Current status of cricopharyngeal myotomy for cervical esophageal dysphagia

OBJECTIVE: We have reviewed our experience with cricopharyngeal myotomyfor a variety of conditions causing cervical esophageal dysphagia toclarify its indications and results as well as to determine what, if any,ancillary procedures are indicated. METHODS: Eighty-three patientsunderwent cricopharyngeal myotomy between January 1970 and January 1995, 54of whom had a pharyngoesophageal diverticulum. The remainder suffered froma variety of motor disorders of the upper esophageal sphincter. Clinicalfollow-up evaluation was obtained in 71 of the 83 patients (86%). RESULTS:Good or excellent results were obtained in 87% of the patients withpharyngoesophageal diverticula, 100% after myotomy plus diverticulectomy,87% after myotomy plus diverticulopexy and 67% after myotomy alone. Ofpatients with hypertensive upper esophageal sphincter, 100% had good orexcellent results, whereas only 60% with nonspecific esophageal motordisorders were so evaluated. None of the patients with bulbar palsy ormiscellaneous conditions had good or excellent results. CONCLUSIONS: Werecommend cricopharyngeal myotomy for all patients with apharyngoesophageal diverticulum coupled with diverticulopexy for themajority, reserving diverticulectomy for those with recurrent pouches orextremely large pouches (6-8 cm in diameter). Good or excellent results canbe expected after myotomy in patients with a hypertensive upper esophagealsphincter. Myotomy is rarely indicated for patients with dysphagiasecondary to bulbar palsy. The role of cricopharyngeal myotomy for patientswith non-specific esophageal motor disorders remains controversial.