Cricopharyngeal Dysfunction: A Systematic Review Comparing Outcomes of Dilatation, Botulinum Toxin Injection, and Myotomy

Objectives: Cricopharyngeal dysfunction may lead to severe dysphagia and aspiration. The objective of this systematic review was to evaluate the existing studies on the effectiveness of myotomy, dilatation, and botulinum toxin (BoT) injection in the management of cricopharyngeal dysphagia. Methods: PubMed and Web of Science databases were searched to identify eligible studies by using the terms cricopharyngeal dysfunction, cricopharyngeal myotomy, cricopharyngeal botox, cricopharyngeal dilation, and their combinations from 1990 to 2013. This was supplemented by hand-searching relevant articles. Eligible articles were independently assessed for quality by two authors. Statistical analysis was performed. Results: The database search revealed 567 articles. Thirty-two articles met eligibility criteria and were further evaluated. The reported success rates of BoT injections was between 43% and 100% (mean=76%), dilation 58% and 100% (mean=81%), and myotomy 25% and 100% (mean=75%). In logistic regression analysis of the patient-weighted averages, the 78% success rate with myotomy was significantly higher than the 69% success rate with BoT injections (P=.042), whereas the intermediate success rate of 73% with dilation was not significantly different from that of either myotomy (P=.37) or BoT (P=.42). There was a statistically significant difference between endoscopic and open myotomy success rates (P=.0025). Endoscopic myotomy had a higher success rate, with a 2.2 odds ratio. Conclusions: The success rate of myotomy is significantly higher than the success rate of BoT injections in cricopharyngeal dysfunction. Moreover, endoscopic myotomy was found to have a higher success rate compared to open myotomy.