Abstract
Objectives:
(1) Evaluate cricopharyngeal myotomy (CPM) for cricopharyngeal dysfunction (CPD) including Zenkers diverticulum (ZD) and cricopharyngeal bar/hypertrophy (CPB). (2) Analyze functional outcomes and quality of life associated with CPD following CPM.
Methods:
A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included patients presenting with CPD undergoing CPM. Standardized questionnaires including the 10-item Eating Assessment Tool (EAT-10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI) were completed preoperatively, at 3 and 6 months postoperatively.
Results:
Thirty-two patients were included (18F; mean 71 years; range, 53-86 years). Primary CPD included ZD (17/32; 53.1%), CPB (6/32; 18.8%), and ZD+CPB (9/32; 28.1%). The most common comorbidities included GERD (11/32; 34.4%), hiatal hernia (6/32; 18.8%), and an underlying neurologic disease (5/32; 15.6%). Twenty-six patients (81.3%) underwent rigid-endoscopic, 3 (9.4%) underwent flexible-endoscopic, and 3 (9.4%) underwent open-transcervical CPM. One patient developed a leak on postoperative day 3. There were no deaths. Three patients experienced treatment failure at 7, 14, and 14 months postoperatively, requiring revision surgery. Mean preoperative RSI was 24.7 (range, 10-40), FOSS was 2.2 (range, 0-4), and EAT-10 was 20.7 (range, 2-34). The 3-month questionnaire (32/32, 100%) demonstrated an improved mean RSI of 7.2 (range, 0-30), FOSS of 0.6 (range, 0-3), and EAT-10 of 4.6 (range, 0-24). A total of 63% (20/32) completed the 6-month questionnaire, demonstrating a stable/improved mean RSI of 4.95 (range, 0-17), FOSS of 0.55 (range, 0-2), and EAT-10 of 3.1 (range, 0-15).
Conclusions:
This represents one of the first prospective studies to demonstrate a significant improvement in functional outcome and quality of life in patients with CPD undergoing CPM.
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