Feasibility, Safety, and Efficacy of Cricopharyngeal Per-oral Endoscopic Myotomy in Elderly Patients: A Prospective Single-center 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, and length of stay were recorded. Results Twelve patients (median age 79 years, interquartile range [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 mm 2 /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.