS: Elevated intrabolus pressure is an important finding. Intrabolus pressure is dependent on many parameters, and hence, is difficult to evaluate. If results found with this model hold true in patients, manometric sensor positioning is crucial, and concurrent fluoroscopy is highly recommended to achieve a standardized manometric technique in pharyngeal manometry.

Herniography: comparison of morbidity and image quality after use of high and low osmolality contrast media.

The morbidity and image quality after administration of three different contrast media were compared in 229 patients referred for herniography. Sixty patients received metrizoate 150 mg I/ml, 92 received metrizoate 200 mg I/ml, and 77 patients, ioxaglate 200 mg I/ml. Patient discomfort was single-blindedly assessed based on an arbitrary verbal rating scale. The number of patients with pain increased with the osmolality of the contrast media. Metrizoate 200 induced pain in 57% of the patients, metrizoate caused pain in 39%, and ioxaglate 200 in 18%. Hernia patients who received metrizoate 200 had pain significantly more often (72%) than patients without hernia (45%). Seven patients, predominantly young men, had a vasovagal reaction associated with the administration of contrast media. The image quality was sufficient after all injections of 200 mg I/ml. The results indicate that low osmolality contrast media with an iodine concentration of about 200 mg I/ml are well suited for herniography.

Topographic representation of the pharyngoesophageal segment during swallowing.

Motility of the pharyngoesophageal segment (PES) was monitored by cineradiography (50 frames a second) during barium swallow and analyzed by a computerized topographic mapping of sagittal wall motion. Through measurement of wall displacement on 20 consecutive levels of the PES, distention, contraction, and peristalsis were studied. Topographic mapping of three patients with normal PES motility, delayed opening of the cricopharyngeus, and incomplete opening of the cricopharyngeus, was performed. These topographic mappings show that "narrowing" at the level of the cricopharyngeus reflects expansion of the hypopharynx and cervical esophagus around the cricopharyngeus, rather than a true narrowing. In addition, analysis of wall motion demonstrated that abnormality of the circopharyngeus is often associated with abnormality of wall motion in the adjoining hypopharynx and cervical esophagus. Thus, topographic mapping of the cricopharyngeus is of value because it enables detailed analysis of wall motion during various pathologic conditions.

Positive contrast herniography in adult patients with obscure groin pain.

To evaluate its clinical benefit in adults, herniography was used in 73 patients with clinically unexplained groin pain. Hernias were demonstrated on the side with symptoms in 26 patients (36%). Relief of groin pain was registered in 16 of 17 patients who subsequently underwent operation. We consider herniography to be of value in the examination of adult patients with clinically unclear groin pain.

Ipsilateral multiple groin hernias.

BACKGROUND: Recurrence rates after surgical repair of groin hernia vary between 3% and 20%. One possible reason for recurrent hernias are ipsilateral multiple hernias, which might have been overlooked at the primary operation. METHODS: In the present series 1010 patients with unclear groin pain underwent herniography. RESULTS: A total of 314 patients had hernias, and seventy-one (23%) of these had multiple hernias. Ipsilateral multiple hernias were found in 18 (6%) patients. Ipsilateral multiple hernias were present in 9 (6%) of 144 patients with an indirect hernia, in 17 (12%) of 144 patients with a direct hernia, in 5 (21%) of 24 patients with a femoral hernia, and in 3 (23%) of 13 patients with an obturator hernia. The hernias were of indirect, direct, femoral, and obturator types. CONCLUSIONS: The frequency of ipsilateral multiple hernias is much higher than the frequency reported during herniorrhaphy. Such overlooked ipsilateral multiple groin hernias may account for some of the so-called recurrences after herniorrhaphy. Therefore a careful exploration of the groin is mandatory. Preoperative herniography may also prove to be useful in patients with recurrent groin symptoms after herniorrhaphy.

Longstanding groin pain in athletes. A multidisciplinary approach.

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.

Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation.

RATIONALE AND OBJECTIVES: Patients with a posterior indentation in the pharyngoesophageal segment (PES) are generally considered to have an abnormality of the cricopharyngeal muscle (CPM). In this study we determined the actual width of the PES and the pressure circumstances during swallowing within the pharynx and PES in such patients. METHODS: Simultaneous videofluoroscopy and solid state manometry, radiologic examination of the pharynx, PES, and cervical esophagus were performed in 16 dysphagic patients with a cricopharyngeal (CP) bar. In eight patients the indentation was 25-50%, and in eight it was more than 50% of the adjacent gullet. Sixteen dysphagic patients without a CP bar were used as control subjects. In each patient swallows of 10-ml barium bolus were recorded. RESULTS: Patients with CP bars had a significantly wider PES above (p = .0005) and below (p = .02) the CPM, whereas the diameter at the level of the CPM was smaller only in the patients with more than 50% indentation compared with the patients without a CP bar. The contraction pressure above the CP bar (i.e., at the level of the inferior pharyngeal constrictor) was significantly (p = .002) weaker in patients with a CP bar (131 +/- 16 mm Hg) than in those without a CP bar (222 +/- 20 mm Hg). CONCLUSION: Our findings in patients with a posterior CP bar suggest that the major abnormality is weak constrictors with outpouching of the gullet above and below. Only in patients with more than 50% indentation was there a slight narrowing at the level of the CP bar. The CPM showed no manometric abnormalities in terms of resting pressure, relaxation, and contraction pressure. Therefore, the CPM is likely to relax and distend normally during swallowing in patients with a CP bar.

Pharyngeal solid-state manometry catheter movement during swallowing in dysphagic and nondysphagic participants.

RATIONALE AND OBJECTIVES: The movements of the soft palate and the larynx are crucial in pharyngeal manometry because of the potential risk of manometry sensor dislocation. METHODS: Twenty dysphagic patients and 20 nondysphagic volunteers were examined with simultaneous videoradiography and intraluminal pharyngeal solid-state manometry. The movements of the manometric sensors were analyzed from lateral videorecording. RESULTS: Two different types of catheter movement were found. The sensor in the upper esophageal sphincter (UES) could either be lifted cranially during the closure of the soft palate (type 1) or stay unaltered in the sphincter until the beginning of the laryngeal elevation and then follow the sphincter cranially during laryngeal elevation with no previous response to soft palate closure (type 2). Type 1 movement was found in eight of 20 patients but in only one of the 20 volunteers. The resting pressure of the upper esophageal sphincter was significantly higher in type 2 (P = 0.004). Nineteen of the 20 patients with a high resting pressure of the UES (83+ mm Hg) were found to have the type 2 movement. CONCLUSION: High resting pressure in the UES permitted the sphincter to grasp the manometry catheter and caused the sensor to follow the cranial movement during laryngeal elevation. Sensor movement is important during pharyngeal manometry, and sensor dislocation out of the sphincter can be misinterpreted as sphincter relaxation. Simultaneous videoradiography provides control of sensor positioning and allows for correction.