Treatments with Balloon Catheter Dilatation and Botulium Toxin Injection in a Patient with Pharyngeal Dysphagia Secondary to Cricopharyngeal Dysfunction

Tae Hoon Oh

doi:10.4166/kjg.2014.63.5.325

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Oh: Treatments with Balloon Catheter Dilatation and Botulium Toxin Injection in a Patient with Pharyngeal Dysphagia Secondary to Cricopharyngeal Dysfunction

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Korean J Gastroenterol 2014;63(5):325-328.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.5.325

Treatments with Balloon Catheter Dilatation and Botulium Toxin Injection in a Patient with Pharyngeal Dysphagia Secondary to Cricopharyngeal Dysfunction

Tae Hoon Oh

Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to: Tae Hoon Oh, Department of Internal Medicine, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. Tel: +82-2-950-8867, Fax: +82-2-950-1955, E-mail: osbbang@paik.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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Fig. 1.

Video-fluoroscopic swallowing study shows retained barium residue on vallecular and pyriform sinus.

Fig. 2.

Sequential change of manometric findings in high resolution esophageal manometry. (A) Initial findings show decreased contractile pressure of pharyngeal muscle with aperistalsis (black arrow), lack of pharyngoesophageal coordination, and incomplete relaxation of upper esophageal sphincter (asterisk), resulting in hindrance of bolus transit. (B) Follow-up study after Botulinum toxin injection shows decreased resting and residual pressure of upper esophageal sphincter during deglutition (asterisk), resulting in complete bolus transit. However, contractile pressures of hypopharynx (black arrow) and proximal segment of esophageal body (arrowhead) near upper esophageal sphincter are also decreased compared to the initial study.

Fig. 3.

Endoscopic treatment of secondary cricopharyngeal dysfunction.(A) Under deep sedation, upper esophageal sphincter was dilated with a 20-mm controlled radial expansion balloon catheter for 2 minutes. (B) Diluted solution, equivalent to 100 U Botulinum toxin A, was injected with an endoscopic sclerosis needle at the upper esophageal sphincter level.

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