윤상인두근 기능부전에 의한 연하곤란 환자에서 고해상도 식도내압검사로 확인한 반복적인 풍선확장술 치료효과 증례 보고
Effect of Repetitive Balloon Dilatation Treatment Confirmed by High-Resolution Manometry in a Patient with Cricopharyngeal Dysfunction: A Case Report
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Cricopharyngeal dysfunction (CPD) has various treatment options, such as balloon dilatation (BD), botulinum toxin injection, and myotomy of the cricopharyngeal muscle. BD is less invasive, easier to implement, and economical compared to other treatments. In this study, the effectiveness and mechanism of repeating BDs in patients with CPD were verified through a videofluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A 44- year-old male developed dysphagia after large epidural hemorrhage in the left-brain hemisphere concurrent with diffuse axonal injury. CPD was confirmed in a videofluoroscopic swallowing study, which he first performed 10 weeks after a traumatic brain injury. Repetitive BDs were performed at 11, 12, 15, 18, 40, and 52 weeks after injury. Before and after the procedure, successive physiological changes were observed by HRM. The UES nadir pressure decreased from 6.4 mmHg to −2.1 mmHg after the first procedure. The pharyngeal residue after swallowing also decreased below 50% due to relaxation of the upper esophageal sphincter (UES), and the decrease in UES pressure was maintained at 52 weeks. The patient showed improved symptoms and could eat a regular diet. This report supports repetitive videofluoroscopic guided BDs as a therapeutic option for CPD.
Abstract
Cricopharyngeal dysfunction (CPD) has various treatment options, such as balloon dilatation (BD), botulinum toxin injection, and myotomy of the cricopharyngeal muscle. BD is less invasive, easier to implement, and economical compared to other treatments. In this study, the effectiveness and mechanism of repeating BDs in patients with CPD were verified through a videofluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A 44- year-old male developed dysphagia after large epidural hemorrhage in the left-brain hemisphere concurrent with diffuse axonal injury. CPD was confirmed in a videofluoroscopic swallowing study, which he first performed 10 weeks after a traumatic brain injury. Repetitive BDs were performed at 11, 12, 15, 18, 40, and 52 weeks after injury. Before and after the procedure, successive physiological changes were observed by HRM. The UES nadir pressure decreased from 6.4 mmHg to −2.1 mmHg after the first procedure. The pharyngeal residue after swallowing also decreased below 50% due to relaxation of the upper esophageal sphincter (UES), and the decrease in UES pressure was maintained at 52 weeks. The patient showed improved symptoms and could eat a regular diet. This report supports repetitive videofluoroscopic guided BDs as a therapeutic option for CPD.
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