Sarah S Al Ghamdi1,2, Michael Bejjani1, Oscar V Hernández Mondragón3, Nasim Parsa4, Muhammad N Yousaf5, Mohammad Aghaie Meybodi1, Bachir Ghandour1, Chonlada Krustri6, Chainarong Phalanusitthepha6, Saowanee Ngamruengphong1, Jose M Nieto7, Mouen A Khashab1. 1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States. 2. Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 3. Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico. 4. University of Missouri Health System, Columbia, Missouri, United States. 5. Medstar Union Memorial Hospital, Baltimore, Maryland, United States. 6. Department of Surgery, Mahidol University, Bangkok, Thailand. 7. Borland Groover Clinic Advanced Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States.
Abstract
BACKGROUND: Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM. METHODS: Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence. RESULTS: 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score. CONCLUSIONS: CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise. Thieme. All rights reserved.
BACKGROUND: Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM. METHODS: Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence. RESULTS: 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score. CONCLUSIONS: CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise. Thieme. All rights reserved.
Authors: Daniel Castaneda; Francisco Franco Azar; Ishtiaq Hussain; Luis F Lara; Ronnie R Pimentel; Gilberto Alemar; Candace Hrelec; Jeffrey Ponsky; Tolga Erim Journal: Surg Endosc Date: 2021-09-15 Impact factor: 3.453