Myotomy for reflux-induced cricopharyngeal dysphagia Five-year review

Myology of the Pharyngoesophageal Segment: Gross Anatomic and Histologic Characteristics

“…Both endotracheal intubation and nasogastric intubation have the potential to produce inflammatory changes in the CP. A history of reflux is difficult to obtain under these circumstances but is reported to produce inflammatory changes in the CP 25,26 . Given the total number of specimens (over 20) reported in these studies, it is improbable that the same pathologic process would be present in all specimens and thus be responsible for what appears to be minimal fiber‐size variation.…”

“…3), and may represent an inflammatory reaction in response to use of a nasogastric tube. Other causes of inflammatory reactions have been reported, notably reflux, as well as polymyositis, oculopharyngeal dystrophy, and CP achalasia 26,41‐43,46 …”

“…The controversy is reflected in clinical practice, with surgeons reporting CP myotomies of various lengths, ranging from cutting the CP alone to extension of the incision both cephalad and caudad for up to 8 cm 22‐30 . Differences in results with varying length of myotomies, however, have not been conclusively shown.…”

“…These changes described are also similar to those described by Bonington et al 35 in their autopsy study of normals noted above. Similarly in 1989, Henderson et al 25,26 studied patients who underwent CP myotomy for“cricopharyngeal dysphagia” with severe reflux. They again noted fibrosis in the specimens along with increased amounts of mitochondria.…”