[Treatments with balloon catheter dilatation and botulium toxin injection in a patient with pharyngeal dysphagia secondary to cricopharyngeal dysfunction]

Simultaneous double balloon dilatation using double channel therapeutic endoscope in patients with cricopharyngeal muscle dysfunction: An observative study

The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (β = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.

Balloon Catheter Dilatation for Treatment of a Patient With Cricopharyngeal Dysfunction After Thermal Burn Injury

Deglutition disorder is a clinical symptom that has been associated with inhalation and cutaneous thermal burn injuries. Deglutition disorder is present in approximately 11% of patients with burn injury and is known to persist for weeks to months postinjury. Here, we report a case of deglutition disorder associated with cricopharyngeal dysfunction in a patient with thermal burn injury. Two patients presented with deglutition disorder lasting for several weeks after thermal injury. Clinically, it manifested as combined liquid and solid food dysphagia. The findings of videofluoroscopic swallow study (VFSS) were poor relaxation of the pharyngoesophageal sphincter (PES), decreased elevation of the laryngohyoid, and inadequate pharyngeal contraction. The PES was dilated with a 20-mm expansion balloon catheter multiple times. The symptoms of deglutition disorder were relieved immediately after the procedure. Balloon catheter dilatation was performed four times at 1- to 2-week intervals. Follow-up VFSS showed that poor relaxation of the PES was improved. The VFSS showed no recurrence at the 3-month follow-up. We found that balloon catheter dilatation for treatment of a patient with cricopharyngeal dysfunction after thermal burn injury was effective, ease of use, and safe.