RESUMEN
OBJECTIVE: To examine the clinical presentation, diagnostic evaluation, and management of Killian-Jamieson diverticula (KJD) through literature review. METHODS: A comprehensive literature review was conducted through December 2018 using keywords Killian-Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care. SOURCES: PubMed and Google Scholar. RESULTS: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery. CONCLUSION: Killian-Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts. LEVEL OF EVIDENCE: 4.
Asunto(s)
Manejo de Atención al Paciente/métodos , Divertículo de Zenker , Diagnóstico Diferencial , Humanos , Divertículo de Zenker/diagnóstico por imagen , Divertículo de Zenker/patología , Divertículo de Zenker/fisiopatología , Divertículo de Zenker/terapiaRESUMEN
Endoscopic treatment methods are currently a priority in the treatment of patients with Zenker's diverticulum. The optimal endoscopy should combine the positive aspects of traditional and tunnel technologies and be fairly simple from technical standpoint, the most radical and safe for the patient. This work evaluates the effectiveness of endoscopic cricopharyngeal esophagomyotomy using combined methods of treating patients with Zenker's diverticulum. From June, 2014 to December, 2018 A. S. Loginov City Clinical Scientific Centre performed 30 surgeries using a new combined technique. The average surgery time is 37.5 minutes. No postoperative complications. Control X-ray examination has shown almost complete absence of the residual cavity of the diverticulum. The combined endoscopic method of treating patients with Zenker's diverticulum allows to create conditions for preventing the recurrence of the disease, thereby ensuring the best result of treatment.
Asunto(s)
Endoscopía , Divertículo de Zenker , Progresión de la Enfermedad , Humanos , Tecnología , Resultado del Tratamiento , Divertículo de Zenker/terapiaAsunto(s)
Trastornos de Deglución/etiología , Estenosis Esofágica/etiología , Hematemesis/etiología , Úlcera/etiología , Divertículo de Zenker/complicaciones , Anciano , Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/terapia , Endoscopía del Sistema Digestivo , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/fisiopatología , Estenosis Esofágica/terapia , Hematemesis/diagnóstico , Hematemesis/fisiopatología , Hematemesis/terapia , Humanos , Masculino , Recuperación de la Función , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Úlcera/diagnóstico , Úlcera/fisiopatología , Úlcera/terapia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/fisiopatología , Divertículo de Zenker/terapiaRESUMEN
Introduction: The Zenker Diverticulum is a rare pathology, the selection of patients for invasive treatments is questionable, as well as the applied therapeutic method. The aim of the study is to evaluate the main methods of classical and endoscopic surgical treatment in this pathology and to correlate pathophysiological aspects with clinical consequences. MATERIAL AND METHOD: We included 36 patients with Zenker hypopharyngeal diverticulum treated in 2010/2017 in two university clinics: 7 patients by classical surgical approach at the General and Esophageal Surgery Clinic of St. Mary's Hospital Bucharest and 29 patients with endoscopic approach at Department of Diagnostic and Interventional Digestive Endoscopy of the Regional Institute of Hepatology and Gastroenterology Prof Dr Octavian Fodor, Cluj-Napoca. The age of the patients ranged from 42 to 84 years and in the 7th to 15th decade. Results: Cricopharyngeal myotomy was performed in all patients. Diverticullectomy was performed in 7 patients treated surgically. The average hospitalization duration was 4 days. Intra-procedural complications showed 3 patients treated endoscopically and consisted of laminar haemorrhage. Two patients were treated with endoscopic endoscopic hemostasis and hot pens and one patient had endoscopic hemostasis with clips. The post-procedural complications were: local pain, leukocytosis, melena, fever, cervical hematoma. These post-treatment events were seen in 6 patients. The posttreatment morbidity was 16.66%. Conclusions: In patients included in the batch, the endoscopic treatment efficiency was 80%. Peristent postinterventional symptomatology was mainly represented by dysphagia, post-procedural syndrome was associated with dysphagia persistence. Patients with persistent post-surgical symptoms were required to reintervention.
