Endoscopy 2022; 54(05): 498-502
DOI: 10.1055/a-1646-1151
Innovations and brief communications

Peroral endoscopic myotomy for management of cricopharyngeal bars (CP-POEM): a retrospective evaluation

Sarah S. Al Ghamdi  ‡   *
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
2   Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
,
Michael Bejjani‡   *
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Oscar V. Hernández Mondragón
3   Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico
,
Nasim Parsa 
4   University of Missouri Health System, Columbia, Missouri, United States
,
Muhammad N. Yousaf 
5   Medstar Union Memorial Hospital, Baltimore, Maryland, United States
,
Mohammad Aghaie Meybodi
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Bachir Ghandour 
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Chonlada Krustri
6   Department of Surgery, Mahidol University, Bangkok, Thailand
,
Chainarong Phalanusitthepha
6   Department of Surgery, Mahidol University, Bangkok, Thailand
,
Saowanee Ngamruengphong
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Jose M. Nieto
7   Borland Groover Clinic Advanced Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States
,
Mouen A. Khashab
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Abstract

Background Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM.

Methods Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence.

Results 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score.

Conclusions CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise.

* Co-first authors.


Fig. 1 s, Table 1 s



Publication History

Received: 19 March 2021

Accepted after revision: 23 July 2021

Article published online:
28 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 et al. Principles of deglutition: a multidisciplinary text for swallowing and its disorders. Shaker R, Belafsky PC, Postma GN. New York: Springer; 2013: 1-1017
    Search in Google Scholar
  • 2 Kühn D, Miller S, Ptok M. Cricopharyngeal bar und dysphagie. Laryngorhinootologie 2013; 92: 230-233
    PubMedSearch in Google Scholar
  • 3 Alberty J, Oelerich M, Ludwig K. et al. Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction. Laryngoscope 2000; 110: 1151-1156
    CrossrefPubMedSearch in Google Scholar
  • 4 Wang AY, Kadkade R, Kahrilas PJ. et al. Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar. Gastrointest Endosc 2005; 61: 148-152
    CrossrefPubMedSearch in Google Scholar
  • 5 Allen J, White CJ, Leonard R. et al. Effect of cricopharyngeus muscle surgery on the pharynx. Laryngoscope 2010; 120: 1498-1503
    CrossrefPubMedSearch in Google Scholar
  • 6 Van Abel KM, Moore EJ, Kasperbauer JL. et al. Functional outcomes and quality of life associated with cricopharyngeal myotomy for cricopharyngeal dysfunction: a prospective study. Otolaryngol Neck Surg 2014; 151 (Suppl. 01) P40
    CrossrefPubMedSearch in Google Scholar
  • 7 Al Ghamdi SS, Farha J, Runge TM. et al. No pouch, no problem: successful endoscopic division of a symptomatic cricopharyngeal bar using a modified peroral endoscopic myotomy technique for Zenker’s diverticulum. VideoGIE 2020; 5: 281-282
    CrossrefPubMedSearch in Google Scholar
  • 8 Elmunzer BJ, Moran RA. Peroral endoscopic myotomy for cricopharyngeal bar. VideoGIE 2020; 5: 378-379
    CrossrefPubMedSearch in Google Scholar
  • 9 Nieto J, Deshmukh AA, Elmeligui AM. et al. S1864 Cricopharyngeal per oral myotomy (C-POEM) for treatment of a cricopharyngeal bar: a novel technique. Am J Gastroenterol 2020; 115: S965-S965
    CrossrefPubMedSearch in Google Scholar
  • 10 Dakkak M, Bennett JR. A new dysphagia score with objective validation. J Clin Gastroenterol 1992; 14: 99-100
    CrossrefPubMedSearch in Google Scholar
  • 11 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedSearch in Google Scholar
  • 12 Marston AP, Maldonado FJ, Ravi K. et al. Treatment of oropharyngeal dysphagia secondary to idiopathic cricopharyngeal bar: surgical cricopharyngeal muscle myotomy versus dilation. Am J Otolaryngol 2016; 37: 507-512
    CrossrefPubMedSearch in Google Scholar
  • 13 Solt J, Bajor J, Moizs M. et al. Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation. Gastrointest Endosc 2001; 54: 767-771
    CrossrefPubMedSearch in Google Scholar
  • 14 Clary MS, Daniero JJ, Keith SW. et al. Efficacy of large-diameter dilatation in cricopharyngeal dysfunction. Laryngoscope 2011; 121: 2521-2525
    CrossrefPubMedSearch in Google Scholar
  • 15 Brøndbo K. Treatment of cricopharyngeal dysfunction by endoscopic laser myotomy. Acta Otolaryngol Suppl 2000; 543: 222-224
    CrossrefPubMedSearch in Google Scholar
  • 16 Pitman M, Weissbrod P. Endoscopic CO2 laser cricopharyngeal myotomy. Laryngoscope 2009; 119: 45-53
    CrossrefPubMedSearch in Google Scholar
  • 17 Herberhold C, Walther EK. Endoscopic laser myotomy in cricopharyngeal achalasia. Adv Otorhinolaryngol 1995; 49: 144-147
    PubMedSearch in Google Scholar
  • 18 Brigand C, Ferraro P, Martin J. et al. Risk factors in patients undergoing cricopharyngeal myotomy. Br J Surg 2007; 94: 978-983
    CrossrefPubMedSearch in Google Scholar