LAUSR

Dear Sir Cricopharyngeal myotomy (CPM) is an established technique for management of dysphagia. The pathophysiology of this condition is thought to be due to failure of relaxation of the upper oesophageal sphincter which is largely made up of the cricopharyngeus muscle. Various techniques have been described to manage cricopharyngeal spasm including endoscopic botulinum injection into the cricopharyngeus, dilatation, endoscopic CPM and open-approach CPM. Endoscopic CPM, often performed using laser, is associated with reduced operative times, inpatient stay and lower morbidity. The technique can be performed without or with mucosal repair. There is evidence of efficacy and reduced complication rates of cricopharyngeal myotomy with mucosal repair (CPM-MR) techniques in the short term; however, long-term outcomes of these patients and indeed the implications of the surgery still require evaluation. To date, the National Institute of Health and Clinical excellence (NICE) guidelines state that although recognised as a technique, more long-term data are required before a formal recommendation regarding endoscopic laser CPM-MR can be issued. This paper looked to retrospectively review patients who had undergone laser CPM-MR over a minimum of 5 years previously and reassess their symptoms using the validated Sydney Swallowing Questionnaire (SSQ) and the Reflux Symptom Index (RSI) and compare their subjective scores preoperatively and postoperatively to their modern-day scores in August 2017.