Asunto(s)
Esofagoscopía , Esófago/cirugía , Divertículo de Zenker/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Trastornos de Deglución/etiología , Esofagoscopía/métodos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Miotomía , Cirugía Endoscópica por Orificios Naturales/métodos , Músculos Faríngeos/cirugía , Estudios Retrospectivos , Factores de Riesgo , Rumanía , Resultado del Tratamiento , Divertículo de Zenker/terapiaAsunto(s)
Presión del Aire , Música , Enfermedades Profesionales/etiología , Enfermedades Faríngeas/etiología , Músculos Faríngeos/anomalías , Divertículo de Zenker/etiología , Adulto , Vendajes de Compresión , Dilatación Patológica , Humanos , Masculino , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/terapia , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/terapia , Negativa del Paciente al Tratamiento , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Divertículo de Zenker , Divertículo de Zenker/terapia , Retratamiento/métodos , Endoscopía , Músculos Faríngeos , Músculos Faríngeos/cirugía , Electrocoagulación/métodos , Trastornos de Deglución/complicaciones , Trastornos de Deglución , Electrocirugia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
Zenker's diverticulum occurs at the dorsal pharyngoesophageal junction through Killian's dehiscence and is caused by increased intrabolus pressure. Symptomatic disease most frequently affects male elderly patients. Primary symptom is oropharyngeal dysphagia, as well as regurgitation of undigested food, halitosis, and chronic aspiration. A barium swallow study is performed to confirm diagnosis. Treatment options for symptomatic patients include open surgery, as well as transoral rigid or flexible endoscopic procedures. Transoral procedures have become the main treatment approach over the past year thanks to reduced intraoperative complication rates compared to open surgery. The septum dividing the diverticulum from the esophagus is most commonly divided by a stapler device, papillotome, or laser. For high-risk patients who are poor candidates for general anesthesia, the procedure can be performed via flexible endoscopy in awake patients, albeit at an increased risk of recurrence.
Asunto(s)
Trastornos de Deglución/diagnóstico , Trastornos de Deglución/terapia , Esofagectomía/métodos , Esofagoscopía/métodos , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapia , Trastornos de Deglución/complicaciones , Diagnóstico Diferencial , Medicina Basada en la Evidencia , Humanos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Divertículo de Zenker/complicacionesRESUMEN
Introducción: el tratamiento endoscópico flexible del divertículo de Zenker es una alternativa a otros abordajes terapéuticos. El presente estudio muestra nuestros resultados a corto y largo plazo de la crico-faringo-mío-septotomía endoscópica flexible. Pacientes y método: análisis retrospectivo de nuestra experiencia entre 2002 y 2015 en pacientes con divertículo de Zenker tratados mediante un endoscopio flexible con la asistencia de un diverticuloscopio flexible. La mío-septotomía se realiza con un papilotomo de aguja bajo sedación profunda o anestesia general. Resultados: de los 64 pacientes tratados dos fallecieron antes de 10 días después del procedimiento por causas no directamente relacionadas con la intervención y otro presentó una perforación faringo-esofágica que se resolvió con tratamiento conservador tras 47 días de ingreso. Carecemos de seguimiento a corto plazo de otros cuatro. Cincuenta y dos de los 57 restantes mostraron un alivio completo de la disfagia a las 6 semanas. Once de ellos presentaron recurrencia sintomática a medio o largo plazo. Ocho fueron retratados con el mismo método endoscópico flexible, uno mediante un abordaje endoscópico híbrido, otro mediante cirugía abierta clásica y otro rechazó el retratamiento. Tras un seguimiento medio de 2 años y medio, 33 de 37 pacientes refieren ausencia o mínima disfagia controlable con restricciones dietéticas puntuales. Conclusiones: el tratamiento endoscópico flexible del divertículo de Zenker es eficaz y seguro. Representa una alternativa en igualdad de condiciones al abordaje endoscópico rígido y a la cirugía abierta clásica y puede aplicarse cuando existe imposibilidad técnica o contraindicación para estos (AU)
