Response to Cricopharyngeal Dilation and Botulinum Toxin Injection Predicts Efficacy of Staged Myotomy in Cricopharyngeal Dysfunction

Objectives: To date, no study has evaluated the use of cricopharyngeal (CP) dilation and botulinum toxin injection (BTX) as a temporary measure to predict myotomy outcomes. We hypothesize that symptom resolution following “trial” dilation and BTX predicts improvement following CP myotomy. Methods: Retrospective review of patients who underwent CP dilation and BTX followed by staged myotomy at a single institution. Pre- and postoperative EAT-10 scores for dilation and BTX and CP myotomy were used to calculate △EAT-10 scores. Univariate linear regression was performed to assess the association between dilation and BTX △EAT-10 and CP myotomy △EAT-10 scores. Results: Forty-two patients underwent CP dilation and BTX. Following CP dilation and Botox, patients who elected for no further treatment (n = 26) had a mean △EAT-10 was –2.93 (SD 8.810, P = .047), while patients who elected for later staged myotomy (n = 16) had a mean △EAT-10 of −5.85 (SD 6.923, P = .020) following dilation and BTX. Following CP myotomy, these 16 patients had mean △EAT-10 of −3.938 (SD 6.104, P = .021). Univariate linear regression revealed a positive association of △EAT-10 scores for dilation and BTX with CP myotomy △EAT-10 scores (β = .695, 95% CI = 0.384, 1.006, R 2 = .62, P < .001). Conclusion: CP dilation and BTX presents a low risk option to “trial” expected results of permanent and higher risk myotomy. Presence or absence of subjective improvement appears to track across both procedures and may help set patient expectations and optimize surgical candidate selection.