D

Figure 16-6 A, This illustration depicts the appearance when the diverticuloscope is properly positioned through the mouth. The upper blade has just entered the esophagus, and the lower blade is within the diverticulum. The scope is held by a mechanical arm that is on the patient's chest, which allows the operator's hands to be free. B, This illustration shows how the endoscopic GIA stapler is placed through the divert!culoscope so that one anvil is within the esophagus and the other is within the diverticulum. When the stapler is fired, the common wall is divided and the cricopharyngeus muscle is part of the divided tissue. This creates a common cavity between the diverticulum and the esophagus and removes the functional obstruction caused by the cricopharyngeus muscle.

Figure 16-6 A, This illustration depicts the appearance when the diverticuloscope is properly positioned through the mouth. The upper blade has just entered the esophagus, and the lower blade is within the diverticulum. The scope is held by a mechanical arm that is on the patient's chest, which allows the operator's hands to be free. B, This illustration shows how the endoscopic GIA stapler is placed through the divert!culoscope so that one anvil is within the esophagus and the other is within the diverticulum. When the stapler is fired, the common wall is divided and the cricopharyngeus muscle is part of the divided tissue. This creates a common cavity between the diverticulum and the esophagus and removes the functional obstruction caused by the cricopharyngeus muscle.

Figure 16-7 A, This radiograph shows the typical appearance of relatively early achalasia. The esophageal body is moderately dilated and it tapers at the gastroesophageal junction, producing the typical "bird's beak" appearance. B, This radiograph shows advanced achalasia with an extremely enlarged esophagus that has assumed a sigmoid configuration owing to the pressure created by the retained contents.

TABLE 16-2 -- Treatment of Achalasia: Pneumatic Dilation

Reference

Year

Improved (%)

Mortality (%)

Postoperative GERD (%)

Vantrappen and Hellemans[ ]

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