Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China.
Scand J Gastroenterol. 2022 Jul;57(7):884-890. doi: 10.1080/00365521.2022.2041716. Epub 2022 Feb 25.
As an upper oesophageal sphincter (UES) dysfunction disorder, cricopharyngeal achalasia (CPA) is a common cause of dysphagia and is associated with an increased risk of pulmonary complications. The aim of this study was to investigate the effectiveness and safety of BTX-A injection using ultrasound combined with balloon guidance for the treatment of CPA caused by stroke.
A total of 21 patients diagnosed with CPA were treated with BTX-A injection into the cricopharyngeal muscle using ultrasound combined with balloon guidance. Primary outcome measures, including the functional oral intake scale (FOIS), videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS), which are quantitative measures for a video fluoroscopic swallowing study (VFSS), and scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed from baseline to 12 weeks after treatment. Repeated measures analysis of variance was used to compare the scores between time points.
BTX-A injection led to improved dysphagia symptoms and scores in 19 patients (90.48%). Among them, 5 cases were cured (23.81%), 11 cases showed significant improvement (52.38%), and 3 cases showed improvement (14.29%). Two cases were absolutely ineffective (9.52%). Compared with the scores prior to treatment, the scores on the FOIS, VDS, PAS, SAS and SDS significantly improved beginning at 3 days ( < .05) and lasting for at least 12 weeks after injection.
Ultrasound with balloon-guided BTX-A injection is probably a relatively safe, easy, and effective technique for the treatment of CPA caused by stroke, with better visualization of the injection procedure. A well-designed controlled trial with a larger sample size is needed for more convincing conclusions.
作为一种上食管括约肌（UES）功能障碍疾病，环咽肌失弛缓症（CPA）是吞咽困难的常见原因，并与肺部并发症风险增加相关。本研究旨在探讨超声联合球囊引导下肉毒毒素 A（BTX-A）注射治疗脑卒中后 CPA 的有效性和安全性。
共对 21 例诊断为 CPA 的患者采用超声联合球囊引导下的环咽肌 BTX-A 注射治疗。主要结局测量指标包括功能性口服摄食量表（FOIS）、视频透视吞咽障碍量表（VDS）和渗透-误吸量表（PAS），这些量表是视频透视吞咽研究（VFSS）的定量指标，以及焦虑自评量表（SAS）和抑郁自评量表（SDS）的评分。从基线到治疗后 12 周评估这些指标。采用重复测量方差分析比较各时间点的评分。
BTX-A 注射使 19 例患者（90.48%）的吞咽困难症状和评分得到改善。其中 5 例治愈（23.81%），11 例显著改善（52.38%），3 例改善（14.29%）。2 例完全无效（9.52%）。与治疗前相比，FOIS、VDS、PAS、SAS 和 SDS 评分在注射后 3 天（ < .05）开始显著改善，并持续至少 12 周。
超声联合球囊引导下 BTX-A 注射治疗脑卒中后 CPA 可能是一种相对安全、简便、有效的方法，该方法具有更好的注射过程可视化效果。需要设计更好的、更大样本量的对照试验，以获得更有说服力的结论。
