Endoscopic approach to cricopharyngeal hypertonicity and hypopharyngeal diverticulum

Cricopharyngeal (CP) muscle dysfunction may be an etiology for oropharyngeal dysphagia. The CP muscle may fail to relax fully, or in a coordinated fashion during the swallowing reflex. Alone this may cause dysphagia, but may also precipitate a pulsion diverticulum, known as Zenker’s diverticulum. When symptom severity and radiographic and endoscopic evaluation warrant intervention, endoscopic and open surgical options to manage these issues are available. This article strives to describe the techniques of endoscopic CP myotomy and Zenker’s diverticulostomy. Patient selection, contraindications for the surgery, and potential complications are described.