Feasibility, safety and efficacy of cricopharyngeal per-oral endoscopic myotomy in elderly patients: a prospective single-centre study

Background and aims: Cricopharyngeal bar-related dysphagia predominantly affects elderly patients with significant comorbidity, in whom surgical myotomy carries substantial risk. Cricopharyngeal per-oral endoscopic myotomy (C-POEM) is an endoscopic alternative; however, data in elderly populations remain limited. We evaluated the feasibility, safety, and efficacy of C-POEM in patients aged ≥70 years. Methods: This prospective study included patients aged ≥70 years who underwent C-POEM between March 2023 and October 2025. Symptoms assessed using the Sydney Swallow Questionnaire (SSQ) at baseline, 4–6 weeks, and 3 months. Objective outcomes measured using EndoFLIP-derived distensibility index (DI) before C-POEM and 3 and 12 months post C-POEM. Technical success, clinical success, adverse events, length of stay were recorded. Results: Twelve patients (median age 79 years, IQR 76.5–83.3; median Charlson Comorbidity Index 6, (IQR 5–7) underwent C-POEM. Technical success was 100%. Clinical success was observed in all patients at 3 months; sustained at 12 month follow up. Median SSQ improved from 897 (IQR 686–1103) to 60 (IQR 20–269; p=0.001), and median UES DI improved from 1.6 (IQR 1.4–2.0) to 4.3 mm²/mmHg (IQR 3.6–5.2; p=0.001). Median length of stay was 3 days (IQR 2–4.5). No procedure-related major adverse events were observed. At a median follow-up of 55 weeks, symptomatic improvement was sustained. Conclusions: In this elderly cohort, C-POEM was feasible, safe, and associated with significant symptomatic and physiological improvement. These findings support C-POEM as a promising option for cricopharyngeal bar-related dysphagia in elderly patients. Larger comparative studies are required to define its role relative to established therapies.