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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1811-E1819
DOI: 10.1055/a-1562-7107
Original article

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Peter I. Wu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Michal M. Szczesniak
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Taher Omari
4   College of Medicine and Public Health, Flinders University, Adelaide, Australia
,
Thomas Y. Lam
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Marc Wong
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Julia Maclean
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Karen K. Ma
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Anne Y. Chan
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Vincent Mok
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Ian J. Cook
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Charles Cock
4   College of Medicine and Public Health, Flinders University, Adelaide, Australia
,
Joseph Sung
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Justin Wu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Philip W. Chiu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
› Author AffiliationsTRIAL REGISTRATION: Non-randomized Interventional Trial ACTRN12619000927123 at https://www.anzctr.org.au/
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Abstract

Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD.

Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up.

Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003).

Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.



Publication History

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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