PREDICTORS OF OUTCOME FOLLOWING CRICOPHARYNGEAL DISRUPTION FOR PHARYNGEAL DYSPHAGIA

The indications for, and predictors of outcome following cricopharynge al disruption in pharyngeal dysphagia are not clearly defined. Our pur pose was to examine the symptomatic response to cricopharyngeal disrup tion, by either myotomy or dilatation, in patients with oral-pharyngea l dysphagia and to determine pretreatment manometric or radiographic p redictors of outcome. Using simultaneous pharyngeal videoradiography a nd manometry, we studied 20 patients with pharyngeal dysphagia prior t o cricopharyngeal diltation (n = 11) or myotomy (n = 8), and 23 health y controls. We measured peak pharyngeal pressure, hypopharyngeal intra bolus pressure, upper esophageal sphincter diameter, and coordination. Response rate to sphincter disruption was 65%. The extent of sphincte r opening was significantly reduced in patients compared with controls (p = 0.004), but impaired sphincter opening was not a predictor of ou tcome. Increased hypopharyngeal intrabolus pressures (> 19 mmHg for 10 ml bolus; > 31 mmHg for 20 ml bolus) was a significant predictor of o utcome (p = 0.01), Neither peak pharyngeal pressure nor incoordination were predictors of outcome. In pharyngeal dysphagia, hypopharyngeal i ntrabolus pressure, and not peak pharyngeal pressure, is a predictor o f response to cricopharyngeal disruption. The relationship between int rabolus pressure and impaired sphincter opening is an indirect measure of sphincter compliance which helps predict therapeutic response.