RESUMO
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.
Assuntos
Administração dos Cuidados ao Paciente/métodos , Divertículo de Zenker , Diagnóstico Diferencial , Humanos , Divertículo de Zenker/diagnóstico por imagem , Divertículo de Zenker/patologia , Divertículo de Zenker/fisiopatologia , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Endoscopia , Divertículo de Zenker , Progressão da Doença , Humanos , Tecnologia , Resultado do Tratamento , Divertículo de Zenker/terapiaAssuntos
Transtornos de Deglutição/etiologia , Estenose Esofágica/etiologia , Hematemese/etiologia , Úlcera/etiologia , Divertículo de Zenker/complicações , Idoso , Deglutição , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Endoscopia do Sistema Digestório , Estenose Esofágica/diagnóstico , Estenose Esofágica/fisiopatologia , Estenose Esofágica/terapia , Hematemese/diagnóstico , Hematemese/fisiopatologia , Hematemese/terapia , Humanos , Masculino , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Úlcera/diagnóstico , Úlcera/fisiopatologia , Úlcera/terapia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/fisiopatologia , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Esofagoscopia , Esôfago/cirurgia , Divertículo de Zenker/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Transtornos de Deglutição/etiologia , Esofagoscopia/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Miotomia , Cirurgia Endoscópica por Orifício Natural/métodos , Músculos Faríngeos/cirurgia , Estudos Retrospectivos , Fatores de Risco , Romênia , Resultado do Tratamento , Divertículo de Zenker/terapiaAssuntos
Pressão do Ar , Música , Doenças Profissionais/etiologia , Doenças Faríngeas/etiologia , Músculos Faríngeos/anormalidades , Divertículo de Zenker/etiologia , Adulto , Bandagens Compressivas , Dilatação Patológica , Humanos , Masculino , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/terapia , Recusa do Paciente ao Tratamento , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Esofagectomia/métodos , Esofagoscopia/métodos , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapia , Transtornos de Deglutição/complicações , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Divertículo de Zenker/complicaçõesRESUMO
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.
Assuntos
Divertículo de Zenker/história , História do Século XIX , História do Século XX , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos/história , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Fonoterapia , Divertículo de Zenker/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Transtornos de Deglutição/etiologia , Divertículo de Zenker/fisiopatologia , Fatores Etários , Idoso , Humanos , Masculino , Sudão , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Endoscopia/métodos , Esfíncter Esofágico Superior/fisiopatologia , Músculos Faríngeos , Divertículo de Zenker , Fatores Etários , Transtornos de Deglutição/etiologia , Gerenciamento Clínico , Halitose/etiologia , Humanos , Refluxo Laringofaríngeo/etiologia , Avaliação de Resultados em Cuidados de Saúde , Músculos Faríngeos/fisiopatologia , Músculos Faríngeos/cirurgia , Fatores Sexuais , Divertículo de Zenker/complicações , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/etiologia , Divertículo de Zenker/fisiopatologia , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Transtornos de Deglutição/complicações , Transtornos de Deglutição/terapia , Divertículo de Zenker/complicações , Divertículo de Zenker/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Cateterismo , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Superior/fisiopatologia , Humanos , Injeções , Músculos Faríngeos/fisiopatologia , Músculos Faríngeos/cirurgia , Divertículo de Zenker/diagnósticoAssuntos
Transtornos de Deglutição/etiologia , Hemorragia Gastrointestinal/etiologia , Hematemese/etiologia , Pneumonia Aspirativa/etiologia , Divertículo de Zenker/diagnóstico , Idoso de 80 Anos ou mais , Sulfato de Bário , Meios de Contraste , Endoscopia do Sistema Digestório , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/instrumentação , Humanos , Masculino , Resultado do Tratamento , Divertículo de Zenker/complicações , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Transtornos de Deglutição/terapia , Esofagoscopia/métodos , Divertículo de Zenker/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Divertículo de Zenker/complicaçõesRESUMO
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.
Assuntos
Transtornos de Deglutição/terapia , Dilatação/métodos , Esfíncter Esofágico Superior/fisiopatologia , Estenose Esofágica/terapia , Doenças Faríngeas/terapia , Músculos Faríngeos/fisiopatologia , Divertículo de Zenker/terapia , Idoso , Sulfato de Bário , Estudos de Coortes , Meios de Contraste/administração & dosagem , Transtornos de Deglutição/fisiopatologia , Dilatação Patológica/fisiopatologia , Dilatação Patológica/terapia , Esfíncter Esofágico Superior/diagnóstico por imagem , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/fisiopatologia , Feminino , Fluoroscopia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/fisiopatologia , Músculos Faríngeos/diagnóstico por imagem , Estudos Retrospectivos , Divertículo de Zenker/diagnóstico por imagem , Divertículo de Zenker/fisiopatologiaAssuntos
Vértebras Cervicais , Perfuração Esofágica/etiologia , Procedimentos Ortopédicos/efeitos adversos , Doenças da Coluna Vertebral/cirurgia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/etiologia , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Divertículo de Zenker/terapiaRESUMO
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.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Divertículo de Zenker/patologia , Idoso , Anastomose Cirúrgica , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/terapia , Esofagectomia , Esofagostomia , Humanos , Hipofaringe/cirurgia , Intestino Delgado/transplante , Excisão de Linfonodo , Masculino , Terapia Neoadjuvante , Divertículo de Zenker/terapiaRESUMO
Zenker's diverticulum is a relatively common problem encountered by head and neck surgeons. Careful review of the available literature regarding its pathogenesis indicates that Zenker diverticulum likely occurs as a result of increased intrabolus pressures during swallowing secondary to cricopharyngeal spasm. Rational treatment for Zenker diverticulum therefore addresses cricopharyngeal spasm. The traditional approach to diagnosis and management of Zenker diverticulum has been based on standard techniques and principles. For example, diverticulectomy with concurrent cricopharyngeal myotomy is an acceptable form of treatment with a high success rate. However, recent advances in endoscopic stapling and carbon dioxide laser technologies have added new options to the therapeutic armament of the otolaryngologist. For appropriately selected patients, endoscopic staple-assisted diverticulostomy is a minimally invasive, safe, and effective procedure associated with shorter hospital stays, more rapid postoperative recovery, decreased time to resumption of oral intake, and high levels of patient satisfaction.