General oto esophageal bars, pouches, and webs

Question 1

What is the test(s) of choice to evaluate for

cricopharyngeal dysfunction?

Answer 1

Videofluoroscopic swallow with esophagram

Question 2

What are the theories behind the relationship

between cricopharyngeal dysfunction and dysphagia?

Answer 2

The cricopharyngeus is normally under tonic contraction
but fails to relax with swallow.
There is a lack of coordination between cricopharyngeus
relaxation and the propulsion of food.

Question 3

Describe the relative contraindications to cricopharyngeal myotomy.

Answer 3

Advanced GERD, progressive neurologic conditions such as
bulbar palsy in patients with a known proximal esophageal
cancer or in patients with a history of radiation to the neck

Question 4

What is the proposed cause of epiphrenic esophageal diverticula?

Answer 4

Pulsion effect created superior to the cardioesophageal

junction

Question 5

What is the proposed cause of traction esophageal

diverticula?

Answer 5

Traction effect caused by inflammation associated with

cervical adenopathy or adjacent fibrotic tissue

Question 6

Between what muscles does a Zenker diverticulum

herniate?

Answer 6

Between the inferior pharyngeal constrictors and the

cricopharyngeus (Killian triangle)

Question 7

Which side does a Zenker diverticulum most commonly involve and why?

Answer 7

It involves the left neck ~ 90% of the time and results from the convexity of the cervical esophagus to the left side and
a more laterally positioned carotid artery on the left side, creating a space for the sac to protrude.

Question 8

Define the Killian-Jamieson area.

Answer 8

Dehiscence between the oblique and transverse fibers of

the cricopharyngeus muscle

Question 9

Define the Laimer triangle.

Answer 9

Dehiscence between the cricopharyngeus muscles and the proximal esophageal muscles

Question 10

What nonmalignant complication of GERD can manifest with progressive esophageal dysphagia
starting with solid-food dysphagia and progressing to both solid and liquid dysphagia?

Answer 10

Peptic stricture

Question 11

Describe the risk factors for developing a peptic

stricture.

Answer 11

Older age, male gender, long history of reflux symptoms,
GERD, scleroderma, Zollinger-Ellison syndrome, nasogastric
tube placement, history of surgical management for
achalasia (Heller myotomy)

Question 12

What is a Schatzki ring?

Answer 12

Smooth, thin (< 4 mm) web of mucosa and submucosa at
the squamocolumnar junction, marking the proximal
margin of a hiatal hernia

Question 13

Describe the characteristics of a muscular esophageal ring.

Answer 13

Hypertrophic musculature within the esophageal body typically located within 2 cm of the GE junction

Question 14

What disease processes increase the likelihood of

developing an esophageal ring?

Answer 14

GERD and eosinophilic esophagitis

Question 15

What is an esophageal web?

Answer 15

Thin mucosal fold covered in squamous epithelium that

extends into the esophageal lumen, most commonly in the anterior cervical esophagus

Question 16

What is the most common cause of an esophageal

web?

Answer 16

Most often, it is idiopathic and asymptomatic.

Question 17

What are common risk factors for the formation of

an esophageal web?

Answer 17

Chronic GERD or iron deficiency associated with Plummer-

Vinson syndrome.

Question 18

Describe the clinical features of Plummer-Vinson

syndrome.

Answer 18

Triad of dysphagia, iron-deficiency anemia, and esophageal
webs. Additionally associated with atrophic glossitis and
squamous cell carcinoma of the oral cavity, esophagus, and
hypopharynx