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

Updated: Jan 23, 2018
  • 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, [24] 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 is most commonly combined with other, more definitive procedures. An example of an endoscopic CP myotomy using a carbon dioxide laser may be seen below. Endoscopic transmucosal CP myotomy with the carbon dioxide laser is also an alternative.

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

A study by Visser et al indicated that laser-assisted and stapler-assisted endoscopic CP myotomy are both effective in treating Zenker diverticulum, with 45 out of 75 patients (60%)—23 out of 42 stapler patients (55%) and 22 out of 33 laser patients (67%)—experiencing complete resolution of symptoms after their initial treatment. Complications and recurrence rates did not significantly differ between the two endoscopic techniques in the study, although the investigators suggested that patients who undergo the stapler-assisted procedure nonetheless are at greater risk of requiring reintervention and of suffering more severe complications. [34]


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