Operating Room or In-Office Injection for Retrograde Cricopharyngeal Dysfunction Botulinum Toxin Injection.

[BACKGROUND] Retrograde Cricopharyngeal Dysfunction (RCPD), also known as "No Burp Syndrome," is a rare condition characterized by the inability to burp due to cricopharyngeus muscle dysfunction. Patients experience bloating, chest and abdominal discomfort, gurgling sounds, and excessive flatulence, which significantly impact quality of life.

[OBJECTIVE] To compare the clinical outcomes and side effect profiles of botulinum toxin injection for RCPD when performed in-office versus in the operating room.

[METHODS] A clinical review of patients with RCPD was conducted, focusing on diagnosis based on history and physical examination. Botulinum toxin was administered to the cricopharyngeus muscle either in-office or in the operating room. Success rates, complications, and patient tolerance were analyzed and compared across both procedural settings.

[RESULTS] Botulinum toxin injection proved effective in both settings, with similar success rates in restoring the ability to burp and relieving associated symptoms. In-office procedures offered advantages in convenience and recovery time, while operating room procedures allowed for greater procedural control under general anesthesia. Side effect profiles differed slightly, with transient throat discomfort more commonly reported in in-office cases.

[CONCLUSION] Both in-office and operating room botulinum toxin injections are effective treatment options for RCPD. The choice of setting should be guided by patient preference, comorbidities, and resource availability, as each approach offers distinct advantages and risk considerations.

[LEVEL OF EVIDENCE] The retrospective case series by Bastian et al. Wajsberg et al. Hoesli et al. and Doruk and Pitman are level III evidence. The prospective cohort study of Doruk et al. is level II evidence.