From the Guidelines
Treatment of a symptomatic cricopharyngeal bar should consider upper oesophageal sphincter dilatation as a viable option, as it can be successful in relieving symptoms of dysphagia, as supported by the UK guidelines on oesophageal dilatation in clinical practice 1.
Treatment Options
When managing a symptomatic cricopharyngeal bar, several approaches can be taken:
- Upper oesophageal sphincter dilatation, which can be performed using balloon or bougie methods, is recommended for treating dysphagia associated with disordered upper oesophageal sphincter opening, including cricopharyngeal bar with or without Zenker’s diverticulum 1.
- The decision to proceed with dilatation should be based on the presence of symptoms and the degree of functional impairment, with the goal of improving swallowing function and preventing complications.
Considerations
- The treatment approach should be individualized, taking into account the patient's symptom severity, comorbidities, and the presence of any associated conditions, such as Zenker’s diverticulum.
- The UK guidelines on oesophageal dilatation in clinical practice provide a strong recommendation (GRADE of evidence: moderate; strength of recommendation: strong) for considering upper oesophageal sphincter dilatation in the treatment of dysphagia with disordered upper oesophageal sphincter opening, including cricopharyngeal bar 1.
Key Points
- Upper oesophageal sphincter dilatation is a viable treatment option for symptomatic cricopharyngeal bar.
- The treatment approach should be tailored to the individual patient's needs and circumstances.
- The goal of treatment is to improve swallowing function, prevent complications, and enhance the patient's quality of life.
From the Research
Treatment Options for Symptomatic Cricopharyngeal Bar
- Symptomatic cricopharyngeal bars can be treated with various methods, including endoscopic dilation, surgical myotomy, and botulinum toxin injections 2, 3, 4, 5, 6.
- Peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to cricopharyngeal bars, with high technical and clinical success rates 2.
- Botulinum toxin injections into the cricopharyngeus muscle have been shown to provide significant improvement in dysphagia symptoms, with limited side effects 3, 4, 5.
- Esophageal dilation is also an effective treatment option, providing immediate relief of dysphagia in most patients, with some experiencing long-term resolution of symptoms 6.
Efficacy and Safety of Treatment Options
- CP-POEM has been shown to be a safe and effective treatment for symptomatic cricopharyngeal bars, with mild to moderate adverse events occurring in a small percentage of patients 2.
- Botulinum toxin injections have been found to be relatively safe, with most patients experiencing significant improvement in symptoms, although the duration of relief may vary 3, 4, 5.
- Esophageal dilation has been shown to be effective in providing long-term relief of dysphagia in some patients, although the effectiveness may decrease over time 6.
Patient Selection and Treatment Outcomes
- Patient selection is crucial in determining the most effective treatment option, with factors such as age, underlying medical conditions, and severity of symptoms influencing treatment outcomes 2, 3, 4, 5, 6.
- Treatment outcomes may vary depending on the underlying cause of the cricopharyngeal bar, with some patients experiencing significant improvement in symptoms and others requiring repeated treatments or alternative therapies 2, 3, 4, 5, 6.