{"title":"Impact of endoscopic laser cricopharyngeal myotomy on lower oesophageal sphincter physiology.","authors":"S Perring, Sar Nouraei","doi":"10.1308/rcsann.2022.0119","DOIUrl":null,"url":null,"abstract":"<p><p>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 (<i>p<</i>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.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"732-736"},"PeriodicalIF":1.1000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528367/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Royal College of Surgeons of England","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1308/rcsann.2022.0119","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
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.
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.