CASE REPORT: Endoscopic Balloon Catheter Dilation for Treatment of Primary Cricopharyngeal Dysfunction

Abstract

Primary cricopharyngeal dysfunction (PCD) is a disorder of unknown etiology that is an increasingly recognized and potentially reversible cause of oropharyngeal dysphagia (1). It is characterized by failed or partial sphincter relaxation, lack of pharyngoesophageal coordination, or a reduction in the muscular compliance of the upper esophageal sphincter (UES) (2, 3). It has a low prevalence and affects mainly elderly people. The most frequent symptoms are dysphagia, choking during meals, aspiration, and immediate expectoration of an offending bolus. Diagnosis can be made by videofluoroscopy or by contrast radiographic studies; these may show a typical cricopharyngeal bar that is a prominent posterior indentation at the level of the UES (4). Manometric studies may not show uniform characteristics and these can include normal or increased resting UES pressure with incomplete relaxation and loss of pharyngoesophageal coordination (5). Treatment is started after secondary causes of oropharyngeal dysphagia are excluded and symptoms can be relieved by cricopharyngeal myotomy in most patients (6). Recently, the use of botulinum toxin injection and endoscopic balloon catheter dilation has been reported to be safe and effective for the treatment of cricopharyngeal dysphagia (7–10). Here we describe the results of treatment with balloon dilation and follow-up in a patient with PCD.