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

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

[METHODS] 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.

[RESULTS] 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.

[CONCLUSION] 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.