Savary Dilation is a Safe and Effective Long-term Means of Treatment of Symptomatic Cricopharyngeal Bar

Patel, Bhaveshkumar J.; Mathur, Arvind; Dehom, Salem; Jackson, Christian S.

doi:10.1097/mcg.0000000000000026

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…Historically, CPB has been treated with dilation, botulinum toxin injection, or open surgery [ 8 ]. A study by Patel BJ et al showed that Savary dilation is both safe and effective, with most patients (81%) free of symptoms at six months [ 4 ]. In another study, Brigand C et al reported similar outcomes for balloon dilation [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…CPBs result from the hypertrophy, myositis, and fibrosis of the cricopharyngeal muscle, which reduces the maximal dimension of the upper esophageal sphincter, despite normal relaxation of the sphincter [ 3 ]. First-line therapy for CPB is esophageal dilation with a large bougie or balloon, with surgical myotomy reserved for cases intractable to dilation [ 4 , 5 ]. However, with the success of per-oral endoscopic myotomy (POEM) for Zenker’s diverticulum (z-POEM), per-oral endoscopic cricopharyngotomy (c-POEM) seems like a natural extension of the technique [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Novel Per-Oral Cricopharyngotomy for Cricopharyngeal Bar: Feasibility Study With Emphasis on Technical Limitations

Pittala¹,

Reinhart²,

Sujka³

et al. 2023

Cureus

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Per-oral endoscopic cricopharyngotomy (c-POEM) is a treatment for cricopharyngeal dysfunction, specifically cricopharyngeal bars (CPB). C-POEM differs from other endoscopic surgical procedures, such as per-oral endoscopic myotomy (POEM), gastric per-oral endoscopic myotomy (g-POEM), and Zenker per-oral endoscopic myotomy (z-POEM). We report three patients who underwent c-POEM for CPB, their clinical course, and outcomes. We underwent a single institution retrospective chart review of three patients who underwent c-POEM and their immediate postoperative course. These three patients represent all patients who underwent c-POEM. The operating surgeons were experienced endoscopists who regularly performed endoscopic myotomy. The three patients were female, over 50 years old, and presented with dysphagia secondary to the CPB. All three patients had perioperative complications consistent with esophageal leaks requiring prolonged hospital courses and recovery. All three patients had improved but persistent dysphagia up to nine months following the procedure. The results of this small case series exemplify the high rate of complications, specifically postoperative esophageal leak, when performing c-POEM for CPB. Thus, we stress caution and recommend against performing c-POEM for CPB.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Per-Oral Cricopharyngotomy for Cricopharyngeal Bar: Feasibility Study With Emphasis on Technical Limitations

Pittala¹,

Reinhart²,

Sujka³

et al. 2023

Cureus

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“…Another limited series reported higher rates of symptomatic improvement in 9 of 10 patients (90%) with similar dilatation techniques (18-20 mm)[9]. Patel et al[13] recently reported a larger experience with 31 patients undergoing Savary dilation with 45 French to 60 French size dilators. In this study, 65% of patients had significant improvement for at least 6 mo using a functional outcome swallow score.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, management has relied upon surgical CP myotomy[5-7]. Endoscopic dilatation poses an attractive option, given the risks associated with myotomy; however, published case series to date have included very small numbers of patients with varying dilatation techniques[8-13]. The aim of our study was to determine the efficacy and safety of through-the-scope (TTS) balloon dilatation of the upper esophageal sphincter (UES) in patients with CPD and to compare the traditional static technique of sequential distention of the balloon with a brusque “pull-back” retrograde approach across the UES.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

Chandrasekhara

Koh

Lattimer

et al. 2017

WJGE

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AIMTo evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement.METHODSAll balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES).RESULTSFour hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunction, Zenker’s diverticulum, age or gender (P > 0.05). The only complication noted was uvular edema and a shallow ulcer after static dilatation in one patient, which resolved spontaneously and did not require hospital admission.CONCLUSIONUES dilatation with a through-the-scope balloon by either static or retrograde technique is safe and effective for the treatment of dysphagia due to CP dysfunction. To our knowledge, this is the first study evaluating retrograde balloon dilatation of the UES.

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“…The majority of patients with OPD can be managed conservatively with swallowing exercises, rheological modification of the diet, swallowing maneuvers such as a head turn or chin tuck, and possibly neuromuscular stimulation. Certain specific structural conditions can be treated with a targeted surgical procedure such as upper esophageal dilation, cricopharyngeus muscle myotomy (CPM), or botulinum toxin injection, laryngeal framework surgery, or hypopharyngeal diverticulectomy/diverticulotomy . Nonoral enteral nutrition via gastrostomy is frequently necessary in severe cases.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

et al. 2017

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Savary Dilation is a Safe and Effective Long-term Means of Treatment of Symptomatic Cricopharyngeal Bar

Abstract: On follow-up from first dilation, 65% patients had statistically significant improvement in FOSS lasting for at least 6 months. Savary dilation seems to be a safe and effective treatment for symptomatic CP bar patients.

Cited by 11 publications

References 18 publications

Novel Per-Oral Cricopharyngotomy for Cricopharyngeal Bar: Feasibility Study With Emphasis on Technical Limitations

Novel Per-Oral Cricopharyngotomy for Cricopharyngeal Bar: Feasibility Study With Emphasis on Technical Limitations

Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

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