Cervical Esophageal Dysphagia

Abstract

Twenty patients with cervical esophageal dysphagia were treated by cricopharyngeal myotomy. Of these 20 patients, ten had pharyngoesophageal diverticula, four had a hypertensive upper esophageal sphincter (UES), four had bulbar palsy, and two had miscellaneous forms of cricopharyngeal dysfunction. Preoperative esophageal manometric examination revealed mean UES pressures of 37.2 mmHg ± 4.8 SEM in patients with diverticulamarkedly lower (p = 0.01) than in normal patients (55.9 mmHg ± 5.0 SEM). In patients with hypertensive UES the mean pressure was 166.2 mmHg ± 13.4, significantly higher (p ≤ 0.001) than normal. Incoordination of the deglutitive response of the UES characterized by premature relaxation and contraction was present in all patients with diverticula and in one other patient. Another patient exhibited incomplete sphincteric relaxation (achalasia). A 4–5 cm myotomy of the cricopharyngeus muscle and adjacent esophageal muscle was performed in all patients. Of the patients with diverticula two also had diverticulectomy. No patient with bulbar palsy was benefited. AH other patients were relieved of dysphagia by the operation, with the exception of one patient with a diverticulum. A subsequent diverticulectomy was required in this patient. Postoperative manometric examination revealed an average decrease in UES pressure of 63% and an average decrease in length of the high pressure zone of 1.4 cm