Upper esophageal sphincter function in patients with Zenker's diverticulum

Abstract

Abstract.Upper esophageal sphincter function (UES) was studied in 8 patients with Zenker's diverticulum. Radiologic and endoscopic studies revealed pharyngoesophageal diverticula of varying size. No tumor or stenosis was found. Esophageal manometry showed no significant difference between patients and 8 matched controls with respect to UES resting pressure, delay of maximal UES relaxation, and maximal pharyngeal contraction. All patients exhibited a drop of the UES pressure to esophageal resting pressure during swallowing. These results indicate that disturbances of UES function in established Zenker's diverticulum are a myth.Key words: Zenkcr's diverticulum -Esophageal motility.Motor disorders of the upper esophageal sphincter (UES) are held to be responsible for the development of a pharyngoesophageal pouch (PED). Several studies support the hypothesis that a disturbance of the swallowing mechanism with elevated resting pressure, premature closure, and incoordinated relaxation of UES might play a key role in the pathogenesis of Zenker's diverticulum [1][2][3][4][5][6]. In a few investigations, however, this hypothesis was questioned [3,7]. We therefore studied UES function in patients with Zenker's diverticulum in comparison to normal controls. Patients and MethodsEight patients 9 6 men and 2 women, 48-75 years old, with Zenker's diverticulum participated. The patients first under- metry. A 4-lumen manometry tube 3 mm m dmmcter w~t dially oriented pressure-detecting orifices spaced 5 cm apar t~ perfused via a low-compliance perfusion pump at a rate, ~ 0.5 ml/min. The catheter was slowly pulled through the Ell at steps of 0.5 cm. Care was taken that at each step at 1~ 1 wet swallow more than 15 s apart from other swallows ~ recorded. The results were compared to 8 healthy matched c~ tro s 31 73 years old. The data were tested for significant ference using the Wilcoxon test for unpaired values. Differ r ofp <0.05 were considered to be significant. Results

Endoscopic Carbon Dioxide Laser Zenker's Diverticulotomy Revisited

“…Van Overbeek 3 stated that the pathogenesis may also be related to the individual anatomic structure, and height, of the triangle of Killian. Numerous other etiologic mechanisms have been considered of influence, including abnormalities in relaxation of the cricopharyngeal muscle and premature muscular contraction or incoordination between pharyngeal contraction and the upper esophageal sphincter, but several studies [4][5][6] suggest that they do not play a role.…”

Killian-Jamieson Diverticulum: Management of a Rare Esophageal Diverticula

“…Esophageal manometry has been used to decipher the etiology of ZD [ 13 ] and Migliore et al recommend surgical intervention only after manometric evaluation [ 14 ]. However, other studies showed inconsistent upper esophageal sphincter pressures with varying timing of contraction [ 15 , 16 ] suggesting that the manometry is an unreliable tool for ZD diagnosis.…”

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“…Frieling et al described an abnormal sequence of pharyngeal and oesophageal contractions [14]. Barthelen et al proposed that there was an anatomical basis for the disease as it was due to patients having a large constrictor-cricopharyngeus space and that there was mucosal prolapse due to loss of tissue elasticity with age [15].…”