Cricopharyngeal myotomy normalizes UES opening size in zenker’s diverticulum repair

Abstract

Objectives: The development of a Zenker’s diverticulum is associated with a hypertonic cricopharyngeus (CP) muscle. Therefore, CP myotomy has been advocated by some authors to be an essential part of repair of Zenker’s diverticulum. However, little objective data exist to show that there is improvement in the upper esophageal opening (UES) after CP myotomy. This study assesses the impact of CP myotomy on UES opening size. Methods: Fifteen patients treated at a university tertiary care center for Zenker’s diverticulum between 1998 and 2003 were identified. All patients underwent open diverticulectomy and CP myotomy along with videofluoroscopic swallow studies before and after repair. The values of UES opening for 3 cc boluses from pre- and postrepair studies were compared to each other as well as to normal controls. Results: Prior to Zenker’s diverticulectomy and CP myotomy, the mean UES opening (n = 15) for a 3 cc bolus was 0.275 cm ± 0.19, which was 50% of the mean of 60 normal controls (0.52 cm ± 0.15) ( P < 0.001). After repair, the mean UES opening for the same bolus size improved by 2-fold to 0.529 cm ± 0.178 ( P < 0.01). There was no significant difference in the UES opening size between the normal controls and the patients who have undergone repair ( P > 0.05). Conclusions: UES opening in patients with Zenker’s diverticulum is 50% of the size in normal controls. CP myotomy helps to normalize the UES opening in Zenker’s diverticulum repair.