Effect of cricopharyngeal myotomy on pharyngoesophageal function: Pre- and postoperative cineradiographic findings

Ekberg, Olle; Lindgren, Sven

doi:10.1007/bf01885090

Cited by 19 publications

(5 citation statements)

References 9 publications

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“…Cineradiographic studies have shown that myotomy produces improvement in the motor function of the entire pharyngoesophageal segment, not just the UES. 179 Injection of botulinum toxin may provide an alternative approach to cricopharyngeal dysfunction, but its exact role in therapy remains to be defined. 180 In a recent trial, 10 patients with well defined UES dysfunction (incomplete or delayed opening primarily) OPD was improved but not resolved.…”

Section: Oropharyngeal Dysphagia (Opd)mentioning

confidence: 99%

Dysphagia in Aging

Achem

DeVault

2005

Journal of Clinical Gastroenterology

154

109

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Dysphagia is a common problem in older patients and is becoming a larger health care problem as the populations of the United States and other developed countries rapidly age. Changes in physiology with aging are seen in the upper esophageal sphincter and pharyngeal region in both symptomatic and asymptomatic older individuals. Age related changes in the esophageal body and lower esophageal sphincter are more difficult to identify, while esophageal sensation certainly is blunted with age. Stroke, Parkinson's disease, amyotrophic lateral sclerosis, Zenker's diverticula, and several other motility and structural disorders may cause oropharyngeal dysphagia in an older patient. Esophageal dysphagia can also be caused by both disorders of motility (achalasia, diffuse esophageal spasm, scleroderma and others) and structure (malignancy, strictures, rings, external compression, and others). Many of these disorders have an increased prevalence in older patients and should be sought with an appropriate diagnostic evaluation in older patients. The treatment of dysphagia in older patients is similar to that in younger patients, but more invasive therapies such as surgery may not be possible in some older patients making less aggressive medical and endoscopic therapy more attractive.

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Section: Oropharyngeal Dysphagia (Opd)mentioning

confidence: 99%

Dysphagia in Aging

Achem

DeVault

2005

Journal of Clinical Gastroenterology

154

109

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“…However, the effect of these procedures is not always predictable and sometimes additional alterations of deglutition arise after surgery. 11,14,15 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction

et al. 2000

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Objectives: To investigate the efficacy of botulinum toxin A (BTA)-induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction. Study Design: Prospective clinical trial in 10 selected patients with pure UES dysfunction. Methods: In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing s tudy (VSS) was done and a clinical symptom score was determined before and after treatment. Results: On VSS relative opening of the UES improved in all pa· tients (mean± SD: 47 ± 14% before versus 71 ± 24% after treatment; P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persist ed in six patients, and moderate dysphagia persisted in three patients. Conclusions: Our results support the u se of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent s tructural stenosis of the UES and the risk ofBTA diffusion into the larynx or hypopharynx.

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“…Radiographic examinations are useful in the immediate postoperative course as well as during a later follow-up for evaluation of patients after cricopharyngeal myotomy (4). Anterior dislocation of the pharynx and cervical esophagus in a patient without leak is without clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Findings after Cricopharyngeal Myotomy

Ekberg

Besjakov²,

Lindgren³

1987

Acta Radiol

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Single film examinations (iodine and/or barium) were reviewed in 28 patients who had undergone surgery on the cricopharyngeal muscle due to Zenker diverticula (24 patients), cricopharyngeal muscle incoordination (3 patients) and pharyngoesophageal web (one patient). All patients had had a myotomy which included the cricopharyngeal muscle and up to 3 cm of the cervical esophagus. Lateral and anterior deviation of the pharynx and cervical esophagus occurred regularly. A pharyngocutaneous fistula developed in 2 patients which healed within 3 weeks. In 5 patients there was a posterior leak of contrast medium during the first postoperative week which healed within 2 weeks. Six of these seven patients with a fistula or a leak had had either a diverticulum removed or sustained an accidental mucosal perforation. No patient had recurrence of diverticula, although, 9 patients developed a cricopharyngeal muscle impression. Iodine and barium examinations are important for monitoring early and late postoperative changes after cricopharyngeus myotomy.

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Effect of cricopharyngeal myotomy on pharyngoesophageal function: Pre- and postoperative cineradiographic findings

Cited by 19 publications

References 9 publications

Dysphagia in Aging

Dysphagia in Aging

Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction

Radiographic Findings after Cricopharyngeal Myotomy

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