Cricopharyngeal spasm and Zenker's diverticulum

Abstract

Cricopharyngeal spasm and Zenker's diverticulum represent disorders of the pharyngoesophageal junction for which a unifying theory of etiology has yet to be established. There is, however, a large body of evidence that supports an association with gastroesophageal reflux. Cricopharyngeal myotomy is the key to successful management of both disorders. Newer transoral endoscopic techniques of management have a lower overall morbidity than traditional open approaches in appropriately selected patients and are therefore gaining popularity as the preferred method of treatment.

Flexible endoscopic and surgical management of Zenker's diverticulum

“…Endoscopic stapling using a rigid endoscope is not feasible in patients with retrognathia, prominent teeth, severe temporo mandibular joint disease and rigid cervical kyphosis that limit neck extension. Anatomic head and neck features that can affect the feasibility of rigid endoscopic treatment and necessitate conversion to an open surgery are seen in about 5% of cases [96].…”

Efficacy of large-diameter dilatation in cricopharyngeal dysfunction

“…Botulinum toxin injection for CP dysfunction has been observed to last from 2 to 12 months, with an average of 5 months of benefit. 3 We observed a benefit that lasted a median of 741 days in the 34 dilations in which improvement was observed. Due to the retrospective nature of this study, we experienced a 67.65% censorship rate, which suggests that actual median duration of benefit may be longer.…”

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

“…19,29,30 The surgery works well in a majority of cases, but when the diverticulum is <3 cm many physicians encounter difficulty in completing the myotomy using the stapler. Currently, the shortest stock stapler is 3 cm.…”

“…These include balloon dilation, botulinum toxin injection, endoscopic CP myotomy, and open CP myotomy. 19 There are limited reports of the postoperative outcomes of these procedures.…”