Jeong Seok-Hoo, Kim Yu Jin, Kim Yoon Jae, Park Ki Deok, Kim Eui Joo, Chung Jun-Won, Kwon Kwang An, Kim Kyoung Oh, Park Dong Kyun, Kim Jung Ho, Cho Jae Hee
a Division of Gastroenterology, Department of Internal Medicine , Catholic Kwandong, University International St. Mary's Hospital , Incheon , Korea.
b Division of Gastroenterology, Department of Internal Medicine , Gil Medical Center, Gachon University College of Medicine , Incheon , Korea.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1201-1205. doi: 10.1080/00365521.2018.1506820. Epub 2018 Oct 24.
Dysphagia associated with neurologic disorders is a problem worldwide. However, few studies have assessed the efficacy of endoscopic botulinum toxin injections into the cricopharyngeal muscle using a pharyngoscope.
Fourteen patients who received an endoscopic botulinum toxin injection due to cricopharyngeal muscle dysfunction and a neurological disorder from 2006 to 2017 were retrospectively reviewed at a single tertiary medical center. The toxin was injected at a 100 international unit (IU) total dose under direct endoscopic vision. The success of the procedure was evaluated comprehensively using the following: clinical resolution of the previous symptoms, functional oral intake scale (FOIS) for the clinical evaluation of swallowing, and videofluoroscopic swallowing study (VFSS) to check decreased retention of barium at the pyriform sinus and the epiglottic vallecula.
The study included 12 males and 2 females (mean age, 58 years old; range, 37-82 years). Three patients (21.4%) were confirmed clinically and eleven were confirmed by VFSS. Eleven patients (78.6%) were managed successfully with the injection. Three patients (21.4%) did not improve despite the injection.
An endoscopic botulinum toxin injection may be a good treatment option for patients with dysphagia and cricopharyngeal dysfunction due to a neurological disorder. Large, prospective, long-term follow-up studies are needed in the future.
与神经系统疾病相关的吞咽困难是一个全球性问题。然而，很少有研究使用咽喉镜评估内镜下向环咽肌注射肉毒杆菌毒素的疗效。
回顾性分析了2006年至2017年在一家三级医疗中心因环咽肌功能障碍和神经系统疾病接受内镜下肉毒杆菌毒素注射的14例患者。在直接内镜观察下，以100国际单位（IU）的总剂量注射毒素。通过以下方面综合评估手术的成功率：既往症状的临床缓解情况、用于吞咽临床评估的功能性经口进食量表（FOIS）以及用于检查梨状窦和会厌谷钡剂潴留减少情况的视频荧光吞咽造影检查（VFSS）。
该研究纳入了12名男性和2名女性（平均年龄58岁；范围37 - 82岁）。3例患者经临床确诊，11例经VFSS确诊。11例患者（78.6%）注射治疗成功。3例患者（21.4%）尽管注射了毒素但病情未改善。
内镜下肉毒杆菌毒素注射可能是因神经系统疾病导致吞咽困难和环咽肌功能障碍患者的一种良好治疗选择。未来需要进行大规模、前瞻性、长期随访研究。
