Cricopharyngeal Achalasia: Management and Associated Outcomes—A Scoping Review

Abstract

Objective There is little consensus regarding the efficacy and safety of treatment options for cricopharyngeal (CP) achalasia. The purpose of this scoping review is to assess the literature regarding the various treatments for this disease. Data Sources PubMed was searched for all articles addressing treatment of adult CP achalasia between January 1990 and June 2019. Review Methods In total, 351 peer-reviewed results were reviewed by 3 otolaryngologists for inclusion. After review of titles, abstracts, and full texts, 60 articles were selected. Results Among included studies, 55% were retrospective and 45% were prospective. Forty-five percent of studies were case series. CP achalasia etiologies included idiopathic (28%), cerebrovascular accident (CVA) (28%), neurologic disease (17%), head and neck radiation treatment (11%), Zenker’s diverticulum (10%), and myositis (5%). Most commonly employed treatments were botulinum toxin injection (40%), endoscopic CP myotomy (30%), dilation with either balloon or bougie (25%), and open CP myotomy (15%). A proportion of patients were treated with more than 1 approach. Most studies included both subjective and objective outcome measures. Complications were reported most often in patients with a history of head and neck radiation. Conclusions Small sample sizes and heterogeneity of causes and treatments of CP achalasia, as well as short duration of follow-up, make it challenging to assess the superiority of one treatment over another. There is a need for a prospective study that more directly compares outcomes of administration of botulinum toxin, dilation, and CP myotomy in patients with CP achalasia of similar etiologies.

Atypical presentations of inclusion body myositis: Clinical characteristics and long‐term outcomes

“…The presence of a cricopharyngeal bar on video‐fluoroscopy is not uncommon in IBM, 25 which frequently leads to obstruction‐related dysphagia and increased risk for aspiration pneumonia 26 . This is not pathognomonic for IBM however, as a cricopharyngeal bar can be encountered in other inflammatory myopathies, inherited myopathies and with aging 27,28 . Nevertheless, recognition of this finding may result in earlier interventions to improve outcomes.…”

“…26 This is not pathognomonic for IBM however, as a cricopharyngeal bar can be encountered in other inflammatory myopathies, inherited myopathies and with aging. 27,28 Nevertheless, recognition of this finding may result in earlier interventions to improve outcomes. In our study, a cricopharyngeal bar was found in 64% of patients with dysphagia onset, which led to cricopharyngeal myotomy or balloon dilatation in all patients.…”

Effect of Cold Fluid Compensatory Swallowing Combined with Balloon Dilation on the Treatment of Poststroke Cricopharyngeal Achalasia: A Pilot Randomized Controlled Trial

“…CPA is a typical dysphagia associated with stroke [ 5 ]. Lateral medullary lesion has been identified as an independent predictor for CPA [ 6 ].…”

Acupuncture combined with balloon dilation for post-stroke cricopharyngeal achalasia: A meta-analysis of randomized controlled trials

“…CPA usually cause severe dysphagia, with serious complications which could lead to an increase in medical expenses and mortality, a decrease in quality of life, etc (Kocdor et al, 2016 ). Currently, balloon dilation is a regular treatment of post-stroke CPA (Dou et al, 2012 ; Dewan et al, 2020 ). Through repeated mechanical traction and dilation, balloon dilation can relax the cricopharyngeal muscle (CPM) and improve swallowing (Suntrup et al, 2015 ).…”