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

Abstract

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.

Comparison of endoscopic radial incision and Savary-Gilliard’s bougie dilation in efficacy on refractory esophagogastric anastomosis strictures

“…Different strictures have different levels of fibrosis or thicknesses of the circular muscle. For those with light fibrosis or a thin muscular layer, a small force is enough to achieve tearing and dilation, whereas for those with obvious scar fibrosis or thick muscular layer, a larger external force is need to achieve the same result (20). Appropriate incision depth under endoscopic vision is the premise of the safety and reliability of ERI (21).…”

Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx - flexible endoscopic management using a novel technique: A case report and review of literature

“…In the past, short-segment cricopharyngeal strictures have also been managed by the endoscopic surgical techniques (rigid endoscopy) employed by ENT surgeons[ 16 , 17 ]. Similar to the endoscopic cricopharyngeal myotomy for Zenker’s diverticulum, there are important differences in the management of cricopharyngeal strictures as well, using flexible versus rigid endoscopic techniques.…”

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

“…From January 2010 to April 2023, 31 patients with pharyngeal dysphagia due to Wallenberg syndrome (WS) who were scheduled to undergo surgery to improve swallowing function based on cricopharyngeal myotomy at Kurume University Hospital were recruited 17–19 . All WS patients had permanent dysphagia for more than 1 year after onset.…”

“…From January 2010 to April 2023, 31 patients with pharyngeal dysphagia due to Wallenberg syndrome (WS) who were scheduled to undergo surgery to improve swallowing function based on cricopharyngeal myotomy at Kurume University Hospital were recruited. [17][18][19] All WS patients had permanent dysphagia for more than 1 year after onset. Patients with an ECOG performance status of ≥3, patients with a Japan coma scale score of ≥1, and patients with a Mini-Mental State Examination 20 score of ≤26 were excluded because daily living ability and cognitive function affect postoperative recovery of pharyngeal dysphagia.…”