Management of Symptomatic Cricopharyngeal Bar

Technical Considerations for Dilatation

Use wire-guided or endoscopically controlled techniques to enhance safety, and consider upper esophageal sphincter dilatation specifically for cricopharyngeal bar with or without Zenker's diverticulum, as recommended by the American Gastroenterological Association 1, 2, 3
Fluoroscopic guidance may enhance safety during dilatation, especially in complex cases, with a low risk of complications 1
Carbon dioxide insufflation is preferred over air during endoscopy to minimize luminal distension and post-procedural pain, resulting in improved patient outcomes 1, 3

Cricopharyngeal myotomy may be considered for patients with structural abnormalities causing dysphagia, according to the American Thoracic Society guidelines 4, 5

Monitor patients for at least 2 hours in the recovery room, and provide clear written instructions regarding fluids, diet, and medications to ensure a smooth recovery 1, 2
Ensure patients are tolerating water before discharge, and suspect perforation if patients develop persistent pain, breathlessness, fever, or tachycardia 1, 2
Provide patients with contact information for the on-call team in case of complications, and consider weekly or two-weekly dilatation sessions until symptomatic improvement is achieved 1

The American Gastroenterological Association guidelines note that cricopharyngeal myotomy is not recommended for dysphagia caused by neurologic insult, but more recent evidence supports the use of dilatation 4, 5