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Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy.
Laryngoscope. 2014 Apr; 124(4):950-4.L

Abstract

OBJECTIVES/HYPOTHESIS

To describe indications, management, and outcomes of endoscopic CO2 laser cricopharyngeal myotomy (CPM).

STUDY DESIGN

Case series with chart review.

METHODS

All patients treated with endoscopic CO2 laser CPM over a 6-year period were identified. A retrospective chart review was performed for surgical indication, history and physical examinations, and swallow evaluations. Swallowing outcomes were assessed using the Functional Outcome Swallowing Scale (FOSS); findings were compared across groups.

RESULTS

Eighty-seven patients underwent endoscopic CO2 laser CPM during the study period for cricopharyngeal dysfunction. Indications included Zenker's diverticulum (ZD) (39), DiGeorge syndrome (two), stroke (five), nerve injury (two), radiation for head and neck cancer (15), idiopathic (16), hyperfunctional tracheoesophageal speech (five) and dysphagia from cricopharyngeus stricture after laryngectomy (three). Mean, median, and mode time to feeding postoperatively were 1.4, 1, and 0 days respectively. Mean, median, and mode hospital stays were 1.8, 1, and 1 day respectively. Overall, FOSS scores improved from 2.6 to 1.6 (P < .001). Improvement was greatest for patients with ZD (2.4 to 1.0) and cricopharyngeal dysfunction from nerve injury (3.3 to 1.8) and least for those with prior radiation (3.9 to 3.2). All patients undergoing CPM for poor tracheoesophageal speech regained speech postoperatively. No patients developed mediastinitis, abscess, or fistula.

CONCLUSIONS

Endoscopic CO2 laser CPM is a safe treatment for cricopharyngeal dysfunction of various causes, though swallowing outcomes may vary depending on the surgical indication. Early feeding postoperatively after CPM is safe and facilitates early hospital discharge.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24114581

Citation

Bergeron, Jennifer L., and Dinesh K. Chhetri. "Indications and Outcomes of Endoscopic CO2 Laser Cricopharyngeal Myotomy." The Laryngoscope, vol. 124, no. 4, 2014, pp. 950-4.
Bergeron JL, Chhetri DK. Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy. Laryngoscope. 2014;124(4):950-4.
Bergeron, J. L., & Chhetri, D. K. (2014). Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy. The Laryngoscope, 124(4), 950-4. https://doi.org/10.1002/lary.24415
Bergeron JL, Chhetri DK. Indications and Outcomes of Endoscopic CO2 Laser Cricopharyngeal Myotomy. Laryngoscope. 2014;124(4):950-4. PubMed PMID: 24114581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy. AU - Bergeron,Jennifer L, AU - Chhetri,Dinesh K, Y1 - 2013/10/29/ PY - 2013/01/10/received PY - 2013/07/31/revised PY - 2013/08/26/accepted PY - 2013/10/12/entrez PY - 2013/10/12/pubmed PY - 2014/5/7/medline KW - Cricopharyngeal dysfunction KW - endoscopic cricopharyngeal myotomy KW - swallowing SP - 950 EP - 4 JF - The Laryngoscope JO - Laryngoscope VL - 124 IS - 4 N2 - OBJECTIVES/HYPOTHESIS: To describe indications, management, and outcomes of endoscopic CO2 laser cricopharyngeal myotomy (CPM). STUDY DESIGN: Case series with chart review. METHODS: All patients treated with endoscopic CO2 laser CPM over a 6-year period were identified. A retrospective chart review was performed for surgical indication, history and physical examinations, and swallow evaluations. Swallowing outcomes were assessed using the Functional Outcome Swallowing Scale (FOSS); findings were compared across groups. RESULTS: Eighty-seven patients underwent endoscopic CO2 laser CPM during the study period for cricopharyngeal dysfunction. Indications included Zenker's diverticulum (ZD) (39), DiGeorge syndrome (two), stroke (five), nerve injury (two), radiation for head and neck cancer (15), idiopathic (16), hyperfunctional tracheoesophageal speech (five) and dysphagia from cricopharyngeus stricture after laryngectomy (three). Mean, median, and mode time to feeding postoperatively were 1.4, 1, and 0 days respectively. Mean, median, and mode hospital stays were 1.8, 1, and 1 day respectively. Overall, FOSS scores improved from 2.6 to 1.6 (P < .001). Improvement was greatest for patients with ZD (2.4 to 1.0) and cricopharyngeal dysfunction from nerve injury (3.3 to 1.8) and least for those with prior radiation (3.9 to 3.2). All patients undergoing CPM for poor tracheoesophageal speech regained speech postoperatively. No patients developed mediastinitis, abscess, or fistula. CONCLUSIONS: Endoscopic CO2 laser CPM is a safe treatment for cricopharyngeal dysfunction of various causes, though swallowing outcomes may vary depending on the surgical indication. Early feeding postoperatively after CPM is safe and facilitates early hospital discharge. LEVEL OF EVIDENCE: 4. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/24114581/Indications_and_outcomes_of_endoscopic_CO2_laser_cricopharyngeal_myotomy_ L2 - https://doi.org/10.1002/lary.24415 DB - PRIME DP - Unbound Medicine ER -