Introduction
Cricopharyngeal bars represent an uncommon and frequently underrecognized cause of oropharyngeal dysphagia, resulting from dysfunction or fibrosis of the cricopharyngeal muscle. Conventional management options include open surgical myotomy or endoscopic dilation. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) has emerged as a minimally invasive technique1.
Case Report
We report two cases of symptomatic cricopharyngeal bar successfully treated with CP-POEM, with mean age of 76±11.3 years-old and Eckardt score of 5.5±3.5. One patient was under anticoagulation with apixaban due to history of ischemic stroke and atrial fibrillation. One of the cases underwent botulinum toxin therapy prior to CP-POEM with temporary symptomatic response. All procedures were performed using a triangle-tip(TT)-knife (Olympus) with SprayCoag 2.5 mode for submucosal tunnelling and Endocut Q 2.0 for cricopharyngeal miotomy (Vio3, ERBE). Hypopharyngeal mucosotomy was closed using through-the-scope clips. Mean procedure time was 103.5±26.2 minutes. In one case, due to space conflict and significant crycopharingeal bar hypertonia, it was necessary to remove the cap trapped in the distal portion of the tunnel with foreign body forceps. In both cases, a temporary subcutaneous emphysema was recorded with capnoperitoneum requiring percutaneous drainage in one case. A single-dose of intravenous corticosteroids after the procedure facilitated extubation of patients due to a significant edema of the hypopharynx and arytenoids. There were no complications after the procedure. At 3.5±3.5 months follow-up, both patients were completely asymptomatic (Eckardt score of 0) with improvement of overall quality of life. We present endoscopic and imaging iconography.
Conclusion
CP-POEM is a minimally invasive endoscopic option that appears to be effective and safe for patients with symptomatic cricopharyngeal bars. In both cases, CP-POEM resulted in rapid and sustained symptom resolution, without major complications. This technique should be considered as first-line approach with improvement in symptom control and lower morbidity than conventional techniques. Larger studies with longer follow-up are warranted to confirm long-term outcomes in broader clinical practice.