Achalasie cricopharyngée primitive: après la difficulté diagnostique, comment choisir entre myotomie et dilatation pneumatique?
Primary crico-pharyngeal achalasia: how to choose between myotomy and pneumatic dilatation after difficult diagnosis?
primitive cricopharyngeal achalasia (PCPA) is a rare case of functional disorder of the upper esophageal sphincter (UES), characterized by an isolated defect of the relaxation and opening of the UES. This disease affects specifically older people, with a muscular involution of the muscles in the UES due to aging.
a 54 year-old male, was admitted for upper dysphasia associated with cough and choking. Gastrooesophageal endoscopy showed impassable stenosis of Killian’s mouth. The esophageal barium swallow revealed a cystic dilatation of the pyriform sinus. ENT assessment and cervical computed tomography excluded a tumoral origin. The pharyngoesophageal transit with a cinevideographic study confirmed the diagnosis of PCPA. The patient underwent a surgical treatment: myotomy with a positive outcome.
PCPA is an elimination diagnosis; its functional origin is demonstrated through endoscopy, manometry and cine-radiography altogether. The treatment of choice is cricopharyngeal myotomy. It can be achieved through rigid endoscopy, using a technique similar to endoscopic treatment of Zenker’s diverticulum. Pneumatic dilatation is efficient in half of cases, and should be tried first.
Fedoua ROUIBAA, N. BELARBI, M. BENNANI, I. SERRAJ, M. RAIS, Z. CHAOUI, Nawal KANOUNI, M. TOUNSI, Naima AMRANI
crico-pharyngeal achalasia, myotomy, upper dysphagia