Cervical Inlet Patches in R‐
CPD
: An Unrecognized Predictor of Treatment Failure
Andrew Geoffrey Tritter, Nabeeha Hasan, Jered Wilson ABSTRACT
Objectives
Little data currently exists on endoscopic findings in patients with Retrograde cricopharyngeus dysfunction (R‐CPD), particularly regarding factors that may help predict treatment outcomes. Here, we describe the previously unreported prevalence of cervical esophageal inlet patches (CIP) among patients undergoing treatment for R‐CPD and evaluate their association with treatment responses while controlling for other patient‐specific factors.
Methods
This was a retrospective cohort review performed on patients undergoing cricopharyngeal botulinum toxin injection (CPBTI) as treatment for R‐CPD. Demographics, patient‐specific factors, and endoscopic findings, including the presence of CIP, were noted. Early and long‐term treatment responses following CPBTI were recorded at 6 weeks and 6 months posttreatment, respectively. Univariate and multivariate analyses were performed to assess associations among endoscopy findings, demographic data, and treatment response at both time points.
Results
A total of 101 patients (average age: 29.2 years, 68.3% female) underwent cervical esophagoscopy with CPBTI. Twenty (19.8%) had one or more CIP in the proximal esophagus. Of 76 patients who also received concurrent flexible esophagogastroscopy, 28 (37.8%) had a hiatal hernia and 34 (44.7%) had distal esophageal mucosal abnormalities. CIP and increasing age were the only significant predictors in this study, with both predicting failure to sustain a long‐term treatment response (CIP: OR 5.14, 95% CI 1.60–16.50, p = 0.006; increasing age: OR 1.09, 95% CI 1.03–1.14, p = 0.001).
Conclusion
There is a high prevalence of CIP in R‐CPD patients, which, along with increasing age, portends significantly increased odds of failure to sustain a long‐term treatment response following an initially successful CPBTI.
Level of Evidence
3.