Office v OR Injection for Retrograde Cricopharyngeal Dysfunction: Evidence-Based Treatment Algorithm

This prospective study compares the outcomes of operating room (OR) and in-office (IO) injection of botulinum toxin (BTX) for retrograde cricopharyngeal dysfunction (RCPD).

Adult patients diagnosed with RCPD receiving IO or OR BTX injections were included in this study. Procedure success was based on patient-reported symptom improvement. Chi-squared tests were used to compare success and repeat injection rates between injection approaches. Primary treatment was defined as 1 IO injection, 2 IO injections within 8 weeks, or 1 OR injection.

One hundred and ninety-eight patients were included in the study with follow-up data available for 185 (118 IO, 67 OR). Initial symptom relief was comparable between IO and OR injections (90.7% vs. 91.0%; p = 0.32). However, rates of repeat injection were higher after IO injection, with 26.2% undergoing a contralateral IO injection within 8 weeks and 54.2% undergoing repeat IO injection at any timepoint. Two IO injections had a comparable long-term success rate to one OR injection (77.8% vs. 70.5%; p = 0.45). For patients with symptom recurrence, secondary treatment with subsequent injection was effective. Patient demographics and medical comorbidities were not predictive of treatment failure.

This study demonstrates that both OR injection and IO injections are viable options for the treatment of RCPD and further proposes a treatment algorithm that guides injection selection based on response patterns. Future studies are needed to assess longer-term outcomes (> 1 year), timing between IO injections, and factors influencing repeat treatment rates to optimize patient outcomes.