Introduction: Flexible endoscopic treatment is one of the alternative approaches for the management of Zenkers diverticum. The present paper shows our short-term and long-term results with flexible endoscopic cricopharyngeal myotomy/septotomy. Patients and methods: A retrospective analysis of our experience in patients with Zenkers diverticulum treated using a flexible endoscope, assisted by a flexible diverticuloscope, between 2002 and 2015. Myotomy/septotomy was performed with a needle-knife papillotome under deep sedation or general anesthesia. Results: Among the 64 patients treated, two died within 10 days of surgery from causes not directly related to the procedure, and one presented with pharyngo-esophageal perforation, which recovered with conservative management at 47 days after admission. Four additional patients were lost to short-term follow-up. Among the 57 remaining patients, 52 had complete relief of dysphagia after 6 weeks. Eleven of these had recurrent symptoms on the mid and the long term. Eight were retreated with the same flexible endoscopic technique, one with a hybrid endoscopic approach, one with classical open surgery and one refused retreatment. After a mean follow-up of 2 years and a half, 33 of 37 patients reported absent or minimal dysphagia, controllable with punctual dietary restrictions. Conclusions: Flexible endoscopic treatment for Zenkers diverticulum is effective and safe. It represents an option on an equal footing to rigid endoscopy and classical open surgery and may also be used when the latter two are technically impracticable or contraindicated (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Divertículo de Zenker/epidemiología , Divertículo de Zenker/terapia , Divertículo de Zenker , Endoscopía , Electrocoagulación/instrumentación , Electrocoagulación/métodos , España/epidemiología , Estudios Retrospectivos , Anestesia General/métodos , Sedación Profunda , Trastornos de Deglución/complicaciones , Trastornos de Deglución/terapia , Plexo Braquial/cirugíaRESUMEN
BACKGROUND: Management of the pharyngeal pouch has evolved enormously since the first description by Ludlow in 1764 and the first case series by Zenker and Von Ziemssen in 1877. With the introduction of antibiotics, and the advancement of surgical technique with the advent of endoscopic surgery and lasers, current management is vastly different to that in the nineteenth century. OBJECTIVES: This paper traces the history of pharyngeal pouch management, and discusses the various treatment options and opinions recorded during the nineteenth and twentieth centuries, comparing these with techniques popular today. RESULTS AND CONCLUSION: Pharyngeal pouch surgery has been associated with significant morbidity, both because of the elderly age of patients typically affected by the condition and because of the surgery itself and potential post-operative complications encountered. The historical development of pharyngeal pouch management and the understanding of pharyngeal pouch pathophysiology are discussed.
Asunto(s)
Divertículo de Zenker/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Procedimientos Quirúrgicos Otorrinolaringológicos/historia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMEN
This study explores the contribution of Speech and Language Therapists (SLTs) to the assessment and management of patients presenting on videofluoroscopic swallow studies (VFSS) with a suspected pharyngo-oesophageal diverticulum. Records for all patients who attended for VFSS in an acute hospital over an eleven-year period were examined (N = 1820). Twenty patients were identified on VFSS as having a suspected diverticulum. Symptoms suggestive of a diverticulum were found during both bedside clinical examination and radiographic examination e.g. respiratory difficulties (n = 15; 75%), voice changes (n = 14; 70/0). VFSS confirmed a reduced risk of aspiration for 14 patients (70%) using a combination of fluid modification (n = 9; 45%), food modification (n = 13; 65%) and swallow strategies (n = 14; 70%). VFSS confirmed aspiration directly related to the diverticulum in 11 patients (55%). Findings indicate that SLTs have the opportunity to identify potential diverticula and implement behavioural management to reduce associated health risks. This is of particular importance to patients who are awaiting, or cannot undergo, surgical repair of their diverticulum.
Asunto(s)
Logopedia , Divertículo de Zenker/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Fluoroscopía , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Divertículo de Zenker/terapiaRESUMEN
The pharyngeal pouch (Zenker's diverticulum) is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the oesophagus). It occurs commonly in elderly patients (over 70 year) and the typical symptoms include dysphagia, regurgitation, chronic cough, aspiration and weight loss. We are reporting a case of an oropharyngeal dysphagia due to a Zenker's diverticulum in 75 years old Sudanese man with a chronic history of dysphagia for solids. The pathophysiology of Zenker's diverticulum, clinical presentation, and management are reviewed.
