Gold Laser Cricopharyngeal Myectomy for Cricopharyngeal Dysfunction.

Abstract

To describe cricopharyngeal myectomy (CPMec) with Gold laser for the treatment of CP bar with Zenker's diverticulum and evaluate long-term outcomes of CPMec with Gold laser, utilizing quantitative fluoroscopic measures, dietary grading, and patient-reported metrics. All patients undergoing CPMec with Gold laser over a 14-year period were evaluated. CPMec entails division of the diverticulum septum with removal of approximately 1 cm³ of muscle and mucosa. Demographic data, Eating Assessment Tool-10 scores, and videofluoroscopic swallow study (VFSS) parameters were compared pre- and postsurgery. Eighty-four patients underwent 90 successfully completed CPMec with Gold laser. EAT-10 scores decreased from mean of 20 to 2 (SD 9, p < 0.00) following surgery. Mean opening of the pharyngoesophageal segment (PESmax) improved from 0.56 to 0.86 cm (SD 0.4, p < 0.007), pharyngeal constriction ratio (PCR) improved from 0.15 to 0.09 (SD 0.1, p < 0.000) and bolus clearance ratio (BCR) improved from 16% residue to 4% (SD 6%, p < 0.000) following surgery. Six recurrences occurred (6.7%) and all were successfully treated with further CPMec (completion rate 90/92, 98%). Four (4.4%) post-operative leaks occurred, and all were managed conservatively. CPMec with Gold laser is safe, achievable, and provides significant symptomatic and objective improvement in swallowing for those with CP bar and Zenker's diverticulum. Removal of tissue reduces recurrence rates following CPMec and does not increase chances of adverse events.