Feasibility and Safety of Cricopharyngeal Per Oral Endoscopic Myotomy (C-Poem) in the Elderly: Preliminary Results From a Prospective Study

Background Cricopharyngeal bar is a recognised cause of upper oesophageal sphincter dysfunction and can lead to significant oropharyngeal dysphagia. This condition predominantly affects elderly patients who often have multiple co-morbidities. Cricopharyngeal Per Oral Endoscopic Myotomy (C-POEM) has been described in limited case series, showing symptom relief and reduced procedural morbidity. In this study, we aim to evaluate the safety and feasibility of C-POEM in this high-risk population. Methods C-POEM cases performed at Royal Perth Hospital from November 2023 to December 2024 were included. Sydney Swallowing Questionnaire (SSQ) score and EndoFLIP planimetry distensibility index (DI) measurements were reviewed from a prospectively collected database. SSQ was calculated pre C-POEM as well as 6 weeks and 3 months post C-POEM. DI measurements were taken pre C-POEM and 3 months post C-POEM. Electronic records were reviewed to calculate patients’ Charlson co-morbidity index (CCI). Adverse events were recorded from clinic follow-up visits. Results Nine patients with a median age of 79 years underwent C-POEM. SSQ and DI results available in 8 and 6 patients respectively. 4 patients had a diagnosis of inclusion body myositis. The mean CCI score was 5.9. Technical success was achieved in all cases. The median reduction in SSQ was from 1011 to 271 and the median improvement in DI was 1.6 to 4.5. Median follow up was 34.9 weeks. There was one adverse event in which a patient aspirated from post-procedure swallow study due to being given barium instead of non-ionic contrast. One patient died from community acquired pneumonia. Conclusion This study demonstrates the feasibility and safety of performing C-POEM in a co-morbid group of elderly patients. Technical success was achieved in all cases and clinical improvement was seen in all cases at 6 weeks follow up supported by reduction in SSQ. If expertise is available, C-POEM should be considered for elderly patients with symptomatic cricopharyngeal bar.