High Resolution Manometry Findings in Patients With Esophageal Epiphrenic Diverticula

Vicentine, Fernando Pompeu Piza; Herbella, Fernando A. M.; Silva, Luciana C.; Patti, Marco G.; Grande, José Carlos Del

doi:10.1016/s0016-5085(11)64358-8

Cited by 12 publications

(24 citation statements)

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“…Though the majority of previous studies of esophageal motility associated with diverticula have used conventional manometry, one study utilizing HRM included nine patients and though they did not apply a consensus classification scheme (e.g. the Chicago Classification), they reported achalasia in six (66%) patients (one of whom the manometry catheter was unable to traverse the EGJ) . Similarly, a study of 21 patients with esophageal diverticula that used endoscopic placement to ensure traversal of the EGJ with the conventional manometry catheter and also 24‐h ambulatory manometry in six patients reported achalasia as the most commonly observed motility diagnosis (43%); however, more similarly to our findings, they also reported 5/21 patients with DES (defined as multipeaked, high‐amplitude contractions with >30% simultaneous pressure waves) and 2/21 with nutcracker (high‐amplitude, long‐duration contraction); thus potentially patients that may have been classified as jackhammer esophagus with HRM/EPT evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal diverticula may also be related to an increased risk for aspiration . A common association with achalasia has been reported in numerous previous studies, most utilizing conventional manometry to assess esophageal motility; thus, the basis of diverticula formation is often thought to be related to increased intra‐esophageal pressures related to esophagogastric junction (EGJ) outflow obstruction (EGJOO) . However, other esophageal motility diagnoses, defined by varying conventional‐manometry‐based criteria, including non‐specific esophageal motility, distal esophageal spasm (DES), and nutcracker esophagus have been reported in varying frequencies in series of patients with esophageal diverticula …”

Section: Introductionmentioning

confidence: 99%

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Esophageal diverticula are associated with propagating peristalsis: a study utilizing high‐resolution manometry

Carlson

Gluskin

Mogni

et al. 2015

Neurogastroenterology Motil

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Background Esophageal diverticula have been associated with esophageal motility disorders, most commonly achalasia. We aimed to evaluate high-resolution manometry (HRM) motility diagnoses and pressurization patterns in patients with esophageal diverticula. Methods Patients were retrospectively identified for distal esophageal diverticula and previously completed HRM. HRMs were analyzed according to the Chicago Classification and the pressure slope of the compartmentalization phase (time between upper esophageal sphincter closure and the transition zone) of esophageal bolus transit was measured. Pressure slopes were also measured in 10 asymptomatic volunteers (controls) for comparison. Results 19 patients (ages 31 – 83) were included. 8 (42%) patients had normal motility, 5 (26%) had esophagogastric junction outflow obstruction, and 2 (11%) had jackhammer esophagus; 4 patients had other motility diagnoses including only one patient with achalasia. A total of 6 patients (32%) had at least one hypercontractile swallow. Greater compartmentalization phase pressure slopes were observed in patients at the mid-esophageal body in both supine [median (IQR): 1.9 mmHg/s (0.9, 3.6)] and upright [1.1 (0.1, 3.1)] positions than in controls [supine: −1.3 (−2.4, −0.11), p = 0.001; upright; −0.71 (−2.1, −0.02), p = 0.005). Conclusions Propagating peristalsis, often with hypercontractility, was commonly seen in our cohort of patients with esophageal diverticula. Abnormal compartmentalization phase pressurization may indicate a relationship of abnormal esophageal wall mechanics and/or compliance with diverticula; however whether these findings are causal or reactionary remains unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal diverticula are associated with propagating peristalsis: a study utilizing high‐resolution manometry

Carlson

Gluskin

Mogni

et al. 2015

Neurogastroenterology Motil

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“…Tan›da alt›n standart özofagografidir (1). Bizim her iki hastam›za da ilk tan› gastroskopi ile konulmufltur.…”

Section: Tartifimaunclassified

Gastroskopi ile tanı konulan orta özofagus (Parabronşial) divertikülü: 2 olgu sunumu ve literatürün gözden geçirilmesi

