Читать книгу The Esophagus - Группа авторов - Страница 161

Webs are thin folds composed of mucosa and submucosa arising predominantly from the anterior wall of the pharyngoesophageal segment and proximal cervical esophagus. Cervical esophageal webs are common findings, occurring in 3–8% of patients who undergo upper gastrointestinal barium studies and in 16% of patients at autopsy [44–47]. The pathogenesis of these webs is uncertain. Some webs in the valleculae have been described as normal variants [48]. Other webs result from diseases that cause chronic scarring. Many patients with cervical esophageal webs also have GERD [31, 49].

Webs are thin (1–2 mm in thickness) folds arising from the anterior wall of the pharyngoesophageal segment or proximal cervical esophagus. A web appears on barium studies as a radiolucent bar in the barium pool or as a thin structure etched in white by barium. Some webs extend circumferentially, with a deeper shelf on their anterior surface. Patients with dysphagia usually have circumferential cervical esophageal webs occluding greater than 50% of the luminal diameter (Figure 6.24). Obstruction is implied by dilatation of the cervical esophagus proximal to the web or by a spurt of barium through the web (the so‐called jet phenomenon) [50, 51].

Figure 6.15 Killian–Jamieson diverticula. (A) Frontal view of the pharynx demonstrates a 1.5 cm sac (thick arrow) just below the level of the cricopharyngeus. A tiny sac is also seen on the right (thin arrow). (B) Lateral view of the pharynx shows that the 1.5 cm sac (thick arrow) extends anterior to the expected course of the cervical esophagus (thin arrow). (C) Lateral view of the pharynx during bolus passage demonstrates that the Killian–Jamieson diverticulum (white arrow) lies below the level of an incompletely opening cricopharyngeus (black arrow). The sac arises from the anterolateral wall of the most proximal cervical esophagus.

Source: Reproduced from Rubesin and Levine [36], with permission.

Figure 6.16 Synchronous Zenker’s and Killian–Jamieson diverticula. Oblique view of the pharynx shows a 2.5 cm Zenker’s diverticulum (Z) with its opening (double black arrow) above the cricopharyngeal bar (thick black arrow). The Killian–Jamieson diverticulum (K) arises below the cricopharyngeal bar, and a portion of the diverticulum extends anterior to the cervical esophagus.

Source: Reproduced from Rubesin [31], with permission.