Cricopharyngeal myotomy is indicated in which situation?

• A. In GERD-related dysphagia
• B. In Zenker's diverticulum when other measures fail
• C. In esophageal cancer
• D. In cricopharyngeal dysfunction causing dysphagia

Answer: (D)

Cricopharyngeal myotomy relieves obstruction at the upper esophageal sphincter by cutting the cricopharyngeus muscle, allowing the bolus to pass more freely during swallowing. This makes it the best choice when dysphagia stems from cricopharyngeal dysfunction (cricopharyngeal achalasia or hypertensive UES). In Zenker’s diverticulum, cricopharyngeal dysfunction often contributes to the problem and myotomy is frequently part of the treatment, but the primary aim is addressing the dysfunctional UES; it is not an option for GERD-related dysphagia or for esophageal cancer, where medical management or oncologic resection is required.