Uyanıkoğlu¹,

Altuntas²,

Aydoğan³

et al. 2015

Endoskopi Gastrointestinal

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Özofagusta divertiküller faringoözofageal, orta (midözofageal-parabronflial) veya epifrenik yerleflimli olabilir. Özofageal divertiküller için standart tan› yöntemi özofagografidir, faringoözofageal divertiküller için troid ultrasonografisi faydal› olabilir. Epifrenik divertikülde yüksek rezolüsyonlu manometri ile tüm hastalarda motor anomali gösterilmifltir (1,2).Divertiküller etyolojilerine göre tüberküloza ba¤l› yap›fl›kl›k gibi nedenlerle, traksiyon veya motilite anomalileri nedeni ile pulsiyon divertikülü fleklinde olabilir. Yabanc› cisim impakt› gibi nadir nedenlerle de oluflabilir. Kesin etyoloji belirlenemeyebilir (3-5).Orta özofagusta gerçek divertikül nadir görülür (6-8), s›kl›kla mediastinal inflamasyona sekonder olup, özofagusun orta kesiminin periözofageal alana do¤ru kese fleklinde büyümesi sonucu ortaya ç›kar (9).Semptomatik hastalarda (8), klasik ameliyat torasik yaklafl›m-d›r (10).Endoskopide orta özofagusta divertikül saptanan, birine torasik divertikülektomi uygulanan iki olgu sunulmufltur. OLGU 1Dispepsi, disfaji ve a¤za yemek geri gelmesi flikayetleri nedeniyle gastroskopi istenen 21 yafl›nda erkek hastan›n gastroskopisinde orta özofagusta ikinci bir lümen fleklinde, yaklafl›k 5-6 cm uzunlu¤unda ve özofagus lümeni geniflli¤inde (Resim 1) divertikül saptand›. Hasta semptomatik oldu¤undan ve divertikül uzun oldu¤undan cerrahi divertikülektomi önerildi.Gögüs cerrahisi taraf›ndan sol torakotomi ile divertikülekto-mi yap›lan hasta takibe al›nd›. OLGU 2Dispeptik yak›nmalar nedeniyle gastroskopi yap›lan 65 yafl›n-da erkek hastan›n orta özofagusunda, genifl tabanl›, yaklafl›k 2 cm derinli¤inde divertikül saptand› (Resim 2). Hasta asemptomatik oldu¤undan ve divertikül genifl tabanl›, küçük oldu¤undan operasyon önerilmedi ve takibe al›nd›. TARTIfiMAOrta özofagusta divertikül nadir görülmektedir (6-8). Tan›da alt›n standart özofagografidir (1). Bizim her iki hastam›za da ilk tan› gastroskopi ile konulmufltur. Opere olan hastaya operasyon öncesi özofagogram ve bilgisayarl› toraks tomografisi çekilmifl, tan› do¤rulanarak, olas› bir malignite ekarte edilmifl ve ameliyat› planlanm›flt›r. Ameliyat sonras› da özofagogram kontrolü yap›lm›flt›r.Orta özofagus divertikülü, tüberküloz gibi inflamasyona veya motilite bozuklu¤una sekonder olabilece¤i gibi, kesin etyoloji belirlenemeyebilir (3-5). Her iki hastan›n hikaye ve muayenelerinde inflamatuvar hastal›k ve motilite bozuklu¤u yoktu, etyoloji belirlenemedi. Ancak her ikisine de motilite testleri yap›lmad›.Semptomatik hastalar ve fistül varl›¤›nda cerrahi tedavi öneril-mektedir (8,11). Divertikül rezeksiyonunda klasik ameliyat torasik yaklafl›m iken, özofageal dismotilite, hiatal herni gibi ek sorunlar oldu¤unda bazen laparoskopik cerrahi de gerekmek-G Ga as st tr ro os sk ko op pi i i il le e t ta an n› › k ko on nu ul la an n o or rt ta a ö öz zo of fa ag gu us s ( (P Pa ar ra ab br ro on nfl fli ia al l) ) d di iv ve er rt ti ik kü ül lü ü: : 2 2 o ol lg gu u s su un nu um mu u v ve e l li it te er ra at tü ür rü ün n g gö öz zd de en n g ge eç çi ir ri il lm...

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“…Apparently, normal motility in manometry test in patients with epiphrenic diverticulum might be related to the type of manometric testing used or the intermittent nature of some disorders such as the diffuse oesophageal spasm. Although earlier series used conventional manometry, a recent study has evaluated oesophageal motility with HRM in patients with ED [13]. This involved nine patients, and all of whom had motility disorder.…”

Section: Aetiologymentioning

confidence: 99%

Pulsion Diverticulum of the Oesophagus: More than just an Out Pouch

Sonbare

2013

Indian J Surg

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Oesophageal diverticulum is divided into two types based on the aetiology: the pulsion and the traction diverticula. Pulsion diverticulum occurs due to increased intraluminal pressure. This can be of three types based on the location along the oesophagus: the Zenker's diverticulum (ZD), the midoesophageal diverticulum (MD) and the epiphrenic diverticulum (ED). A PubMed search was conducted for the words 'pulsion', 'diverticulum' and 'oesophagus' for all studies published from January 1980 to March 2013 in the English language. A total of 31 studies were identified, and out of which, five were not included in the review. The pulsion diverticulum of the oesophagus is an uncommon disorder. Its aetiology is related to the motility disorders of the oesophagus. Patients usually present with chest-related symptoms or oesophageal symptoms, which are related to the underlying motility disorder. Evaluation includes barium studies, gastrointestinal endoscopy, CT scan and oesophageal manometry. Surgery is the treatment of choice for symptomatic and large diverticula, although the outcome in asymptomatic patients is unknown. The surgical options include diverticulectomy or diverticulopexy with an adequate myotomy. Most patients with ZD are now treated by using endoscopic techniques, although no randomised trial has shown its superiority over the open technique. Minimally invasive surgery has also been used for patients with MD and ED. Although isolated case series has shown good improvement in symptoms and reduction in mortality with minimally invasive techniques in patients with ED, its role in thoracic oesophageal diverticulum is debated.

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High Resolution Manometry Findings in Patients With Esophageal Epiphrenic Diverticula

Cited by 12 publications

References 0 publications

Esophageal diverticula are associated with propagating peristalsis: a study utilizing high‐resolution manometry

Esophageal diverticula are associated with propagating peristalsis: a study utilizing high‐resolution manometry

Gastroskopi ile tanı konulan orta özofagus (Parabronşial) divertikülü: 2 olgu sunumu ve literatürün gözden geçirilmesi

Pulsion Diverticulum of the Oesophagus: More than just an Out Pouch

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