The upper esophageal sphincter in gastroesophageal reflux disease

Lippincott, Michelle; Velanovich, Vic

doi:10.21037/aoe-21-3

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…When conducting C-POEM, or any intervention of the upper esophageal sphincter, one should consider the potential issues from its disruption. Abnormal upper esophageal sphincter function can lead to troublesome regurgitation, and has been linked to the development of laryngeal symptoms (e.g., hoarse voice, globus) [ 15 ]. Nonetheless, there is currently a paucity of data, and these symptoms were not reported by our patients on follow up.…”

Section: Discussionmentioning

confidence: 99%

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

Norton

2024

aog

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Background A cricopharyngeal bar refers to a radiological description of a prominent cricopharyngeal muscle. While these may be incidental, they can lead to significant oropharyngeal dysphagia due to incoordination of the upper esophageal sphincter and true luminal narrowing. Various treatments have been used for the management of cricopharyngeal bar, including botulinum toxin injection, dilation, and surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (C-POEM) is a novel procedure that uses the principles of “third-space” endoscopy to treat symptomatic cricopharyngeal bar. Methods We report a retrospective case series of 5 patients referred with oropharyngeal dysphagia to 2 UK tertiary referral centers between 2022 and 2023 who subsequently underwent C-POEM. Technical success was defined as completion of all steps of the C-POEM procedure and clinical success as a reduction in the pre-treatment Dakkak and Bennett score to ≤1, or 0 if the pre-treatment score was 1. Results C-POEM was associated with a technical success of 100% and clinical success of 100% over a median follow up of 2 months (interquartile range 1-8). There was 1 adverse event due to a small mucosal defect and associated leak on barium swallow, which was the result of difficult access during mucosal closure. This was managed conservatively with antibiotics. A step-by-step video demonstration of the procedure is provided. Conclusion C-POEM offers an alternative upfront therapy for symptomatic cricopharyngeal bar, but should be undertaken by endoscopists with significant experience in third-space endoscopy in view of the difficulty of working within the hypopharynx.

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Section: Discussionmentioning

confidence: 99%

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

Norton

2024

aog

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The upper esophageal sphincter in the high-resolution manometry era

Norton

Herbella

Schlottmann

et al. 2021

Langenbecks Arch Surg

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The Importance of Looking at the REST of the Swallow in Patients With Head and Neck Cancer

Gregor

2023

Perspect ASHA SIGs

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Purpose: The swallowing continuum is highly complex and interrelated and has both upstream and downstream implications for volitional swallowing behaviors, anatomic and physiologic impairments, and interventions. Pathologic reflux can cause a plethora of upstream anatomic and physiologic changes in the swallow with associated consequences. Although pathologic reflux can occur in isolation, there is a high incidence of both pathologic reflux and esophageal pathology in patients with head and neck cancer. Along with their known oropharyngeal dysfunction that can evolve over time posttreatment and cause downstream effects in the swallowing continuum, pathologic reflux and esophageal pathology can cause upstream effects, further complicating the interplay and contributing to the overall swallowing impairment. Conclusions: The entire swallowing continuum should be evaluated with videofluoroscopy at yearly intervals in patients with head and neck cancer so that the multidisciplinary dysphagia team understands the interplay, which informs best interventions. The Robust Esophageal Screening Test (REST) is a standardized, validated esophageal screening protocol that can be implemented during the videofluoroscopic swallowing study to better identify potential esophageal pathology, which can be of complex etiology in this population. Results of a recent quality improvement project implementing REST protocol with patients with head and neck cancer found significant esophageal pathology and enhanced team collaborations and decision making for optimal patient care (Gregor & Watts, 2022).

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The upper esophageal sphincter in gastroesophageal reflux disease

Cited by 3 publications

References 25 publications

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

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

The upper esophageal sphincter in the high-resolution manometry era

The Importance of Looking at the REST of the Swallow in Patients With Head and Neck Cancer

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