Upper esophageal sphincterotomy in dysphagic patients with and without a diverticulum

Abstract

Symptoms of high dysphagia are sometimes too readily interpreted as symptoms of globus. When patients have unmistakable difficulties during meals, focused diagnostic procedures are indicated. The upper esophageal sphincter (UES) is the key structure at the transition from hypopharynx to esophagus. In many disorders presenting with dysphagia, the UES mechanism remains intact and can cause the symptoms. Especially in patients with a hypopharyngeal (Zenker's) diverticulum and in patients with a hypopharyngeal paralysis due to a neurologic disorder, sphincterotomy may be indicated. In the microendoscopic treatment of Zenker's diverticulum, a transmucosal sphincterotomy is created and at the same time a more ample overflow from diverticulum to esophagus is effected. In view of our results in 507 patients we are justified in maintaining that this procedure can be regarded as a safe and effective treatment. In patients with neurologic dysphagia, sphincterotomy by an external approach can ensure adequate passage of food from the hypopharynx to the esophagus, resulting in marked improvement of the dysphagic symptoms. Our technique and results of external approach sphincterotomy are described here.

Endoscopic Staple‐Assisted Esophagodiverticulostomy for Zenker's Diverticulum

“…The finding in our patients of a diverticular remnant on postoperative contrast esophagography has been described both by Collard et al 15 for ESED and by others after endoscopic laser or diathermic myotomy 3,4 . Although a radiographically identifiable residual pouch can be seen after endoscopic division of the common wall, the esophagodiverticulostomy allows both contrast material and ingested food to pass easily into the esophageal lumen.…”

“…In one of the largest studies, van Overbeek 3 reported a 99% patient satisfaction rate following endoscopic diathermy or laser myotomy performed in 508 patients. In this series the incidence of significant complications was 8%, with a 2% rate of mediastinitis and one death.…”

Predictors of Outcome following Cricopharyngeal Disruption for Pharyngeal Dysphagia

“…Although this group of disorders is heterogeneous, some overlap exists in relation to component mechanisms of dysfunction. Disruption of the cricopharyngeus muscle by myotomy is an accepted form of therapy for dysphagia but precise indications for it are undefined and postoperative results are variable with reported response rates of 50%-70% [7][8][9][10][11][12][13][14]. The heterogenicity of patient populations studied may partly explain this variable response rate.…”

Acquired pharyngoesophageal diverticulum in childhood

“…The cause relates to a weak muscular point at the pharyngoesophageal junction at the time of birth. 5 These lesions are indistinguishable clinically and radiologically from non-congenital diverticula. Nevertheless, they can easily be identified pathologically due to their complete muscular walls.…”