An 83-year old woman with a several year history of difficulty in swallowing. The contrast study shows a large pharyngeal pouch. Treated by endoscopic cricopharyngeal myotomy. Her symptoms were greatly improved by the procedure.
Comment: Large pouches, such as the one shown in this radiograph are best treated by endoscopic cricopharyngeal myotomy. In this procedure, a short rigid esophagoscope is used to display the openings into the pouch and the adjacent esophagus. An automatic stapling device is passed down the esophagoscope and used to divide (and staple) the bar of tissue between pouch and esophagus. The bar (shown by the arrow) is the cricopharyngeus.
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