A new paradigm of endoscopic cricopharyngeal myotomy with CO<sub>2</sub> laser

Chitose, Shun‐ichi; Sato, Kiminori; Hamakawa, Sachiyo; Umeno, Hirohito; Nakashima, Tadashi

doi:10.1002/lary.21362

Cited by 23 publications

(19 citation statements)

References 7 publications

(11 reference statements)

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“…2 In the present case, the patient was diagnosed as having a benign fibrotic stricture of idiopathic etiology. This surgical technique involves strictureplasty of the UES using mECPM, which involves resection of the cricopharyngeal muscle followed by horizontal suturing of the mucosa covering the area of resection.…”

Section: T He Endoscopic Surgical Technique Presentedmentioning

confidence: 73%

“…2 To prevent postoperative adhesion of the UES, the technique for patients with benign fibrotic strictures of the UES not only requires an incision but also horizontal suturing of the mucosa to cover the resected area of the cricopharyngeal muscle. 2 To prevent postoperative adhesion of the UES, the technique for patients with benign fibrotic strictures of the UES not only requires an incision but also horizontal suturing of the mucosa to cover the resected area of the cricopharyngeal muscle.…”

Section: T He Endoscopic Surgical Technique Presentedmentioning

confidence: 99%

“…This technique is a modification of conventional endoscopic cricopharyngeal myotomy (mECPM), 2 and involves resection of the cricopharyngeal muscle, followed by horizontal suturing of the mucosa covering the resected area. This technique is a modification of conventional endoscopic cricopharyngeal myotomy (mECPM), 2 and involves resection of the cricopharyngeal muscle, followed by horizontal suturing of the mucosa covering the resected area.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Chitose

Sato

Fukahori

et al. 2017

Digestive Endoscopy

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A 43-year-old man with complaints of increased difficulty swallowing and weight loss underwent videofluorographic examination of swallowing, which revealed severely reduced cricopharyngeal opening. Endoscopic cricopharyngeal myotomy was carried out using a modified technique (mECPM). A benign fibrotic stricture of the upper esophageal sphincter (UES) was identified under visualization of a distending operating laryngoscope. A vertical midline incision in the strictured mucosa and submucosal resection of the cricopharyngeal muscle were done using a CO laser. The initial vertical mucosal incision was tightly sutured in the horizontal direction with absorbable surgical sutures. Histopathological examination of the cricopharyngeal muscle revealed infiltration of inflammatory cells. The patient started oral intake on postoperative day 7. He has been symptom free for 2 years with an improved body mass index, and postoperative laryngoscopy revealed no salivary retention in the piriform sinuses. The technique presented here provides sufficient opening of the UES by eliminating the problem of restenosis. mECPM will be useful for treating benign fibrotic strictures of the UES.

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Section: T He Endoscopic Surgical Technique Presentedmentioning

confidence: 73%

Section: T He Endoscopic Surgical Technique Presentedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Chitose

Sato

Fukahori

et al. 2017

Digestive Endoscopy

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“…In describing the CPM technique, most authors simply report that the CP muscle is exposed with a diverticuloscope . We found that in 10 cases (11.5%), the CP was so tightly contracted that the esophageal inlet lumen could not be exposed, necessitating dilation prior to myotomy, thus allowing appropriate exposure to perform the procedure.…”

Section: Discussionmentioning

confidence: 94%

“…Additionally, publications on endoscopic CPM report variations in operative technique and postoperative management, including mucosal closure, time to feeding, and length of admission. With such ambiguity, optimal management remains unclear …”

