Comparison of Methods for Determining Cricopharyngeal Intrabolus Pressure in Normal Patients as Possible Indicator for Cricopharyngeal Myotomy

Bammer, T.; Salassa, John R.; Klingler, Paul J.

doi:10.1067/mhn.2002.128554

Cited by 23 publications

(47 citation statements)

References 12 publications

(24 reference statements)

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“…In our ACO study group, the mean intrabolus pressure gradient across the osteophyte was 39.78 mm Hg before the surgery. When comparing these manometric results with the normal results previously reported from our institution, 12 preoperative IB-Gra in our patients were markedly higher than normal. Moreover, we found a statistically significant postoperative decrease in IB-Gra from 39.78 to 19 mm Hg (p < .001).…”

Section: Discussionsupporting

confidence: 39%

“…Publications on MFG at our institution included proposed catheter standards, intrabolus pressure determination and normal cricopharyngeal intrabolus pressures in the young and old population. 12,15,16 In the latter study, the mean midbolus pressures in older subjects was 10.8 AE 8.8 mm Hg and the mean gradient pressure across the 3-cm cricopharyngeal region for the same subjects was 4.38 AE 3.1 mm Hg. Regarding these findings and on the basis of a single case, it was suggested that intrabolus pressure gradient across the cricopharyngeal region may be an indicator for patients who might benefit from cricopharyngeal myotomy.…”

Section: Discussionmentioning

confidence: 96%

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Anterior cervical osteophyte dysphagia: Manofluorographic and functional outcomes after surgery

et al. 2010

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Functional (FOSS) and objective MFG (IB-Gra) improvements occurred in patients who had ACO dysphagia and underwent surgery. These findings support high IB-Gra as a reliable objective indicator for surgical intervention for ACO dysphagia and IB-Gra as an appropriate parameter for follow-up after ACO removal. In selected patients, ACO removal by anterolateral-transcervical approach is a safe and highly effective treatment.

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Section: Discussionsupporting

confidence: 39%

Section: Discussionmentioning

confidence: 96%

Anterior cervical osteophyte dysphagia: Manofluorographic and functional outcomes after surgery

et al. 2010

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“…Finally, UES pressures are comprised of muscular activity from the inferior constrictor, cricopharyngeus, and the circular skeletal muscles in the cervical esophagus [114][115][116][117]. The bolus also exerts a measurable pressure during passage through the UES [118][119][120], and there are additional pressure components from positioning of the larynx and other regional pharyngeal structures [114,121]. Additionally, the high-pressure zone of the UES rises in the pharynx due to hyolaryngeal elevation and pharyngeal shortening [102,120,122,123], and subtle differences in these muscular activations has the potential to influence the extent and timing of UES pressure activity on different manometric sensors.…”

Section: Discussionmentioning

confidence: 99%

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Jones

Meisner

Broadfoot

et al. 2018

Front. Appl. Math. Stat.

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Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter (UES) reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3-10 consecutive swallows had no overall difference in variability, but sets of two swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

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“…[24][25][26] There is reported death from aspiration following botulinum toxin injection. 27 Endoscopic resection of the CP bar by the use of the CO 2 laser has been reported. A recent review by Pitman et al looked at the seven series in the literature in the past 10 years that focus exclusively on CO 2 laser myotomy and exclude patients with Zenker's diverticulum.…”

Section: Discussionmentioning

confidence: 99%

Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

et al. 2009

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Objectives/Hypothesis: Transoral treatment of cricopharyngeal bar and small Zenker's diverticulum remains a challenge. We propose a new transoral approach for transoral cricopharyngeal myotomy (TOCPM) for patients with cricopharyngeal spasm and pharyngeal bar, and for transoral resection of diverticula (TORD) with cricopharyngeal myotomy in the patient with small (<3 cm) Zenker's diverticulum.Methods: A retrospective review was conducted of 45 patients with cricopharyngeal spasm (21) and Zenker's diverticulum (24), where 14 patients were considered suitable for TORD and TOCPM. TOCPM used the Weerda laryngoscope (Karl Storz, Tuttlingen, Germany) to expose the cricopharyngeal bar using a microscope; the mucosa is cut and then the muscle is transected using monopolar cautery. A 0 endoscope is inserted through the incision to ensure complete myotomy. Incision closure is by interrupted 4-0 Vicryl sutures (Ethicon Inc., Somerville, NJ) and fibrin glue. For the TORD procedure, the diverticular sac is everted and then resected using scissors. Through the sac opening, the TOCPM is completed. The sac opening is then closed as described in TOCPM. The patients are kept without food for 24 hours, followed by feeding and discharge. Modified barium swallow (MBS) evaluated functional results.Results: Fourteen patients underwent TOCPM (eight), and TOCPMþTORD (six). There was one case of TOCPM that was aborted due to excessive bleeding, which prevented full myotomy. The rest did well. All were discharged the next day. Two poor results from the TOCPM and TOCPMþTORD group were due to poor esophageal motility. The remainder of patients had resolution of dysphagia and normalized MBS. No patient developed stricture or complications.Conclusions: Short segment Zenker's diverticulum and cricopharyngeal bar can now be addressed completely with a transoral approach. Because there is complete closure of the mucosal incision, prolonged hospitalization can be avoided.

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Comparison of Methods for Determining Cricopharyngeal Intrabolus Pressure in Normal Patients as Possible Indicator for Cricopharyngeal Myotomy

Abstract: Intrabolus pressure anomalies in the cricopharyngeal region have been proposed as an indicator for selecting patients who would benefit from cricopharyngeal myotomy. The methods of determining intrabolus pressures vary, with resulting variations in recommendations.

Cited by 23 publications

References 12 publications

Anterior cervical osteophyte dysphagia: Manofluorographic and functional outcomes after surgery

Anterior cervical osteophyte dysphagia: Manofluorographic and functional outcomes after surgery

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

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