The oesophageal plexus is formed around the thoracic oesophagus by the two vagal trunks as they descend through the posterior mediastinum, rotating around the oesophagus and exchanging fibres extensively. By the time they reach the oesophageal hiatus, the left vagus lies anterior and the right vagus posterior, forming the anterior and posterior vagal trunks. The plexus also receives sympathetic contributions from the thoracic sympathetic trunks via the greater splanchnic nerves and the oesophageal branches.
The oesophageal plexus coordinates oesophageal peristalsis and lower oesophageal sphincter tone. In achalasia, the myenteric neurons of the oesophageal plexus degenerate, causing failure of LOS relaxation and aperistalsis. Disruption during oesophagectomy produces aperistalsis in the gastric conduit and requires gravity and pyloric drainage for stomach emptying. Thoracoscopic splanchnicectomy in chronic pancreatitis passes through the posterior thorax adjacent to the oesophageal plexus level.
Idiopathic degeneration of the inhibitory neurons in the oesophageal myenteric plexus causes failure of lower oesophageal sphincter relaxation and aperistalsis, producing progressive dysphagia and regurgitation managed by pneumatic dilation, Heller myotomy, or peroral endoscopic myotomy (POEM).
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