Nosadini A

Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia

BACKGROUND Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent cricopharyngeal myotomy. The subjective and objective response to myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months). RESULTS Radiologic evidence of functional obstruction caused by incoordination and incomplete relaxation of the upper esophageal sphincter was significantly reduced. Manometric recordings of resting and closing pressures of the upper esophageal sphincter were also significantly altered by the myotomy. Resting pressures decreased from 65 to 18 mm Hg and closing pressures dropped from 69 to 22 mm Hg. The relaxation time and poor coordination at the level of the upper esophageal sphincter, observed in the preoperative period, persisted after the operation. Radionuclide emptying studies in which a single liquid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds. Subjectively, 33 patients initially had frequent aspiration episodes. Twenty became free of symptoms after myotomy (p < 0.01) and in six others the symptoms were improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitations and aspirations after their operation. Twenty-three other patients had improvement in symptoms. Ten patients reported no change in symptoms. All of them either were unable to swallow voluntarily or had dysarthria when assessed before the operation. One retropharyngeal hematoma is the only postoperative complication recorded. The operative mortality was 2.5% (1/40). CONCLUSIONS Cricopharyngeal myotomy palliates neurogenic oropharyngeal dysphagia in patients with intact oral-phase deglutition.

Cricopharyngeal Myotomy and Stapling: Treatment of Choice for Zenker’s Diverticulum

The first successful excision of a pharyngoesophageal (Zenker’s) diverticulum was performed by Wheeler in 1885 [1]. This procedure has been repeatedly criticized because of the potential incidence of leakage from the suture line and recurrent pouch formation [2]. The addition of a cricopharyngeal myotomy, first proposed by Aubin [3], has been more recently advocated by many authors [4–7], although no prospective studies have definitely shown that this approach results in a decreased leak or recurrence rate.

Gastro-Oesophageal Reflux in Italian Healthy Volunteers and Patients: Relationship between Gastro-Oesophageal Reflux, Endoscopic Oesophagitis and Symptoms

Prolonged pH monitoring of the distal oesophagus is considered the most sensitive test for detecting gastro-oesophageal reflux (GOR). Local patterns of GOR are needed because of its large diffusion in countries with different dietetic and behavioural habits and the use of the test in outpatients. 15 healthy volunteers and 30 patients affected by GOR disease were studied by means of a 24-hour oesophageal pH test. Moreover, the results obtained in the pathological group were compared with endoscopic findings and symptoms to find out whether there exists a relationship between pH test, oesophagitis and symptom severity. We found an average of 25 ± 17.3 reflux episodes/24 h; the percentage of acid exposure of the distal oesophagus was 1.6 ± 1.4; the percentage of acid exposure while the volunteers where recumbent was 0.81 ± 1.09: the number of reflux episodes longer than 5 min was 0.57 ± 1.04 and the duration of the longest episode was 4.5 ± 3 min in healthy subjects. There were no statistical differences compared with the values of healthy American subjects except for the percentage of acid exposure in supine position. This higher exposure of the distal oesophagus to the gastric refluxed juice could be explained by the different dietetic habits of the Italian volunteers, who ate late in the evening and went to bed in the postprandial phase. In the pathological group (identified by values greater than the mean plus 2 SD) no connection between the severity of oesophagitis and the severity of refluxes was observed. The pH test discriminated only symptomatic patients with or without oesophagitis but allowed no further division in this group to be made. The severity of the symptoms was related only to the percentage of acid exposure of the distal oesophagus in upright position. No relationship with the other parameters adopted was found. In conclusion, the 24-hour pH test is the test of choice for detecting and quantifying GOR disease. However, it is only a semiquantitative test and cannot be used for a prognosis of GOR disease development.

Recurrence of Esophageal Achalasia: Diagnosis and Treatment

Heller’s myotomy is a widely accepted operation for relief of dysphagia in patients with esophageal achalasia, giving excellent to good results in 80%-95% of cases [1–3]. In the remaining cases, presenting with recurrence of esophageal symptoms and requiring further treatment, the causes of failure of myotomy are usually related either to imperfect surgical technique or to late complications of the myotomy [3–5]. The present study was undertaken in an effort to define a variety of causes for postmyotomy disability and also to establish criteria for diagnosis and treatment.

Lower Esophageal Sphincter and Acupuncture: Electromanometric Evaluation in Esophageal Achalasia

The results of acupuncture in the treatment of gastrointestinal motility disorders indicate that variations in lower esophageal sphincter pressure during acupuncture may be evaluated by manometry. Twe

Synchronous and metachronous malignancies in patients with primary carcinomas of the esophagus and cardia

The frequency, therapeutic management, and prognosis of multifocal carcinomas within the esophagus, and of synchronous or metachronous malignancies in other organs were prospectively studied in a seri

Patterns of Neoplastic Recurrence After Radical and Palliative Resection of Cancer of the Esophagus

Surgery is the single most effective therapeutic approach to esophageal cancer. However, the long-term prognosis has not changed significantly over the past 2 decades despite the increased resectability rates and the developments of technique [2, 5]. This is mainly due to the high recurrence rate. Therefore, a better understanding of the natural history of this tumor and of pitfalls of surgery is of primary importance for a better planning of therapy.