ABSTRACT
Over the last 20-30 years, treatment of pharyngoesophageal diverticula was subject to a number of fundamental changes. Considering the classical open transcervical approaches, the necessity for myotomy of the upper esophageal sphincter with the goal of interrupting the pathogenesis of the disease has become a standard component of the operation. On the other hand, with the growing popularity of rigid and flexible endoscopic techniques, pharyngoesophageal diverticula are increasingly being treated by gastroenterologists and otorhinolaryngologists, often with the argument of a technically easier and less invasive procedure; however, it remains unclear whether this shift towards endoscopic techniques truly translates into better outcome quality. This aim of this CME article is to summarize the available scientific evidence on the complex pathophysiology, diagnostics and treatment of pharyngoesophageal diverticula and to provide the reader with an updated guide to best clinical practice for diagnostics and treatment.
Subject(s)
Zenker Diverticulum/surgery , Contrast Media/administration & dosage , Deglutition/physiology , Diagnosis, Differential , Esophageal Sphincter, Upper/physiopathology , Esophagoscopy/methods , Humans , Outcome and Process Assessment, Health Care , Postoperative Complications/etiology , Surgical Stapling/methods , Tomography, X-Ray Computed , Zenker Diverticulum/classification , Zenker Diverticulum/diagnostic imaging , Zenker Diverticulum/physiopathologyABSTRACT
To determine quality of life (QoL) in individuals with dysphagia related to identified Zenker's diverticulum before (T1) and one year after undergoing endoscopic laser diverticulotomy surgery (T2). A total of 43 individuals (18 women and 25 men) were included at T1 and 37 of these responded at T2 (13 women and 24 men). Health-related QoL (HRQoL) was determined with the short form 36 (SF-36) and disease-specific QoL (DSQoL) was assessed with the MD Anderson Dysphagia Inventory (MDADI). In addition, two questions about specific symptoms related to Zenker's diverticulum were added and ordered as a fifth subscale of MDADI. Comparisons were made between patients and an age- and gender-adjusted normative sample from the Norwegian population. Significant differences were found in all subscales on MDADI, but none between T1 and T2 on SF-36. Compared to the normative sample, the component score MCS of SF-36 was significantly lower in the dysphagia patients at both T1 and T2. The attrition sample had significantly lower PCS than the completers. The results substantiate that disease severity is associated with poorer disease-related QoL, and that the disease-specific QoL is significantly improved one year after laser diverticulotomy.
Subject(s)
Deglutition Disorders/etiology , Esophagoscopy/methods , Laser Therapy/methods , Quality of Life , Zenker Diverticulum/surgery , Aged , Case-Control Studies , Deglutition Disorders/classification , Deglutition Disorders/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Severity of Illness Index , Statistics, Nonparametric , Treatment Outcome , Zenker Diverticulum/classification , Zenker Diverticulum/complicationsABSTRACT
Se presenta un caso de divertículo faringosefágico o de Zenker diagnosticado y operado en el Servicio de Cirugía General del Hospital Universitario Carlos Manuel de Céspedes, se señaló su clasificación clínica y diagnóstica, se realizó como técnica quirúrgica la diverticulopexia más miotomía del músculo cricofaringeo; se comentó sobre las teorías actuales de la etiología de esta entidad y las técnicas quirúrgica más empleadas(AU)
It is presented a case of pharyngo- oesophageal diverticulum so called zenker diagnosed and resected in a General Surgery Room from University Hospital Carlos Manuel de Céspedes. Its clinical and diagnostic classification was showed. As a surgery technique it was made a diverticulopexy plus miotomy of cricopharyngeal musle. A comment was made on up-to-date theories on this entity etiologic, and surgical techniques more employed(AU)
Subject(s)
Humans , Zenker Diverticulum/classification , Zenker Diverticulum/surgery , Diverticulum, Esophageal/classification , Diverticulum, Esophageal/surgeryABSTRACT
OBJECTIVE: The aim of the present study was to evaluate the long-term success of endoscopic stapling as a primary procedure for the treatment of pharyngeal pouches. METHODS: This study is a retrospective case review of 25 patients with pharyngeal pouches treated by endoscopic stapling (23 stapled, 2 abandoned) over a 4-year period (1994 to 1998) at a University teaching hospital in the United Kingdom. Outcome measures used were relief of symptoms over a long-term follow-up of 2 to 5 years. RESULTS: Of the 25 patients analyzed, 12 patients (48%) have remained asymptomatic after their initial stapling. Eight patients (32%) were relieved of their symptoms after revision stapling. The overall long-term success rate for endoscopic stapling was 80% (20 of 25 patients) CONCLUSION: Reduced morbidity and few complications in the elderly make endoscopic stapling a favored primary technique of treating pharyngeal pouches. Open surgery is recommended only in healthy patients with very large pouches.
Subject(s)
Endoscopy, Gastrointestinal/methods , Surgical Stapling/methods , Zenker Diverticulum/surgery , Aged , Aged, 80 and over , Barium Sulfate , Contrast Media , Deglutition Disorders/etiology , Endoscopy, Gastrointestinal/adverse effects , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Morbidity , Patient Selection , Radiography , Reoperation , Retrospective Studies , Severity of Illness Index , Surgical Stapling/adverse effects , Time Factors , Treatment Outcome , Vomiting/etiology , Zenker Diverticulum/classification , Zenker Diverticulum/complications , Zenker Diverticulum/diagnostic imagingABSTRACT
Se presentan 29 pacientes con diagnóstico de divertículo de Zenker operados entre Junio de 1981 y Junio de 1995, a todos ellos se les realizó como tratamiento miotomía cricofaringea,asociado a diverticulectomía en 25 casos y a diverticulopexia en los 4 restantes.El porcentaje de complicaciones fue del17,2 por ciento y no hubo mortalidad en la serie
Subject(s)
Humans , Adult , Zenker Diverticulum/surgery , Zenker Diverticulum/classificationABSTRACT
Se presentan 29 pacientes con diagnóstico de divertículo de Zenker operados entre Junio de 1981 y Junio de 1995, a todos ellos se les realizó como tratamiento miotomía cricofaringea,asociado a diverticulectomía en 25 casos y a diverticulopexia en los 4 restantes.El porcentaje de complicaciones fue del17,2 por ciento y no hubo mortalidad en la serie
Subject(s)
Humans , Adult , Zenker Diverticulum/surgery , Zenker Diverticulum/classificationABSTRACT
In a retrospective study of 143 patients with Zenker's diverticulum followed for a period of 20 years, we classified the diverticula into 4 categories (A, B, C and D) using Brombart's scheme as a basis; the difference between the first two categories, however, was made on the basis of a morphological-dynamic criterion rather than a purely morphological one. Furthermore, a quantitative index was introduced to define the size of the diverticulum. In two cases we noted a substantial increase in volume with the transition from category C to D after more than 3 years, but we were unable to demonstrate an evolution from category A to B, nor from B to C. Our study confirms, on a large scale, the presence of three possible pathogenetic mechanisms, as proposed earlier in the literature: decreased relaxation of the upper esophageal sphincter as the most frequent factor in all categories except category A, and delayed opening or early closing of this sphincter as less frequent factors. The good relaxation of the upper esophageal sphincter in our category A, the different sex ratio and the absence of evolution in this category suggest that category A does not necessarily evolve further.
