Endoscopic Botulinum Toxin Injection for Infantile Cricopharyngeal Achalasia: Long Term Effects of a Single Procedure - A Case Report

Abstract

Background: The cricopharyngeus muscle forms the Upper Esophageal Sphincter and separates the esophagus from the hypopharynx. Its main function is to prevent reflux of gastric contents causing Laryngo-Pharyngeal Reflux. Achalasia secondary to cricopharyngeal muscle dysfunction is more common in adults, the treatment of which would be a cricopharyngeal myotomy. However when this is encountered in the pediatric age group, the challenge lies in accurately diagnosing it and choosing the appropriate management option. We would like to report one such case of cricopharyngeal spasm causing achalasia in an infant presenting with failure to thrive and aspiration pneumonitis and was diagnosed and treated with endoscopic botulinum toxin injection, a minimally invasive procedure and associated with less morbidity, early recovery times and significant improvement of symptoms. Positive response to the minimally invasive method of Inj.Botulinum Toxin with minimal morbidity can always be reassuring of a successful cricopharyngeal myotomy, if required, at a later date. Hence, a trial of Inj.Botulinum Toxin in an otherwise rare condition with a difficult diagnosis can be a safe approach in the pediatric age group and can help prognosticate the role of second stage cricopharyngeal myotomy, if required. Objectives: Minimally invasive procedure on an infant with achalasia secondary to cricopharyngeal spasm presenting with failure to thrive and aspiration pneumonia. Methods: Injecting Botulinum toxin into cricopharyngeal sphincter endoscopically. Results: Positive response seen in the infant evidenced by weight gain and tolerance to solid feeds. Conclusion: Positive response to the minimally invasive method of Inj.Botulinum Toxin with minimal morbidity can always be reassuring of a successful cricopharyngeal myotomy, if required, at a later date. Keywords: Cricopharyngeus, Achalasia, Infant, Endoscopic Botulinum toxin injection