title: Improvement in the Reflux Symptom Index Following Surgery for Cricopharyngeal Dysfunction.
abstract: OBJECTIVE
  Gastroesophageal reflux may contribute to the development of cricopharyngeal dysfunction and Zenker's diverticulum. Common dictum suggests that if upper esophageal sphincter tone is reduced through cricopharyngeal myotomy, symptoms of laryngopharyngeal reflux may worsen. We hypothesized that patients who undergo myotomy should show decreased dysphagia symptoms with concurrent worsening of reflux symptomatology and that these changes would be greater in those patients undergoing complete versus partial myotomy.
  
  
  METHODS
  A retrospective chart review was performed for patients who underwent endoscopic or open cricopharyngeal myotomy, with or without Zenker's diverticulectomy. Preoperative and postoperative reflux symptomatology was subjectively measured with the Reflux Symptom Index (RSI), and dysphagia symptomatology was measured with the Eating Assessment Tool 10 (EAT-10). Patients who underwent partial myotomy via endoscopic stapling of Zenker's diverticulum were compared with patients who underwent complete myotomy (either endoscopic laser-assisted or via an open transcervical approach). The patients were further subdivided into three groups for data analysis: endoscopic staple diverticulotomy, laser cricopharyngeal myotomy, and open approach.
  
  
  RESULTS
  A total of 41 patient charts were reviewed. Of these 41 patients, 17 underwent endoscopic stapler-assisted diverticulotomy, 4 underwent endosopic laser-assisted cricopharyngeal myotomy, and 20 underwent open transcervical cricopharyngeal myotomy, with diverticulectomy as indicated. Mean pre- and postoperative RSIs were 21.8 and 8.9, respectively (P < 0.001). Mean pre- and postoperative EAT-10 scores were 19.1 and 5.0, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Patients' reflux symptoms significantly improved after cricopharyngeal myotomy, with significant improvement in dysphagia symptoms. Concern for worsening of reflux symptoms following surgery does not appear to be clinically common.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.. Electronic address: njiang83@gmail.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Jiang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: C Kwang
authors.initials: CK
authors.lastname: Sung
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Damrose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
keywords: Bronchoesophagology; Cricopharyngeal dysfunction; Laryngopharyngeal reflux; Surgical outcomes; Swallow/dysphagia