Efficacy and Safety of Electromyography‐Guided Injection of Botulinum Toxin to Treat Retrograde Cricopharyngeus Dysfunction

Abstract

Objective To report the efficacy and safety of electromyography-guided percutaneous botulinum toxin injection into the cricopharyngeus muscle in an office setting for treatment of the inability to belch and associated symptoms caused by retrograde cricopharyngeus dysfunction (R-CPD). Study Design Retrospective case series of treated patients. Setting Tertiary care laryngology clinic. Methods A retrospective review was performed on 18 consecutive patients who were diagnosed syndromically with R-CPD. The combined diagnostic test and treatment—specifically, botulinum toxin injection into the cricopharyngeus muscle—was accomplished in an office setting by a single surgeon using electromyography guidance. Items assessed are efficacy, safety, complications, and duration of benefit. Results All 18 patients (100%) treated in the in-office setting gained the ability to burp with improvement in the associated symptoms of R-CPD at initial follow-up. Of those who had the in-office procedure performed initially, 80% maintained the ability to burp at 6 months with relief of all the associated symptoms of R-CPD. No patients experienced permanent complications from the injection, but 7 patients experienced varying degrees of noisy breathing within 1 week after the procedure, which was managed with breathing techniques and resolved. Conclusion In a case series of 18 patients with R-CPD, all patients gained the ability to burp with improvement in the majority of their symptoms of R-CPD at the time of their initial follow-up at 1 week. None experienced severe complications, and 7 experienced transient noisy breathing, which resolved.

Case report: A case of novel treatment for retrograde cricopharyngeal dysfunction

“…Generally, a single guidance method may not be accurate in positioning; therefore, most of the articles in the published literature reported a combination of several guidance methods. Bastian and Smithson ( 1 ) and Bastian and Hoesli ( 2 ) reported two methods of guidance: laryngoscopic guidance under general anesthesia, which has high requirements in terms of equipment and technology, and trans cricothyroid membrane puncture, which has high requirements for the operator in terms of skill and to precisely locate the puncture point. The proposed localization method is relatively simple and easy to implement.…”

“…Retrograde cricopharyngeal dysfunction (R-CPD) was first described in 2019 by Bastian et al and it is characterized by an inability to belch, excessive flatulence, unpleasant gurgling noises, and discomfort in the lower neck, chest, and abdomen ( 1 ). The results of auxiliary examinations will be normal.…”

“…The results of auxiliary examinations will be normal. Bastian and Smithson ( 1 ) and Bastian and Hoesli ( 2 ) reported the usage of botulinum toxin (BTX) injection for the treatment of R-CPD using two guidance methods: laryngoscopic guidance under general anesthesia and piercing of the cricothyroid membrane and traversing the lumen, posterior cricoid plate, and posterior cricoarytenoid muscles to reach the cricopharyngeal muscle with electromyographic guidance under topical anesthesia. These two methods have a relatively high need for equipment and technology.…”

Lateral Transcervical In‐office Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction

“…[2][3][4][5] In 2021, the first study analyzing the efficacy and safety of in-office (IO) injection into CP in 18 patients with a 6-month follow-up was published. 6 The proposed methodology is a transcricoid approach, which requires topical anesthesia of the airway and bilateral electromyography (EMG) guided BTX injections through the posterior cricoid plate via a cricothyroid membrane puncture. Thirty-nine percent of these patients developed varying degrees of noisy breathing indicating vocal fold hypomobility: two patients had dyspnea on exertion, two stridor with exertion, one with a day-long dyspnea, and one with noisy breathing at night.…”

Retrograde Cricopharyngeus Dysfunction: An Orphan Disease?

“…In March 2019, we published the first of 3 articles (1–3) describing how to both diagnose and treat a newer but still orphan gastrointestinal syndrome, the key feature of which is the inability to belch. We proposed the name retrograde cricopharyngeus dysfunction (R-CPD) because the cricopharyngeus muscle is the primary component of the dysfunctional upper esophageal sphincter .…”