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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.

SUBMITTER: Elmunzer BJ 

PROVIDER: S-EPMC7426955 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Peroral endoscopic myotomy for cricopharyngeal bar.

Elmunzer B Joseph BJ   Moran Robert A RA  

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20200609 8


<h4>Background and aims</h4>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]).<h4>Methods</h4>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 es  ...[more]

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