Cricopharyngeal Dysphagia: An Evidence-Based Approach to Diagnosis and Management

Abstract

Program Description: For the past decade, the management of a cricopharyngeal dysphagia including a Zenker’s Diverticulum has predominantly been endoscopic. Recent literature has suggested that long-term outcomes may not be as successful with the endoscopic technique as once believed. The purpose of this miniseminar is to thoroughly review the literature on this topic and present the most up to date, evidence-based court room style debate on this topic. This 90-min miniseminar will review: 1) the normal anatomy of the cricopharyngeus and the upper esophagus. 2) Methods of assessing this area, ie, radiographic, endoscopic, manometry, pH probe. 3) Medical management and its role in this disease process. 4) Surgical techniques: Open techniques: Diverticulectomy with stapled or hand-sewn closure, diverticuloplasty, +/- cricopharyngeal myotomy. Closed (endoscopic) technique: diverticulotomy utilizing stapled, laser, bovie. 5) What is the appropriate management of the patient with a When to botox? When to dilate? What are the long-term results of this management? This miniseminar will be interactive. At numerous times during the discussion questions will be asked of the audience to keep them involved and entertained. The open vs closed surgical debate will be a court-room style debate with the Moderator acting as the judge or arbitrator. Each presenter will have 8 mins to define their side of the argument and to present the data. Four minutes will be allowed for cross examination or rebuttal, 2 mins for the closing argument if needed. The audience will give the verdict at the end. A series of questions will be asked of the jury (audience) at the end. Events/Schedule: Normal anatomy of the cricopharyngeus and its assessment: 10 min (Robert Stachler, MD). Medical and surgical management of cricopharyngeal dysfunction: 20 min (Milan Amin, MD). Introduction of the debate of surgical management: 7 mins (Milan Amin, MD). Presiding Arbitrator: Robert J. Stachler, MD. Courtroom: 30 mins total. Pro-open diverticulectomy: Al Meroti, MD; Pro-endoscopic diverticulectomy: Phil Song, MD, Ramon Franco, MD. Questions and Answers (Case presentation if time allows): 20 mins. Miniseminar Evaluation for the Audience: This should be an interactive presentation with questions for the audience to answer and an opportunity for the audience to give a verdict on which technique seems to have the best evidence. This is not a question of right or wrong. It is a question of best evidence. The jury will be prompted on this very point. Decisions are rendered based on the best evidence only.

Educational Objectives: 1) Appreciate the newest techniques available to manage cricopharyngeal dysphagia. 2) Evaluate and treat cricopharyngeal dysphagia. 3) Become facile with the medical management currently available to treat CP dysphagia.