4th Year Advanced Endoscopy Fellows Program | October 2021-Sanaka

Sanaka_Oropharyngeal Dysphagia

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This document discusses the case of a 59-year-old female with a history of irritable bowel syndrome and progressive oropharyngeal dysphagia. The patient had a cricopharyngeal bar on a modified barium swallow (MBS) with obstruction and mild aspiration, as well as a small mouth opening. Two years prior, she had undergone an esophagogastroduodenoscopy (EGD) with Savory dilation, but only experienced temporary symptom relief. The patient was looking for a long-term treatment option. The suggested next steps included an evaluation by an ear, nose, and throat (ENT) specialist and considering open surgery or flexible endoscopic dilation by a gastroenterologist. The patient opted for the second option. However, during the EGD procedure, the pediatric bite block used for access was too narrow, preventing the use of Savory dilators. An alternative approach called C-POEM (cricopharyngeal myotomy using peroral endoscopic myotomy) was performed under general anesthesia. Post-operatively, the patient was well and had a swallow study, which showed a contained leak into the submucosal pouch. The patient was discharged home with nasogastric tube feedings for 10 days and subsequent swallow studies were normal, with complete resolution of dysphagia. A retrospective study from Mayo Clinic compared endoscopic dilation and surgical myotomy for cricopharyngeal bar treatment, showing that myotomy had a higher success rate with no recurrent symptoms. Additionally, a small case series of three patients who underwent C-POEM showed 100% improvement.

Keywords

oropharyngeal dysphagia

cricopharyngeal bar

modified barium swallow

Savory dilation

flexible endoscopic dilation

C-POEM

cricopharyngeal myotomy

swallow study

nasogastric tube feedings

retrospective study