Pharyngoesophageal (Zenker's) diverticulum: A reappraisal

Esophageal Diverticula

“…The sphincter is shaped like a slit, not a circle, leading to forced against a contracted UES [9]. Knuff et al compared nine patients with Zenker 's diverticulum, with a mean age of 60 years, to a control group of 15 patients matched for age [10]. Manometric measurements were obtained using a water -perfused system, which produces less reliable measurements than microtransducers.…”

“…Furthermore, manometry may be diffi cult to perform as the manometric catheter tends to coil in the diverticulum. There have been reports of low resting pressure of the sphincter [10,34] , as well as normal basal pressures [11] in patients with Zenker ' s diverticulum. The fi nding of cricopharyngeal incoordination is inconsistent, as discussed above in the section on pathogenesis.…”

Esophagus: anatomy and developmental and structural anomalies

“…Early studies suggested that the UES failed to relax in this condition leading to the term cricopharyngeal achalasia. Subsequent combined manometric/ fluoroscopic studies demonstrated complete UES relaxation but diminished opening [174,175]. As a result, hypopharyngeal pressures are increased and thought to lead to progressive protrusion through an area of relative mural weakness in the triangle of Killian.…”

Proposed Catheter Standards for Pharyngeal Manofluorography (Videomanometry)

“…A slight bend in this end length facilitates catheter placement through the genu of the nasopharynx. It also solves the problem of placement through the cricopharyngeus into the esophagus when Zenker's diverticula or other pharyngeal ''dead ends'' (postsurgical) are present [15,36]. We also believe that a length of the catheter should extend through the cricopharyngeus into the esophagus.…”

“…These variations in manometry technology and catheter designs contribute to the varying, and sometimes conflicting results obtained by different laboratories [4,8,9,11,12]. Clinical application of pharyngeal manometry without simultaneous videofluoroscopy has been commercially ''standardized'' by Synetics with use of the Castell method [10,[13][14][15][16][17]. This method uses one unidirectional and two sequential circumferential solid state sensors with spacing of 3 cm and 2 cm.…”