Peroral endoscopic myotomy for cricopharyngeal bar

Abstract

Background and aims: Definitive treatment options for refractory dysphagia due to cricopharyngeal bar are limited. We aimed to demonstrate a novel adaptation of peroral endoscopic myotomy to treat this condition (cricopharyngeal peroral endoscopic myotomy [c-POEM]).

Methods: The approach to c-POEM is similar to that in the distal esophagus for the treatment of achalasia. A submucosal injection and overlying mucosal incision are performed, ideally 1.5 to 2 cm upstream of the upper esophageal sphincter, and then a submucosal tunnel is extended beyond the level of the cricopharyngeus. The target muscle is then transected before closure of the mucosotomy.

Results: In 3 cases of refractory cricopharyngeal bar, c-POEM was successfully performed. Although no major adverse events occurred, significant postprocedural edema at the level of the upper esophageal sphincter prolonged hospitalization in 2 of the 3 patients. After recovery, all patients reported complete resolution of dysphagia and tolerated an unrestricted diet.

Conclusions: C-POEM allows reliable and complete muscular division in patients with refractory cricopharyngeal bar who have limited treatment options.

Keywords: c-POEM, cricopharyngeal peroral endoscopic myotomy.

Figure 1

Septum between the diverticulum and true esophageal lumen that serves as a target for therapy in Zenker’s diverticulum.

Figure 2

Fully exposed cricopharyneal muscle.