A novel endoscopic surgery for dysphagia after stroke

Area of Science:

• Neurology
• Gastroenterology
• Otolaryngology

Background:

• Dysphagia is a frequent complication in stroke survivors, significantly impacting their quality of life.
• Sustained dysphagia (lasting over 6 months) presents a persistent challenge in stroke patient management.

Purpose of the Study:

• To assess the efficacy and safety of temperature-controlled plasma radiofrequency (coblation)-assisted endoscopic cricopharyngeal myotomy (CAECPM).
• To evaluate CAECPM as a treatment for chronic dysphagia in patients who have experienced a stroke.

Main Methods:

• A retrospective case-control study involving 24 stroke patients with sustained dysphagia.
• Comparison between transcervical cricopharyngeal myotomy (CPM) (n=16) and CAECPM (n=12).
• Swallowing function assessed using the Chinese version of the swallow quality-of-life questionnaire (CSWAL-QOL), videofluoroscopic swallowing study (VFSS) swallowing (VFSS-SWAL) score, and VFSS aspiration (VFSS-ASPI) score. Esophageal pressure and complications were also recorded.

Main Results:

• CAECPM treatment led to improved CSWAL-QOL scores and reduced VFSS-SWAL and VFSS-ASPI scores.
• A significant reduction in upper esophageal sphincter pressure was observed post-CAECPM.
• Minor complications included subcutaneous and mediastinal emphysema in one patient and gastric regurgitation in two patients.

Conclusions:

• CAECPM demonstrates potential as an effective and safe therapeutic option for persistent dysphagia in stroke patients.
• This exploratory study suggests CAECPM warrants further investigation.
• Larger, prospective studies are necessary to confirm these findings and validate the treatment's efficacy.