Balloon Cricopharyngeoplasty for Cricopharyngeal Achalasia

Abstract

Objective: To evaluate a series of patients with dysphagia who required diagnostic rigid endoscopy including failed flexible endoscopies (had hypopharyngeal cancer). To present a rare case of cricopharyngeal achalasia and to document the diagnostic process followed. Determine the efficacy and the safety of endoscopic balloon cricopharyngeoplasty (EBCP) for cricopharyngeal achalasia. Method: To evaluate 99 consecutive patients including 5 failed flexible endoscopies (referred from elsewhere) who underwent rigid hypopharyngoscopy ± laryngoscopy for dysphagia ± hoarse voice since 2005, and to present 1 unusual case of cricopharyngeal achalasia and its effective management with EBCP. Results: Among the 99 patients, the 5 patients had prior flexible endoscopy/gastroscopy showed hypopharyngeal cancer (2 circumferential, 2 pyriform fossae, and 1 with tumor with bilateral cervical and distant metastasis). The false reassurances of these flexible endoscopies lead to the advanced presentations of these tumors. One representative case includes an 80-year-old Asian female patient presented with 3-year history of progressive severe dysphagia, cachexia, and choking on liquids. Cricopharyngeal achalasia was noted on rigid endoscopy and EBCP was performed, which was well tolerated with no postoperative complications with complete relief of dysphagia. The patient was discharged on the same day. Conclusion: Cricopharyngeal achalasia is a rare and potentially lethal cause of dysphagia, due to aspiration in the elderly. EBCP offers a safe an effective, safe alternative to conventional procedures. Symptomatic relief is immediate and complete with no long-term recorded recurrence; hence, EBCP is proposed as a simple alternative to laser/open procedures.