title: Endoscopic cricopharyngeal myotomy for management of cricopharyngeal achalasia (CA) in an 18-month-old child.
abstract: A 6-month-old patient presented with dysphagia and failure to thrive. Video fluoroscopic swallow study (VFSS), esophagogastroduodenoscopy, and manometry were diagnostic for CA. A gastrostomy tube was placed at 8 months. Botulinum toxin injection improved symptoms, but within 10 weeks symptoms returned. At 18 months, an uncomplicated endoscopic CPM was performed. A postoperative VFSS demonstrated cricopharyngeal bar resolution. Within 3 months, patient was feeding orally without a G tube. Pediatric CPA treatment options consist of dilation, botox, and transcervical CPM. To our knowledge, this is the youngest patient treated with endoscopic CPM. Intraoperative video and photographs are presented.
authors.affiliation: Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Rchun@mcw.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Chun
authors.forename: Mathew
authors.initials: M
authors.lastname: Sitton
authors.forename: Neelesh A
authors.initials: NA
authors.lastname: Tipnis
authors.forename: Joan C
authors.initials: JC
authors.lastname: Arvedson
authors.forename: Aparna
authors.initials: A
authors.lastname: Rao
authors.forename: Jason
authors.initials: J
authors.lastname: Dranove
authors.forename: David J
authors.initials: DJ
authors.lastname: Brown
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003413:Cricoid Cartilage / Q000002:abnormalities / Q000601:surgery*; D003680:Deglutition Disorders / Q000503:physiopathology / Q000601:surgery*; D049631:Esophageal Sphincter, Upper / Q000187:drug effects / Q000503:physiopathology; D004945:Esophagoscopy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry; D010609:Pharyngeal Muscles / Q000002:abnormalities / Q000601:surgery; D010614:Pharynx / Q000002:abnormalities / Q000601:surgery*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins