The Cricopharyngeal Sphincter: Its Relationship to the Relief of Pharyngeal Paralysis and the Surgical Treatment of the Early Pharyngeal Pouch

Lund, W. S.

doi:10.1017/s0022215100068857

Cited by 44 publications

(7 citation statements)

References 6 publications

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“…In addition, older people have higher hypopharyngeal wave amplitudes that could result from faulty opening or increased connective tissue in the CP. Pharyngeal mucosal herniation in Westrin's model would result from elevation of normal UES pressures, including increased resting pressures, cricopharyngeal achalasia, incomplete/delayed relaxation and opening, premature closure and lack of coordination between pharyngeal contractions and UES opening/dysmotility secondary to neurologic injury [25][26][27][28][29][30][31][32][33]. Histological studies established the presence of inflammation and fibrosis, confirming the hypothesis of the poorly compliant cricopharyngeal mechanism [26].…”

Section: Pathogenesis Of Zdmentioning

confidence: 82%

Flexible endoscopic and surgical management of Zenker's diverticulum

Dzeletovic

Ekbom

Baron

2012

Expert Review of Gastroenterology & Hepatology

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Section: Pathogenesis Of Zdmentioning

confidence: 82%

Flexible endoscopic and surgical management of Zenker's diverticulum

Dzeletovic

Ekbom

Baron

2012

Expert Review of Gastroenterology & Hepatology

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“…Consequently, they advocated that myotomy should be performed selectively [74]. Another concern about myotomy was the risk of aspiration pneumonia when the protection barrier of UES is compromised by the myotomy [106]. From our literature review though, the postoperative aspiration pneumonia in open surgery is very rare (0.3%, 9/2,826).…”

Section: Necessity Of Myotomymentioning

confidence: 99%

Surgical Treatment of Zenker's Diverticulum

Yao¹,

Zhao²,

Hu³

et al. 2013

Dig Surg

154

152

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Background: Different surgical techniques have been indicated for the management of Zenker's diverticulum (ZD), including diverticulectomy, diverticulopexy, and diverticular inversion, with or without myotomy, and myotomy alone. More recently, minimally invasive techniques (such as the transoral endoscopic approach) have become increasingly reliable for this disorder. We therefore conducted this systematic review in order to gain a profound understanding of the current trend and evidence in surgical management of ZD. Methods: Medline and PubMed were searched to identify studies on surgical intervention of ZD published in English between January 1990 and March 2011. Results: We identified 6,915 patients from 93 studies evaluating the effect of the surgical intervention for ZD. No randomized controlled trials comparing one technique with another were identified. Conclusion: Diverticulectomy with myotomy has become the mainstream treatment option for ZD. In certain selected patients, endoscopic diverticulotomy may offer some advantages over open surgery, such as less trauma and a lower complication rate. It is important to individualize optimal therapy for each patient. More randomized controlled trials with long-term follow-up results are required to draw a valid conclusion on the best surgical intervention modality for ZD.

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“…In the past, the nature of cricopharyngeal abnormality associated with Zenker's diverticulum has been controversial. Radiographic studies suggested the presence of cricopharyngeal spasm, hypertrophy, and abnormalities in UES relaxation [6,8,[9][10][11][12][13][14].…”

Section: Resultsmentioning

confidence: 99%

Upper esophageal sphincter function in patients with Zenker's diverticulum

et al. 1988

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Abstract.Upper esophageal sphincter function (UES) was studied in 8 patients with Zenker's diverticulum. Radiologic and endoscopic studies revealed pharyngoesophageal diverticula of varying size. No tumor or stenosis was found. Esophageal manometry showed no significant difference between patients and 8 matched controls with respect to UES resting pressure, delay of maximal UES relaxation, and maximal pharyngeal contraction. All patients exhibited a drop of the UES pressure to esophageal resting pressure during swallowing. These results indicate that disturbances of UES function in established Zenker's diverticulum are a myth.Key words: Zenkcr's diverticulum -Esophageal motility.Motor disorders of the upper esophageal sphincter (UES) are held to be responsible for the development of a pharyngoesophageal pouch (PED). Several studies support the hypothesis that a disturbance of the swallowing mechanism with elevated resting pressure, premature closure, and incoordinated relaxation of UES might play a key role in the pathogenesis of Zenker's diverticulum [1][2][3][4][5][6]. In a few investigations, however, this hypothesis was questioned [3,7]. We therefore studied UES function in patients with Zenker's diverticulum in comparison to normal controls. Patients and MethodsEight patients 9 6 men and 2 women, 48-75 years old, with Zenker's diverticulum participated. The patients first under- metry. A 4-lumen manometry tube 3 mm m dmmcter w~t dially oriented pressure-detecting orifices spaced 5 cm apar t~ perfused via a low-compliance perfusion pump at a rate, ~ 0.5 ml/min. The catheter was slowly pulled through the Ell at steps of 0.5 cm. Care was taken that at each step at 1~ 1 wet swallow more than 15 s apart from other swallows ~ recorded. The results were compared to 8 healthy matched c~ tro s 31 73 years old. The data were tested for significant ference using the Wilcoxon test for unpaired values. Differ r ofp <0.05 were considered to be significant. Results

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The Cricopharyngeal Sphincter: Its Relationship to the Relief of Pharyngeal Paralysis and the Surgical Treatment of the Early Pharyngeal Pouch

Cited by 44 publications

References 6 publications

Flexible endoscopic and surgical management of Zenker's diverticulum

Flexible endoscopic and surgical management of Zenker's diverticulum

Surgical Treatment of Zenker's Diverticulum

Upper esophageal sphincter function in patients with Zenker's diverticulum

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