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Albeniz E, Estremera-Arevalo F. Cricopharyngeal achalasia and upper oesophageal endoscopic myotomy (CP-POEM). Best Pract Res Clin Gastroenterol 2024; 71:101937. [PMID: 39209419 DOI: 10.1016/j.bpg.2024.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 09/04/2024]
Abstract
Cricopharyngeal achalasia (CPA), also known as cricopharyngeal bar, is a rare motor disorder affecting the upper oesophageal sphincter. This comprehensive literature review focuses on clinical aspects that can assist physicians in daily decision-making. The diagnosis of CPA is primarily based on symptoms of upper dysphagia and radiological identification of a posterior bar. However, the diagnostic process is not standardized and necessitates a multimodal approach, including radiological, endoscopic, and manometric studies performed by various specialists. Treatment options for CPA include botulinum toxin injection, endoscopic balloon dilatation, open or endoscopic surgery, and cricopharyngeal peroral endoscopic myotomy (CP-POEM). CP-POEM is the latest indication for POEM and has shown promising results with minimal adverse events, though high-quality evidence is still lacking.
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Affiliation(s)
- Eduardo Albeniz
- Gastroenterology Department Hospital Universitario de Navarra, NavarraBiomed, UPNA, IdiSNA, Spain.
| | - Fermin Estremera-Arevalo
- Gastroenterology Department Hospital Universitario de Navarra, NavarraBiomed, UPNA, IdiSNA, Spain.
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Pittala K, Reinhart N, Sujka JA, Velanovich V, DuCoin CG. Novel Per-Oral Cricopharyngotomy for Cricopharyngeal Bar: Feasibility Study With Emphasis on Technical Limitations. Cureus 2023; 15:e36663. [PMID: 37102013 PMCID: PMC10124148 DOI: 10.7759/cureus.36663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
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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Affiliation(s)
- Karthik Pittala
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Nolan Reinhart
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Joseph A Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Christopher G DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
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Albéniz E, Estremera-Arevalo F, Rosón PJ, Fernandez Cano F, Heredia ML, Ishaq S, Vila JJ. Cricopharyngeal peroral endoscopic myotomy for achalasia of the cricopharynx: "to do or not to do". Endoscopy 2022; 54:E382-E383. [PMID: 34374042 DOI: 10.1055/a-1544-7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.,Navarrabiomed Biomedical Research Center, Public University of Navarre, Navarre Institute for Health Research, Pamplona, Spain
| | | | - Pedro J Rosón
- Gastroenterology Endoscopy Unit, Hospital Quirónsalud Málaga, Málaga, Spain
| | | | - María L Heredia
- Gastroenterology Department, Mateu Orfila General Hospital, Mahon, Spain
| | - Sauid Ishaq
- Health and Science, Birmingham City University, Birmingham, United Kingdom.,University of Birmingham, Russells Hall Hospital, Birmingham, United Kingdom
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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Al Ghamdi SS, Bejjani M, Hernández Mondragón OV, Parsa N, Yousaf MN, Aghaie Meybodi M, Ghandour B, Krustri C, Phalanusitthepha C, Ngamruengphong S, Nieto JM, Khashab MA. Peroral endoscopic myotomy for management of cricopharyngeal bars (CP-POEM): a retrospective evaluation. Endoscopy 2022; 54:498-502. [PMID: 34710910 DOI: 10.1055/a-1646-1151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.,Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Nasim Parsa
- University of Missouri Health System, Columbia, Missouri, United States
| | | | - Mohammad Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | | | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jose M Nieto
- Borland Groover Clinic Advanced Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Zhang LY, Kalloo AN, Ngamruengphong S. Therapeutic Endoscopy and the Esophagus: State of the Art and Future Directions. Gastroenterol Clin North Am 2021; 50:935-958. [PMID: 34717880 DOI: 10.1016/j.gtc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Therapeutic gastrointestinal endoscopy is rapidly evolving, and this evolution is quite apparent for esophageal diseases. Minimally invasive endoluminal therapy now allows outpatient treatment of many esophageal diseases that were traditionally managed surgically. In this review article, we explore the most exciting new developments. We discuss the use of peroral endoscopic myotomy for treatment of achalasia and other related diseases, as well as the modifications that have allowed its use in treatment of Zenker diverticulum. We cover endoscopic treatment of gastroesophageal reflux disease and Barrett's esophagus. Further, we explore advanced endoscopic resection techniques.
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Affiliation(s)
- Linda Y Zhang
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, 1800 Orleans St, Sheikh Zayed Tower, Suite M2058, Baltimore, MD 21287, USA
| | - Anthony N Kalloo
- Department of Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA; Department of Medicine, Johns Hopkins Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th Floor, A-501, Baltimore, MD 21224, USA.
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