Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement. METHODSAll balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES). RESULTSFour hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunction, Zenker’s diverticulum, age or gender (P > 0.05). The only complication noted was uvular edema and a shallow ulcer after static dilatation in one patient, which resolved spontaneously and did not require hospital admission. CONCLUSIONUES dilatation with a through-the-scope balloon by either static or retrograde technique is safe and effective for the treatment of dysphagia due to CP dysfunction. To our knowledge, this is the first study evaluating retrograde balloon dilatation of the UES.

Retrograde cricopharyngeal dysfunction(R-CPD):What do we know so far?

Objective:This comprehensive review aims to explain the disease pathophysiology,clinical presentation,and management options.Methods:A review was carried out in the following databases:Medline,Scopus,Web of Science,and Cochrane.The following terms were used alone and combined:Retrograde,Cricopharyngeus muscle,Dysfunction,Abelchia,and inability to burp.Results:A total of 68 articles were identified,and only 11 were found to be relevant and included in writing this review.Retrograde cricopharyngeal dysfunction(R-CPD)is a relatively new disease entity that has recently been described in clinical literature.It is caused by the inability of the cricopharyngeus muscle to relax.Unlike cricopharyngeal dysfunction(CPD),which is well-known and characterized by dysphagia,R-CPD is characterized by the inability to belch in almost all patients,which is considered diagnostic for the condition.Conclusions:High-resolution manometry(HRM)is the definitive diagnostic modality.Most patients reported in the literature responded well to treatment with botulinum toxin injection.

逆行性环咽肌功能障碍

逆行性环咽肌功能障碍是新近认识的一种疾病,以不能打嗝、恶心、胸痛、咽喉部咕噜声、腹部过度胀气及呕吐困难等为主要临床表现,环咽肌肉毒素注射多数可取得较好疗效。本文对其临床表现、诊断和治疗进行综述,旨在使广大医患认识该病,使患者得到及时治疗。

Current status of minimally invasive endoscopic management for Zenker diverticulum

Surgical resection has been the mainstay of treatment of pharyngoesophageal(Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplishedthrough the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.

Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique

AIM To investigate the role of a novel minimally invasive endoscopic technique in the management of tight neartotal corrosive strictures of the proximal esophagus involving the hypopharynx.METHODS Two patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guidewire across the stricture, and stricture dilatation, using 10 F coaxial diathermy and balloon dilators, followed byelectro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.RESULTS Both patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.CONCLUSION We report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.