How is CP myotomy performed for the treatment of Zenker diverticulum?

Updated: Oct 16, 2020
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

This procedure was described in several reports during the 1970s as a sole form of intervention for Zenker diverticulum. Although the rationale for and the benefits of the procedure are generally well recognized, myotomy alone has been associated with persistent symptoms in up to 30% of patients, [27] as well as with more frequent complications. In addition, recurrence requiring repeat surgery has been necessary more frequently with myotomy alone than with other procedures.Therefore, CP myotomy, when performed through a transcervical approach, is most commonly used for CP achalasia alone. When a diverticulum is present, a diverticulectomy is performed. On occasion, a high-risk patient may be treated with open CP myotomy without diverticulectomy to avoid the risk of fistula formation and the attendant morbidity.

A more commonly employed approach for CP myotomy is the endoscopic transmucosal CP myotomy, which is usually carried out with rigid instrumentation. An example of an endoscopic transmucosal CP myotomy using a carbon dioxide (CO2) laser may be seen below. This approach is appropriate for CP achalasia alone or in patients who have developed small Zenker diverticula.

Cricopharyngeal myotomy. Demonstration of a transmucosal cricopharyngeal myotomy using a CO2 laser. The buccopharyngeal fascia layer is meticulously preserved.

 


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