Current evidence on the safety and efficacy of endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of the information for the public is recommended.
Audit and review clinical outcomes of all patients having endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia (see further information).
Patient selection for endoscopic carbon dioxide laser cricopharyngeal myotomy should be done by a multidisciplinary team that specialises in managing oropharyngeal dysphagia.
Further research on endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia could include the publication of collaborative audit data. Reports should separate outcomes for different groups of patients; in particular for patients with primary neuromuscular dysfunction alone, those with associated phargyngeal diverticula and those with dysphagia caused by radiotherapy. Outcome measures should include dysphagia scores, quality of life, long‑term outcomes and the need for further treatment. All complications should be reported. NICE may update this guidance on publication of further evidence.