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Ultrasound, electromyography, and balloon guidance for injecting botulinum toxin for cricopharyngeal achalasia: A case report.
Chen, Jian-Min; Chen, Yang-Jia; Ni, Jun; Wang, Zhi-Yong.
Afiliación
  • Chen JM; Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, China.
Medicine (Baltimore) ; 100(11): e24909, 2021 Mar 19.
Article en En | MEDLINE | ID: mdl-33725963
INTRODUCTION: Botulinum toxin (BTX) injection is a widely used treatment option for dysphagia associated with cricopharyngeal (CP) muscle achalasia, but uniform standards and protocols for administration techniques and injection sites are still lacking. This case study suggests that a unique administration technique involving a combination of ultrasound, electromyography, and balloon guidance for injecting the CP muscle can reduce inadvertent migration of BTX to non-injected tissues and increase the effectiveness and safety of BTX treatment. PATIENT CONCERNS: We describe the case of a 74-year-old man who could not swallow food or saliva for 8 months. DIAGNOSIS: The patient showed signs of true bulbar paralysis, including dizziness, hoarseness, and dysphagia. The fiberoptic endoscopic evaluation of swallowing showed massive mucilage secretion and residual materials in the postcricoid region and aspiration when swallowing 1 ml of yogurt. The video fluoroscopic swallowing study showed profoundly limited epiglottic folding and CP muscle non-relaxation, despite several unsuccessful swallow attempts. INTERVENTIONS: To manage insufficient relaxation opening of the CP muscle, BTX injection was performed using ultrasound, electromyography, and balloon catheter guidance. The narrow CP muscle situated above the balloon was identified as the target of injection by ultrasound. OUTCOMES: The patient was able to eat a soft diet. The follow-up fibrotic endoscopic swallowing study demonstrated a reduction in the amount of pharyngeal residue. The video fluoroscopic swallowing study showed that CP muscle relaxation was significantly enhanced and no penetration was shown. CONCLUSION: The unique administration technique with triple guidance holds several advantages, suggesting that it may be a promising treatment for CP muscle achalasia.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cateterismo / Acalasia del Esófago / Ultrasonografía / Sistemas de Liberación de Medicamentos / Toxinas Botulínicas Tipo A / Electromiografía Tipo de estudio: Diagnostic_studies / Guideline / Prognostic_studies Límite: Aged / Humans / Male Idioma: En Revista: Medicine (Baltimore) Año: 2021 Tipo del documento: Article País de afiliación: China Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cateterismo / Acalasia del Esófago / Ultrasonografía / Sistemas de Liberación de Medicamentos / Toxinas Botulínicas Tipo A / Electromiografía Tipo de estudio: Diagnostic_studies / Guideline / Prognostic_studies Límite: Aged / Humans / Male Idioma: En Revista: Medicine (Baltimore) Año: 2021 Tipo del documento: Article País de afiliación: China Pais de publicación: Estados Unidos