Should I embrace surgery for R-CPD?

For those with severe R-CPD (Retrograde Cricopharyngeus Dysfunction) who don't find relief from other therapies, surgery may be an option to consider. There are a few different surgical procedures that can be performed to address the impaired upper esophageal sphincter in R-CPD.

Cricopharyngeal Myotomy

This is the most common surgery for R-CPD. It involves making incisions in the cricopharyngeus muscle fibers at the top of the esophagus to weaken and lengthen the sphincter. This helps open the passageway for easier swallowing. It is typically done endoscopically through the mouth without any external incisions.

Zenker's Diverticulotomy

A pouch called a Zenker's diverticulum sometimes develops just above the upper sphincter in R-CPD patients. Diverticulotomy surgery removes this sac, which can improve swallowing. It may be done endoscopically or through open neck surgery.

Upper Esophageal Sphincter Botox Injections

Injecting botulinum toxin into the cricopharyngeus muscle paralyzes it temporarily, allowing the sphincter to open more readily. While not a permanent solution, Botox can provide several months of symptom relief before re-injection is needed.

Dilation Procedures

Techniques like endoscopic balloon dilation or rigid dilation can stretch and expand the sphincter muscle opening to make it easier for food to pass through. However, scarring may cause narrowing again over time.

Laryngoplasty

Rarely used, this surgery reconstructs the larynx to open the upper sphincter in severe cases. It has higher risks than other procedures but may be an option after other treatments fail.

As with any surgery, risks like bleeding, infection, and scarring need to be considered. Be sure to discuss thoroughly with your doctor to determine if surgery could be beneficial for your situation. For select R-CPD patients, surgical sphincter intervention may provide longer-term improvement in managing troublesome swallowing difficulties.