Peroral endoscopic myotomy for management of cricopharyngeal bars (CP-POEM): a retrospective evaluation

Abstract

Background Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM. Methods Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence. Results 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score. Conclusions CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise.

Peroral endoscopic myotomy for the management of symptomatic cricopharyngeal bar (C-POEM): a case series and video demonstration

“…The benefit of an endoscopic approach (e.g., rigid, flexible) is that it mitigates against some of the major risks of surgery, which can include recurrent laryngeal nerve injury, fistula formation, and mediastinitis [ 11 ]. Risks from any type of myotomy have been reported to range from 0-39% [ 9 ], with the risk of open myotomy 13.6% in 1 study, compared to 7.4% in the largest C-POEM series to date [ 8 , 12 ]. Regarding outcomes, endoscopic myotomy has shown equivalent efficacy, and in 1 report better efficacy, compared to traditional open myotomy [ 9 , 12 ].…”

“…Early data from case series are encouraging, with high technical and clinical success rates based on the resolution of symptoms [ 6 , 7 ]. The largest cohort to date is a retrospective series on 27 patients that had a technical success of 100%, clinical success of 100% over a median follow up of 42 months, and an adverse event rate of 7.4% [ 8 ]. Here, we report our experience of 5 patients undergoing C-POEM for symptomatic cricopharyngeal bar with a step-by-step video demonstration.…”

POEM from A to Z: current perspectives

“…The largest study to date is a retrospective study including 27 patients showed a 100% technical and clinical success rate with a 7.4% of AEs (16).…”

Third-space endoscopy: the final frontier

“…Cricopharyngeal bar POEM (CP-POEM) allows the transection of the cricopharyngeus and a small amount of the distal esophageal muscle using principles of TSE. A retrospective study of 27 patients reported 100% clinical and technical success with mild to moderate adverse events in 7.4% of the patients [ 93 ]. It should be noted that CP-POEM can be technically challenging as the cricopharyngeus muscle is not always apparently identified endoscopically to estimate the site of mucosal entry.…”