Endoscopic cricopharyngeal myotomy

Dysphagia secondary to cricopharyngeal muscle dysfunction (achalasia) is not uncommon. Dysfunction can be seen in isolation, in association with Zenker's diverticulum, or as a contributing component to more global dysfunction of the swallowing mechanism. Treatment has traditionally involved an open transcervical approach under general anesthesia, with complete lysis of the muscle fibers and concomitant extraction of the associated diverticulum when indicated. In select patients, the muscle can be divided endoscopically. Endoscopic myotomy offers several advantages over traditional open myotomy, including the avoidance of an incision, no risk of recurrent laryngeal nerve or great vessel injury, and low risk of perforation and fistula. In addition, endoscopic myotomy affords precise targeting of the affected muscle. This article will describe the technique, its indications, and its potential complications.