General oto esophageal bars, pouches, and webs Flashcards
What is the test(s) of choice to evaluate for
cricopharyngeal dysfunction?
Videofluoroscopic swallow with esophagram
What are the theories behind the relationship
between cricopharyngeal dysfunction and dysphagia?
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.
Describe the relative contraindications to cricopharyngeal myotomy.
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
What is the proposed cause of epiphrenic esophageal diverticula?
Pulsion effect created superior to the cardioesophageal
junction
What is the proposed cause of traction esophageal
diverticula?
Traction effect caused by inflammation associated with
cervical adenopathy or adjacent fibrotic tissue
Between what muscles does a Zenker diverticulum
herniate?
Between the inferior pharyngeal constrictors and the
cricopharyngeus (Killian triangle)
Which side does a Zenker diverticulum most commonly involve and why?
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.
Define the Killian-Jamieson area.
Dehiscence between the oblique and transverse fibers of
the cricopharyngeus muscle
Define the Laimer triangle.
Dehiscence between the cricopharyngeus muscles and the proximal esophageal muscles
What nonmalignant complication of GERD can manifest with progressive esophageal dysphagia
starting with solid-food dysphagia and progressing to both solid and liquid dysphagia?
Peptic stricture
Describe the risk factors for developing a peptic
stricture.
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)
What is a Schatzki ring?
Smooth, thin (< 4 mm) web of mucosa and submucosa at
the squamocolumnar junction, marking the proximal
margin of a hiatal hernia
Describe the characteristics of a muscular esophageal ring.
Hypertrophic musculature within the esophageal body typically located within 2 cm of the GE junction
What disease processes increase the likelihood of
developing an esophageal ring?
GERD and eosinophilic esophagitis
What is an esophageal web?
Thin mucosal fold covered in squamous epithelium that
extends into the esophageal lumen, most commonly in the anterior cervical esophagus
What is the most common cause of an esophageal
web?
Most often, it is idiopathic and asymptomatic.
What are common risk factors for the formation of
an esophageal web?
Chronic GERD or iron deficiency associated with Plummer-
Vinson syndrome.
Describe the clinical features of Plummer-Vinson
syndrome.
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
