Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers.

This study in cadavers was carried out to resolve whether a functional flap valve exists at the gastroesophageal (GE) junction and whether an accentuation of this valve (valvuloplasty) could increase the GE pressure gradient. Cadavers were investigated with open manometry catheters in the esophagus and stomach. Stepwise (50 ml) filling of the stomach demonstrated a GE pressure gradient of 4.6 +/- 1.6 cmH2O. This gradient could be significantly increased to 12.5 +/- 3.1 cmH2O (p less than 0.05) by performing a valvuloplasty procedure through a gastrostomy. By depressing the fundus of the stomach, the angle of His was made more obtuse and the flap valve component eliminated. This maneuver resulted in reflux in all cadavers before as well as after valvuloplasty. These experiments and observations taken together with our valvuloplasty procedure, confirm that a flap valve mechanism exists at the GE junction.