Asunto(s)
Trastornos de Deglución/etiología , Divertículo de Zenker/fisiopatología , Factores de Edad , Anciano , Humanos , Masculino , Sudán , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMEN
This article introduces the pathogenesis and relevant anatomy of Zenker diverticulum. The clinical symptoms and relevant investigation are presented along with the various therapeutic interventions including open and endoscopic approaches. Techniques to perform the myotomy and diverticulectomy are expanded on and include traditional suture ligation, endoscopic stapling devices, microlaryngoscopic CO2 laser and flexible LISA laser. The article concludes with a management algorithm for this entity based on the size of the diverticulum.
Asunto(s)
Endoscopía/métodos , Esfínter Esofágico Superior/fisiopatología , Músculos Faríngeos , Divertículo de Zenker , Factores de Edad , Trastornos de Deglución/etiología , Manejo de la Enfermedad , Halitosis/etiología , Humanos , Reflujo Laringofaríngeo/etiología , Evaluación de Resultado en la Atención de Salud , Músculos Faríngeos/fisiopatología , Músculos Faríngeos/cirugía , Factores Sexuales , Divertículo de Zenker/complicaciones , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/etiología , Divertículo de Zenker/fisiopatología , Divertículo de Zenker/terapiaRESUMEN
Cricopharyngeal dysphagia and Zenker 's diverticulum result from cricopharyngeal dysfunction, a failure of the upper esophageal sphincter to relax at the initiation of swallowing. The focus of surgical management involves a cricopharyngeal myotomy that is performed by either an open or an endoscopic approach. The endoscopic approach offers faster operating times, a shorter hospital stay, earlier time to oral intake, and lower complication rates, but a role for open cricopharyngeal myotomy remains.
Asunto(s)
Trastornos de Deglución/complicaciones , Trastornos de Deglución/terapia , Divertículo de Zenker/complicaciones , Divertículo de Zenker/terapia , Toxinas Botulínicas Tipo A/administración & dosificación , Cateterismo , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Esfínter Esofágico Superior/fisiopatología , Humanos , Inyecciones , Músculos Faríngeos/fisiopatología , Músculos Faríngeos/cirugía , Divertículo de Zenker/diagnósticoAsunto(s)
Trastornos de Deglución/etiología , Hemorragia Gastrointestinal/etiología , Hematemesis/etiología , Neumonía por Aspiración/etiología , Divertículo de Zenker/diagnóstico , Anciano de 80 o más Años , Sulfato de Bario , Medios de Contraste , Endoscopía del Sistema Digestivo , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/instrumentación , Humanos , Masculino , Resultado del Tratamiento , Divertículo de Zenker/complicaciones , Divertículo de Zenker/terapiaRESUMEN
BACKGROUND AND STUDY AIM: Endoscopic treatment of Zenker's diverticulum has been successfully reported over the last 10 years using different approaches. The hook-knife is a new device originally developed for endoscopic submucosal dissection procedures. This study aimed to investigate the safety and efficacy of endoscopic myotomy performed with the hook-knife. PATIENTS AND METHOD: From July 2005, 32 consecutive patients (23-male, mean age 74.8 years) with dysphagia secondary to the presence of Zenker's diverticulum were prospectively enrolled. Myotomy was performed using a straight-end transparent hood to the tip of the scope and the hook-knife for the incision of the bridge between the Zenker's diverticulum and the esophagus. Clinical outcome was evaluated assigning a dysphagia symptom score from 0 (symptoms absent) to 4 (inability to swallow saliva). RESULTS: General anesthesia was used in 4 patients, deep sedation with propofol in 23 patients, while midazolam was used in 5 patients. The mean procedural time was 28 minutes. Complications occurred in 2 patients (6.25 %). At 1 month follow-up, the mean dysphagia score was significantly improved from 2.9 to 0.6 ( P < 0.001) with 87.5 % of patients free of symptoms and 4 patients with dysphagia that was persistent but milder than before the treatment. Three of these 4 patients underwent a successful second endoscopic treatment with complete relief of dysphagia; one was not re-treated because of advanced age (92 years). During the follow-up period (23.87 +/- 9.6 months), 2 patients developed dysphagia recurrence. The overall success rate was 90.6 %. CONCLUSIONS: Diverticulectomy with a flexible scope and the hook-knife may represent a safe and effective alternative treatment for patients with Zenker's diverticulum.
