Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke

Abstract

Objectives: At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke.

Methods: From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function.

Results: In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05).

Conclusions: BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.

Keywords: botulinum toxin; brainstem stroke; cricopharyngeal achalasia; dysphagia; endoscope.

图1

消化内镜引导下环咽肌BTX-A注射 Figure 1 Endoscopic guided injection of BTX-A into the cricopharyngeal muscle A: BTX-A is injected using an endoscope via a needle catheter into cricopharyngeal muscle. B: Asterisks indicate the 2 injection sites of cricopharyngeal muscle under the endoscope. BTX-A: Botulinum toxin Type A.

图2

吞咽造影 Figure 2 Swallowing imaging A: Cricopharyngeal muscle is basically not open, and the concentrated barium contrast agent stagnated in the lower pharynx, mistakenly inhaling into the airway before botulinum toxin injection. B: Cricopharyngeal muscle opens and a concentrated barium contrast agent passes through the upper esophagus after 2 weeks of botulinum toxin injection.