Section: Introductionmentioning

confidence: 99%

Indications and outcomes of endoscopic CO₂ laser cricopharyngeal myotomy

Bergeron

Chhetri

2013

The Laryngoscope

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Objectives/Hypothesis To describe indications, management, and outcomes of endoscopic CO2 laser cricopharyngeal myotomy (CPM). Study Design Case series with chart review. Methods All patients treated with endoscopic CO2 laser CPM over a 6-year period were identified. A retrospective chart review was performed for surgical indication, history and physical examinations, and swallow evaluations. Swallowing outcomes were assessed using the Functional Outcome Swallowing Scale (FOSS); findings were compared across groups. Results Eighty-seven patients underwent endoscopic CO2 laser CPM during the study period for cricopharyngeal dysfunction. Indications included Zenker’s diverticulum (ZD) (39), DiGeorge syndrome (two), stroke (five), nerve injury (two), radiation for head and neck cancer (15), idiopathic (16), hyperfunctional tracheoesophageal speech (five) and dysphagia from cricopharyngeus stricture after laryngectomy (three). Mean, median, and mode time to feeding postoperatively were 1.4, 1, and 0 days respectively. Mean, median, and mode hospital stays were 1.8, 1, and 1 day respectively. Overall, FOSS scores improved from 2.6 to 1.6 (P < .001). Improvement was greatest for patients with ZD (2.4 to 1.0) and cricopharyngeal dysfunction from nerve injury (3.3 to 1.8) and least for those with prior radiation (3.9 to 3.2). All patients undergoing CPM for poor tracheoesophageal speech regained speech postoperatively. No patients developed mediastinitis, abscess, or fistula. Conclusions Endoscopic CO2 laser CPM is a safe treatment for cricopharyngeal dysfunction of various causes, though swallowing outcomes may vary depending on the surgical indication. Early feeding postoperatively after CPM is safe and facilitates early hospital discharge.

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Relationship between Swallowing Pressure and Saliva Residue on Endoscopic Evaluation in Pharyngeal Dysphagia

Chitose,

Fukahori,

Kurita

et al. 2024

The Laryngoscope

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ObjectiveIn pharyngeal dysphagia, poor pharyngeal contraction and upper esophageal sphincter (UES) dysfunction result in post‐swallow saliva residue (SR). This study aimed to clarify the relationship between swallowing pressure and SR in the valleculae and piriform sinuses on flexible endoscopic evaluation of swallowing (FEES).MethodsPharyngeal dysphagia patients with Wallenberg syndrome were included. Amounts of post‐swallow SR in the valleculae and piriform sinuses were classified into four grades using SR scores based on FEES. The Hyodo score was also calculated to evaluate swallowing function. High‐resolution manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro‐hypopharyngeal, and UES zones on swallowing were obtained for comparison with SR and Hyodo scores.ResultsOf the 31 recruited, data from 26 patients who successfully underwent FEES and manometry were analyzed. Vallecular SR scores were strongly negatively correlated with a maximum pressure of the oropharynx (r = −0.52, p = 0.006), distal contractile integrals (DCI) of the oropharynx (r = −0.52, p = 0.007), and DCI of the oro‐hypopharynx (r = −0.55, p = 0.004). Hyodo scores for parameters 1 and 4 (corresponding to salivary pooling and pharyngeal clearance, respectively) were strongly negatively correlated with a maximum hypopharyngeal pressure (r = −0.57, p = 0.002) and strongly positively correlated with peristaltic velocity (r = 0.53, p = 0.007), respectively. SR scores and Hyodo scores related to SR were not correlated with pressure data of the UES.ConclusionManometric analysis of our SR scoring method using FEES revealed that a higher amount of SR in the valleculae, but not in the piriform sinuses, is associated with weaker pharyngeal pressure in pharyngeal dysphagia, especially at the oropharyngeal level.Level of Evidence4 Laryngoscope, 2024

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A new paradigm of endoscopic cricopharyngeal myotomy with CO₂ laser

Cited by 23 publications

References 7 publications

Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Indications and outcomes of endoscopic CO₂ laser cricopharyngeal myotomy

Relationship between Swallowing Pressure and Saliva Residue on Endoscopic Evaluation in Pharyngeal Dysphagia

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A new paradigm of endoscopic cricopharyngeal myotomy with CO2 laser

Cited by 23 publications

References 7 publications

Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Endoscopic surgical technique for benign fibrotic strictures of the upper esophageal sphincter

Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy

Relationship between Swallowing Pressure and Saliva Residue on Endoscopic Evaluation in Pharyngeal Dysphagia

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Product

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A new paradigm of endoscopic cricopharyngeal myotomy with CO₂ laser

Indications and outcomes of endoscopic CO₂ laser cricopharyngeal myotomy