Diseases of the Esophagus (1993) 6 17-19

© 1993 Longman Group UK Ltd

DISEASES OF THE
ESOPHAGUS

Length of the human esophagus in vivo during manometric studies

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A. Csendes, A. Henriquez, P. Csendes
Department of Surgery, University Hospital, Santiago, Chile

SUMMARY. The length of the muscular esophagus was measured during manometry in 209 adult subjects. All
of them had normal upper gastrointestinal (Gl)endoscopy. On average the esophagus was 27,5 + 2.1 cm, long
as determined from the proximal to the lower esophageal sphincter. A direct correlation was shown between
the length of the esophagus and the subject's height.

In all classic textbooks of anatomy, surgery or gastro- constantly perfused by a pneumohydraulic pump
enterology it is said that the esophagus is 25 cm or (Arndorfer Inc.) at a rate of 0.5 ml/min and connected to
10 inches long on average.1-7 All these studies were Statham transducers (p 23 Dd) and to a Gilson Poly-
made in normal adult cadavers. Despite a great number graph M4PM. Each catheter had the side-holes 5 cm
of publications concerning esophageal motility studies, apart. The catheters had a metric scale in cm and were
there is no mention of the exact length of the esophagus introduced by mouth, after slight pharyngeal anaesthe-
in vivo. In some reports, the normal anatomy and histol- sia. Special care was taken for measurement of the
ogy of the esophagus is described, but its length is not esophagus: from the proximal crycopharyngeal sphincter
discussed.8-9 to the distal lower esophageal sphincter. The measure-
During numerous manometric studies, we have ob- ments were taken twice, and for each pull-through three
served that the esophagus was usually longer than measurements were taken. Because the three catheters
25 cm. The purpose of this prospective study was to were tied together this meant that for each patient we
determine the exact length of the adult esophagus in men had six measurements, whose mean value was deter-
during manometry. mined. The measurements were practically the same for
each catheter.
Values were expressed in cm as the mean +SD. In
MATERIAL AND METHOD each case the patient's height was carefully measured
and correlated to the length of the esophagus.
1. Subjects: 209 adult subjects with a mean age of 48
years (range 22-78) in whom a manometric study was
performed were included. In all of them an upper GI RESULTS
endoscopy demonstrated the absence of gross intra-
luminal or mucosal disease: severe esophagitis, ulcer, The mean length of the esophagus, measured in 209
stricture, carcinoma, lye ingestion, etc. 109 subjects cases, was 27.5 ± 2.1 cm. However, the length of the
without esophageal symptoms were used as controls. esophagus according to the subject's height is shown
100 cases had esophageal motor disorders or gastro- in Table 1 and Figure 1. There is a direct correlation
esophageal reflux without endoscopic esophagitis.
2. Manometric evaluation: all cases were submitted to Table 1. Length of the human esophagus during manometry
esophageal manometry, employing a 3-lumen catheter Height of n Length of the range
(Arndorfer Inc.) with an internal diameter of 1.1 mm, Subjects (cm) esophagus
>180 6 30.4 ± 2.4 26 - 35
175-179 15 29.2 ± 1.5 26-32
Address offprint requests to A. Csendes, Professor of Surgery, 170-174 28 27.7 ± 2.9 24-33
Department of Surgery, Clinical Hospital, University of Chile, Santos 165- 169 42 27.4 ± 2.7 24-33
Dumont 999, Santiago, Chile. 160-164 40 27.0 ±3.2 22 - 32
<159 59 26.1 ±2.2 22-31
Accepted 21 October 1992

17
18 Diseases of the Esophagus
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Length of esophagus
Fig. 1—Length of the esophagus during manometric studies
according to the subject's height.
between the height and the length of the esophagus. The
taller the subject the longer the esophagus. On average,
the lower esophageal sphincter was located at 42.5 +
1.5 cm from the incisors; the proximal crycopharyngeal
sphincter at 14.7 + 2.1 cm from the incisors.
DISCUSSION
The results of the present study suggest that the in vivo
adult esophagus in men measures some centimeters
more than the values reported by studies in normal adult
cadavers and that there is a direct correlation between
the subject's height and length of the esophagus.
Several classic textbooks of anatomy12 and surgical
anatomy3-5 indicate the length of the esophagus to be
25 cm or 10 inches.'2 The same is stated in two classic
textbooks of gastroenterology.67 In a collected review by
Palmer,10 the length of the esophagus in normal adult
cadavers is reported to be 25 cm in males and 23 cm in
females (±6-9 cm). The distance from the incisor teeth
to the cardia was 40 cm in males and 37 cm in females in
a study by Lerche.''
The length of the esophagus can be measured by: radi-
ology, endoscopy, during surgery, based on pathological
findings, in cadavers and finally in vivo by direct
manometric measurements with no pre-medication. As
the esophagus is a muscular organ, obviously the meas-
urements of the muscular structure determine its length.
That is why we believe that our manometric studies in
vivo are more exact and represent the real length of the
muscular esophagus. This organ extends from the neck
where the fibers of the crycopharyngeal muscle start,
which represents the upper esophageal sphincter. Some
authors think that the length of the crycopharyngeal
muscle cannot, per se, justify all sphincteric activity and
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1 1 1 1 r
27 28 29 30 31
(cm)
some contribution from the thyropharyngeal fibers has
been postulated. However, with manometric studies it is
easy to define the location of the upper sphincter. In our
studies this is at a mean distance of 15 cm from the
incisors and corresponds to the level of the sixth cervical
vertebra. The lower limit of the esophagus is the distal
lower esophageal sphincter, which is normally in an
abdominal position, at a mean distance of 42 cm from
the teeth. The differences of our results from those of
cadavers could be due to the fact that our measurements
are physiological and in vivo, while in cadavers it is
difficult to locate precisely where the muscles change
their physiological activity and represent both sphinc-
ters: the upper and the lower. Endoscopic measurements
of the length of the esophagus are not precise, because
they only visualize the mucosal limit and not the true
esophagogastric junction. Measurements of the resected
esophagus are misleading and erroneous due to stretch-
ing of the esophagus. The same occurs with measure-
ments at surgery. Radiologic measurements are incorrect
because they visualize the lumen of the organ and there
is always some magnification on exposure. There is only
one report by a Chinese author,12 who has determined
the length of the esophagus in 104 patients employing
a fiberoptic gastroscope. He reports a mean length of the
esophagus of 28 cm, very similar to our manometric
measurements, as is the positive correlation that he has
found between the length of the esophagus and the
height of the patient.
The importance of the present study lies in the exact
measurement of the whole length of the esophagus
which enables the definition of more precise surgical
terms such as subtotal or total esophagectomy in patients
with carcinoma of the esophagus, or severe achalasia or
motor disorders submitted to total esophagectomy, and
during manometric studies to correctly evaluate the

mid-distal and mid-proximal segment of the esophagus.
It is also important for a precise correlation with
endoscopic localization of esophageal strictures
disease.
References
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1964: 152.
2. Cunningham D J, ed. Human anatomy. M Marin
1946: 646.
3. Thorek P, Ed. Anatomy in surgery. J B Lippincott
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4. Higgins G A, ed. Orrs' operation of general surgery. W B
Saunders 1969:375.
5. Rhoads J E, Allen J G, Harkins H N, ed. Surgery,
Length of the human esophagus in vivo during manometric studies 19
principles and practice. J B Lippincott Co. 1970: 795.
6. Bockus H L, ed. Gastroenterology W S Saunders Co.
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7. Sleisenger M H, Fordtran J S, ed. Gastrointestinal
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10. Palmer E D. An attempt to localize the normal
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