Impact of endoscopic laser cricopharyngeal myotomy on lower oesophageal sphincter physiology.

IF 1.1 4区 医学 Q3 SURGERY
S Perring, Sar Nouraei
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引用次数: 0

Abstract

Dysphagia is a watershed symptom that localises poorly. Dividing causes of dysphagia into oropharyngeal and oesophageal does not always best serve the patient. We report the case of a patient whose diagnosis and treatment required three separate specialist referrals to two specialties, with 18 months passing between initial referral and definitive treatment. The predominant pathology was isolated upper oesophageal sphincter dysfunction that responded well to laser cricopharyngeal myotomy. Following surgery, patient symptoms resolved and lost weight was regained. High-resolution manometry showed that the upper sphincter resting pressure had fallen from 117±45 to 21±11mmHg, but the lower sphincter resting pressure had risen, albeit without symptoms, from 16±8 to 44±17mmHg (p<0.001 in both cases). Surgery on upper oesophageal sphincter in the presence of lower oesophageal sphincter incompetence is known to lead to intractable regurgitation and pneumonia, and this novel physiological observation further emphasises the need to holistically consider the patient and to systematically evaluate the entire swallowing system before undertaking invasive interventions.

内窥镜激光环咽肌切开术对下食道括约肌生理学的影响。
吞咽困难是一种定位不清的分水岭症状。将吞咽困难的病因分为口咽和食道并不总是对患者最有利的。我们报告了一例患者的病例,该患者的诊断和治疗需要分别转诊到两个专科,从最初转诊到最终治疗需要 18 个月的时间。主要病理是孤立的上食道括约肌功能障碍,对激光环咽肌切开术反应良好。手术后,患者症状缓解,体重也有所恢复。高分辨率测压显示,上括约肌静息压从 117±45 mmHg 降至 21±11 mmHg,但下括约肌静息压有所升高,尽管没有症状,但从 16±8 mmHg 升至 44±17 mmHg(两例均为 p0.001)。众所周知,在存在下食道括约肌功能不全的情况下对上食道括约肌进行手术会导致顽固性反流和肺炎,而这一新颖的生理学观察结果进一步强调了在进行侵入性干预之前全面考虑患者并系统评估整个吞咽系统的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
316
期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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