Endoscopic CO2 laser-assisted surgery for cricopharyngeal dysfunction

Endoscopic cricopharyngeal myotomy was performed on 29 patients with dysphagia from failed relaxation of the cricopharyngeal muscle. The patient outcome was retrospectively evaluated. The average age at the time of treatment was 62 years (range: 38-81 years), and the mean follow-up was 18 months (range:1-36 months). The procedure was the first to be performed in all except four of the patients. Preoperative and postoperative assessments included videofluoroscopic and flexible endoscopic evaluations of the swallow as well as patients' subjective ratings for dysphagia and aspiration. These investigations and self-assessments were rated from 0 (poor or abnormal) to 4 (good or normal). Surgical procedures were performed under general anesthesia. Using the diverticuloscope, the posterior portion of the cricopharyngeal muscle was exposed and CO2 laser sectioned. The wound was then covered with fibrin glue. Patients were parenterally fed for 72 h. Postoperative videofluoroscopy showed the absence of leakage, and all patients resumed oral intake on day 2. The median self-rating score improved from 1 to 4 for dysphagia and from 3 to 4 for aspiration. The outcome of the flexible endoscopic evaluation of swallow improved from 2 to 4 and videofluoroscopy improved from 2 to 4. No surgical complication occurred. Endoscopic CO2 laser-assisted surgery is an effective and safe alternative for the treatment of cricopharyngeal dysmotility.