Endoscopic cricopharyngeal myotomy.
A 53-year-old man came to us with a 7-year history of dysphagia for solids and liquids, which had caused him to lose 22 lbs over the preceding 3 years. He was otherwise healthy. A fiberoptic endoscopic evaluation of his swallowing with sensory testing revealed some pooling of puree and solid food in the piriform sinuses; findings on the remainder of the examination were unremarkable. Laryngeal sensory thresholds were normal (<4 mm Hg). A fluoroscopic swallow evaluation detected hypertrophy of the cricopharyngeal muscle (figure, A). Manometry of the upper esophageal sphincter revealed a high resting pressure (160 mm Hg) with poor relaxation (residual pressure: 20 mm Hg). The patient underwent an endoscopic cricopharyngeal myotomy with the carbon dioxide (C[O.sub.2]) laser (figure, B and C). Postoperatively, he experienced complete relief of his dysphagia and is now symptom-free.
[FIGURES A-C OMITTED]
From the Scripps Center for Voice and Swallowing, La Jolla, Calif.