Management of cricopharyngeal achalasia in an 8-month child using endoscopic cricopharyngeal myotomy

A term baby was transferred to our tertiary care center with desaturations and inability to manage upper airway secretions. Rigid bronchoscopy and swallowing study revealed cricopharyngeal (CP) achalasia. A gastrostomy tube insertion and Botulinum Toxin-A injection were performed at 6 weeks of age. Improvement of symptoms was observed, however were short-lived requiring recurrent injections. Given the symptom severity, at 8 months, a successful endoscopic CP myotomy was performed. Patient was able to tolerate oral feeds as early as 2 months post-operatively. This is the youngest patient, to our knowledge, treated with endoscopic CP myotomy. Intraoperative pictures and video are presented.