Which procedure targets the cricopharyngeus muscle to relieve Zenker's symptoms?

• A. Cricopharyngeal myotomy.
• B. Heller myotomy.
• C. POEM.
• D. Endoscopic stapled diverticulostomy.

Answer: (A)

Zenker’s symptoms come from the upper esophageal sphincter not relaxing properly, caused by the cricopharyngeus muscle. When this muscle fails to relax, pressure builds during swallowing and the pharyngeal mucosa herniates, forming the diverticulum and causing dysphagia, regurgitation, and other symptoms. Targeting and releasing that muscle directly addresses the source of the obstruction, so cutting the cricopharyngeus—cricopharyngeal myotomy—lowers the outflow resistance at the upper esophagus and allows food to pass more easily into the esophagus. This reduces stasis in the diverticulum and alleviates the Zenker’s symptoms.

The other procedures involve different targets: a Heller myotomy and POEM are directed at the lower esophageal sphincter for achalasia, not the upper sphincter. Endoscopic stapled diverticulostomy treats the diverticular sac by creating a passage between the diverticulum and the esophagus, but it doesn’t specifically relieve cricopharyngeal muscle tightness.