Cervical Inlet Patches in R-CPD: An Unrecognized Predictor of Treatment Failure

Little data currently exists on endoscopic findings in patients with Retrograde cricopharyngeus dysfunction (R-CPD), particularly regarding factors that may help predict treatment outcomes. Here, we describe the previously unreported prevalence of cervical esophageal inlet patches (CIP) among patients undergoing treatment for R-CPD and evaluate their association with treatment responses while controlling for other patient-specific factors.

This was a retrospective cohort review performed on patients undergoing cricopharyngeal botulinum toxin injection (CPBTI) as treatment for R-CPD. Demographics, patient-specific factors, and endoscopic findings, including the presence of CIP, were noted. Early and long-term treatment responses following CPBTI were recorded at 6 weeks and $\ge$  6 months posttreatment, respectively. Univariate and multivariate analyses were performed to assess associations among endoscopy findings, demographic data, and treatment response at both time points.

A total of 101 patients (average age: 29.2 years, 68.3% female) underwent cervical esophagoscopy with CPBTI. Twenty (19.8%) had one or more CIP in the proximal esophagus. Of 76 patients who also received concurrent flexible esophagogastroscopy, 28 (37.8%) had a hiatal hernia and 34 (44.7%) had distal esophageal mucosal abnormalities. CIP and increasing age were the only significant predictors in this study, with both predicting failure to sustain a long-term treatment response (CIP: OR 5.14, 95% CI 1.60-16.50, p = 0.006; increasing age: OR 1.09, 95% CI 1.03-1.14, p = 0.001).

There is a high prevalence of CIP in R-CPD patients, which, along with increasing age, portends significantly increased odds of failure to sustain a long-term treatment response following an initially successful CPBTI.