Efficacy of balloon dilatation therapy for cricopharyngeal achalasia in patients with brainstem lesions

Objective To investigate the effects of using a catheter balloon to treat crieopharyngeal achala-sia in patients with brainstem lesions. Methods Thirty cases of dysphagia caused by brainstem lesions were diag-nosed as crieopharyngeal achalasia through videofluoroscopy of swallowing.The cases were divided into a treatment group and a control group randomly.The treatment group was treated with balloon dilatation and routine dysphagia re-habilitation training once daily,while the control group was treated with routine dysphagia rehabilitation training only.The treatment end point was either the patient resuming an oral diet or after 4 weeks of treatment.All eases were evaluated videofluoroscopically with a drinking test pre-and pest-treatment.Results After 10 to 24 balloon dilata-tions,10 of the 15 patients in the treatment group regained the ability to take solid food and water orally,thoush 2 of them could take pasty food only.Only 2 of the 15 patients in the control group regained the ability to take common food by mouth,though 5 of them could take pasty food.The other patients had no improvement.There wag a signifi-cant difference between the two groups.The cricopharyngeal aehalasia of 12 patients in the ffeatment group improved from incomplete relaxation/opening to complete relaxation/opening.Pooling and residue in the pyriform sinus or val-leculae was reduced and no misaspiration was observed.In the control group only 7 patients had some improvement.The mesn time for the bolus passing the pharynx after treatment was significantly shortened from 0.23 s to 0.15 s in the treatment group,but not significantly in the control group.Conclusions Catheter balloon dilatation is effective for cricopharyngeal achalasia caused by brainstem injury and is helpful for relieving the symptoms in the pharynx phase and the esophagus phase of dysphagia. Key words: Cricopharyngeal achalasia; Dysphagia; Videofluoroseopie swallowing study; Balloon dila-tation