Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

Abstract

AIMTo evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement.METHODSAll balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES).RESULTSFour hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunction, Zenker’s diverticulum, age or gender (P > 0.05). The only complication noted was uvular edema and a shallow ulcer after static dilatation in one patient, which resolved spontaneously and did not require hospital admission.CONCLUSIONUES dilatation with a through-the-scope balloon by either static or retrograde technique is safe and effective for the treatment of dysphagia due to CP dysfunction. To our knowledge, this is the first study evaluating retrograde balloon dilatation of the UES.

Simultaneous double balloon dilatation using double channel therapeutic endoscope in patients with cricopharyngeal muscle dysfunction

“…[ 29 , 30 ] Recently, it was reported that EBD using the retrograde method was also safe and effective for CPD, compared with the classic static technique. [ 31 ] However, dilatation using 1 balloon or bougie would not be effective in patients with UES relaxation dysfunction because the UES is not round. [ 32 ] Pilot data suggest that EBD using 2 simultaneous controlled radial expansion balloon dilators is feasible, safe, and effective.…”

Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia

“…[9] Such a dilatation procedure exerts radial and axial (sheering) forces to the UES with the distended balloon and a pull-up maneuver, similar to the endoscopic balloon catheter dilatation introduced in previous reports. [10]…”

Medial pontomedullary junctional infarction presenting vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia and dysphagia without lateral gaze palsy, curtain sign and hoarseness: a case presentation of a novel brain stem stroke syndrome with sensory disturbance-based dysphagia and review of the literature

“…CPD may have led to severe dysphagia and aspiration [16]. Symptoms of CPD can range from a globus sensation to oropharyngeal dysphagia manifested by regurgitation, coughing choking and recurrent aspiration [17]. The sensory stimuli that trigger and modulate swallowing include tactile stimuli (light and heavy pressure, air puffs, different bolus volumes and viscosities), chemical stimuli (water, other solutions, cations and anions), thermal stimuli and combined stimulus modalities [18–21].…”