Efficacy of large-diameter dilatation in cricopharyngeal dysfunction

Abstract

Objectives/hypothesis: To investigate patient outcomes with large-diameter bougienage in isolated cricopharyngeal dysfunction and understand how esophageal dilatation can be used as an effective diagnostic and therapeutic modality in treating dysphagia.

Study design: Retrospective review.

Methods: A retrospective chart review was performed on 46 patients meeting the criteria for cricopharyngeal dysphagia from 2004 to 2008 presenting in the outpatient setting. Patients were treated with 60 French esophageal dilators. Outcomes were analyzed as a function of symptomatology, manometry, duration of benefit, and safety.

Results: Over the period reviewed, 59 dilatations were performed on 46 patients with cricopharyngeal dysfunction. Eight patients were dilated more than once. Four patients were lost to follow-up. The average starting Functional Outcome Swallowing Score (FOSS) was 2.07. Of the patients reviewed, 64.29% experienced an improvement in their FOSS with a median duration of 741 days. There were five minor complications and no major complications.

Conclusions: In the largest series of esophageal dilatation for cricopharyngeal dysfunction in the literature, we found large-bore bougienage to have significant utility due to its efficacy, ease of use, and safety when compared to other modalities such as botulinum injection, balloon dilatation, and cricopharyngeal myotomy.