Endoscopic CO2 laser cricopharyngeal myotomy

Cricopharyngeal dysfunction due to various causes can lead to severe upper pharyngeal dysphagia with or without laryngeal penetration. Resurgence of Dohlman's endoscopic diverticulotomy for Zenker's diverticulum has been brought about by the development of the diverticuloscope, improved intravenous analgesia, and the advent of the laser. Recent use of videofluoroscopy for swallowing documents a frame-by-frame picture of swallowing with special focus on the cricopharyngeal function and its stages of malfunction. The "cricopharyngeal crescent" (cricopharyngeal bar) as termed by Jackson is visible during endoscopy and can be incised in layers under the operating microscope with the CO2 or contact Nd:YAG laser. This paper introduces the staging of cricopharyngeal dysfunction regarding its initiation and progression in correlation with its symptoms and videofluoroscopic pictures. It also reports the application of endoscopic laser cricopharyngeal myotomy for 44 patients with cricopharyngeal dysfunction besides 4 with Zenker's diverticulum. This procedure is found to be effective, safe, brief, and prompt in restoring swallowing.