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

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 eff...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Peter I. Wu, Michal M. Szczesniak, Taher Omari, Thomas Y. Lam, Marc Wong, Julia Maclean, Karen K. Ma, Anne Y. Chan, Vincent Mok, Ian J. Cook, Charles Cock, Joseph Sung, Justin Wu, Philip W. Chiu
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/809fe130a7b44feaaaac9218ccf9c4f5
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:809fe130a7b44feaaaac9218ccf9c4f5
record_format	dspace
spelling	oai:doaj.org-article:809fe130a7b44feaaaac9218ccf9c4f52021-11-13T00:00:31ZCricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease2364-37222196-973610.1055/a-1562-7107https://doaj.org/article/809fe130a7b44feaaaac9218ccf9c4f52021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1562-7107https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background 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.Peter I. WuMichal M. SzczesniakTaher OmariThomas Y. LamMarc WongJulia MacleanKaren K. MaAnne Y. ChanVincent MokIan J. CookCharles CockJoseph SungJustin WuPhilip W. ChiuGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1811-E1819 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Peter I. Wu Michal M. Szczesniak Taher Omari Thomas Y. Lam Marc Wong Julia Maclean Karen K. Ma Anne Y. Chan Vincent Mok Ian J. Cook Charles Cock Joseph Sung Justin Wu Philip W. Chiu Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
description	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.
format	article
author	Peter I. Wu Michal M. Szczesniak Taher Omari Thomas Y. Lam Marc Wong Julia Maclean Karen K. Ma Anne Y. Chan Vincent Mok Ian J. Cook Charles Cock Joseph Sung Justin Wu Philip W. Chiu
author_facet	Peter I. Wu Michal M. Szczesniak Taher Omari Thomas Y. Lam Marc Wong Julia Maclean Karen K. Ma Anne Y. Chan Vincent Mok Ian J. Cook Charles Cock Joseph Sung Justin Wu Philip W. Chiu
author_sort	Peter I. Wu
title	Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
title_short	Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
title_full	Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
title_fullStr	Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
title_full_unstemmed	Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease
title_sort	cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with parkinson’s disease
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/809fe130a7b44feaaaac9218ccf9c4f5
work_keys_str_mv	AT peteriwu cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT michalmszczesniak cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT taheromari cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT thomasylam cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT marcwong cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT juliamaclean cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT karenkma cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT anneychan cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT vincentmok cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT ianjcook cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT charlescock cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT josephsung cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT justinwu cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease AT philipwchiu cricopharyngealperoralendoscopicmyotomyimprovesoropharyngealdysphagiainpatientswithparkinsonsdisease
_version_	1718430327461904384

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

Ejemplares similares