Botulinum Toxin Injection in Retrograde Cricopharyngeal Dysfunction: A Meta-Analysis

Area of Science:

• Gastroenterology
• Otolaryngology
• Neurology

Background:

• Retrograde cricopharyngeal dysfunction (RCPD) presents as an inability to burp, often accompanied by gurgling, chest/abdominal discomfort, and flatulence.
• Current treatment for RCPD involves cricopharyngeal Botulinum Toxin-A (BonT-A) injections, but optimal dosage and delivery methods remain undetermined.

Purpose of the Study:

• To quantitatively assess the efficacy, safety, and optimization strategies for BonT-A injections in managing RCPD.
• To summarize current evidence on BonT-A treatment outcomes for RCPD.

Main Methods:

• A systematic meta-analysis was conducted using data from PubMed, Embase, and Scopus up to October 19, 2024.
• Included randomized and non-randomized studies of BonT-A injections for RCPD in all age groups.
• Pooled logit-transformed proportions were analyzed using random-effects models; meta-regression identified associated factors.

Main Results:

• Thirteen studies (N=699) were included, showing high pooled early (91.45%) and sustained (79.90%) symptom relief.
• Transient dysphagia was the most common complication (51.04%).
• Direct rigid-endoscopic visualization (92.19% early success) and higher BonT-A doses (up to 100 units) were associated with improved sustained success.

Conclusions:

• Cricopharyngeal BonT-A injections demonstrate significant safety and efficacy for RCPD treatment.
• Utilizing 100 units of BonT-A under direct rigid-endoscopic visualization may optimize treatment outcomes.
• Further randomized controlled trials are recommended to establish definitive causality.