Which is the better method for location of the gastro-esophageal junction: radiography or manometry?

To evaluate whether location of the gastro-esophageal junction (GEJ) could be determined with the same accuracy on radiography as by manometry with special reference to pH probe positioning.

Ninety patients with suspected esophageal motility disorders underwent simultaneous manometry and video-radiography. The lower esophageal sphincter pressure (LESP) and location was determined, and pressure recordings were made in the body of the esophagus. The GEJ and any structural changes were diagnosed on radiography during single-barium swallows and continuous barium drinking. Simultaneous radiographic and manometric investigations were performed with the pressure-catheter placed 5 cm proximal to the superior border of the GEJ located by manometry, and the distance to the radiographically determined superior border could be measured directly on the videotapes using a radiopaque metric ruler placed under the patient.

On radiography, the GEJ proved to be situated < 2 cm distally as compared to its location determined by manometry in 95.6% of the patients, and the maximal difference was 2.5 cm. The LESP or structural changes had no significant influence on the results.

The variation of location of GEJ on radiography as compared with manometric findings was sufficiently small to accept both methods as valid in the positioning of the pH probe properly.