Asunto(s)
Trastornos de Deglución/terapia , Esofagoscopía/métodos , Divertículo de Zenker/terapia , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Divertículo de Zenker/complicacionesRESUMEN
OBJECTIVES/HYPOTHESIS: Prolonged obstruction at the level of the lower esophageal sphincter is associated with a dilated, poorly contractile esophagus. The association between prolonged obstruction at the level of the upper esophageal sphincter (UES) and dilation and diminished contractility of the pharynx is uncertain. The purpose of this investigation was to evaluate the association between prolonged obstruction at the level of the UES and dilation and diminished contractility of the pharynx. STUDY DESIGN: Case-control study. METHODS: The fluoroscopic swallow studies of all persons with cricopharyngeus muscle dysfunction (CPD) diagnosed between January 1, 2006 and December 31, 2008 were retrospectively reviewed from a clinical database. Three categories of CPD were defined: nonobstructing cricopharyngeal bars (CPBs), obstructing CPBs, and Zenker diverticulum (ZD). The primary outcome measure was the pharyngeal constriction ratio (PCR), a surrogate measure of pharyngeal strength on fluoroscopy. Secondary outcome measures included pharyngeal area in the lateral fluoroscopic view and UES opening. The outcome measures were compared between groups and to a cohort of nondysphagic age- and gender-matched controls with the analysis of variance. RESULTS: A total of 100 fluoroscopic swallow studies were evaluated. The mean age (+ or -standard deviation) of the cohort was 70 years (+ or -10 years). Thirty-six percent were female. The mean PCR progressively increased, indicating diminishing pharyngeal strength, from the normal (0.08), to the nonobstructing CPB (0.13), to the obstructing CPB (0.22), to the ZD group (0.28) (P < .001 with trend for linearity). There was a linear increase in pharyngeal area from the normal (8.75 cm(2)) to the nonobstructing CPB (10.00 cm(2)), to the obstructing CPB (10.46 cm(2)), to the ZD group (11.82 cm(2)) (P < .01 with trend for linearity). CONCLUSIONS: The data suggest that there is an association between cricopharyngeus muscle dysfunction and progressive dilation and weakness of the pharynx. Laryngoscope, 2010.
Asunto(s)
Trastornos de Deglución/terapia , Dilatación/métodos , Esfínter Esofágico Superior/fisiopatología , Estenosis Esofágica/terapia , Enfermedades Faríngeas/terapia , Músculos Faríngeos/fisiopatología , Divertículo de Zenker/terapia , Anciano , Sulfato de Bario , Estudios de Cohortes , Medios de Contraste/administración & dosificación , Trastornos de Deglución/fisiopatología , Dilatación Patológica/fisiopatología , Dilatación Patológica/terapia , Esfínter Esofágico Superior/diagnóstico por imagen , Estenosis Esofágica/diagnóstico por imagen , Estenosis Esofágica/fisiopatología , Femenino , Fluoroscopía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/fisiopatología , Músculos Faríngeos/diagnóstico por imagen , Estudios Retrospectivos , Divertículo de Zenker/diagnóstico por imagen , Divertículo de Zenker/fisiopatologíaAsunto(s)
Vértebras Cervicales , Perforación del Esófago/etiología , Procedimientos Ortopédicos/efectos adversos , Enfermedades de la Columna Vertebral/cirugía , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/etiología , Perforación del Esófago/diagnóstico , Perforación del Esófago/terapia , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Enfermedades de la Columna Vertebral/complicaciones , Divertículo de Zenker/terapiaRESUMEN
Squamous cell carcinoma in a Zenker diverticulum is a very rare condition. We report a case of a patient with a Zenker carcinoma, who was primarily functionally inoperable and therefore received neoadjuvant radiochemotherapy before cardiac bypass surgery. After a complicated course with cardiogenic shock and myocardial infarction, a re-evaluation of functional risk analysis and the tumor situation revealed operability. Subsequently, partial hypopharyngectomy and partial cervical esophageal resection with lymphadenectomy was performed. Reconstruction of the gastrointestinal continuity was made by interposition of a free small bowel graft and microvascular anastomosis. The postoperative course showed a small anastomotic leakage of the hypopharyngeal-small bowel anastomosis, which was successfully treated conservatively.