Myotomy for reflux-induced cricopharyngeal dysphagia. Five-year review

This report describes 25 patients with reflux-induced cricopharyngeal dysphagia ultimately requiring surgical management. Eighteen patients underwent cricopharyngeal myotomy alone and seven patients required cricopharyngeal myotomy after an antireflux operation failed to correct this symptom. Cricopharyngeal incoordination was demonstrated at manometry in over 90% of patients. Treatment included cricopharyngeal myotomy, which was extended proximally to the pharynx and distally to the intrathoracic esophagus. Results were excellent to satisfactory in 24 of 25 patients. Pathologic examination of the cricopharyngeal muscle demonstrated a wide variety of myopathic degenerative changes. We stress that cricopharyngeal myotomy may be performed even in the presence of reflux without fear of subsequent aspiration.