Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1811-E1819
DOI: 10.1055/a-1562-7107
Original article

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

Peter I. Wu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Michal M. Szczesniak
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Taher Omari
4   College of Medicine and Public Health, Flinders University, Adelaide, Australia
,
Thomas Y. Lam
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Marc Wong
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Julia Maclean
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Karen K. Ma
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Anne Y. Chan
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Vincent Mok
5   Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Ian J. Cook
2   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia
3   St George and Sutherland Clinical School, University of NSW, Sydney, Australia
,
Charles Cock
4   College of Medicine and Public Health, Flinders University, Adelaide, Australia
,
Joseph Sung
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Justin Wu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
,
Philip W. Chiu
1   Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
› Author AffiliationsTRIAL REGISTRATION: Non-randomized Interventional Trial ACTRN12619000927123 at https://www.anzctr.org.au/
› Further Information
Also available at
   Permissions and Reprints

Abstract

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.



Publication History

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kalia L, Lang A. Parkinsonʼs disease. Lancet 2015; 386: 896-912
    CrossrefPubMedSearch in Google Scholar
  • 2 Pringsheim T, Jette N, Frolkis A. et al. The prevalence of Parkinson's disease: A systematic review and meta-analysis. Movement Disorders 2014; 29: 1583-1590
    CrossrefPubMedSearch in Google Scholar
  • 3 Dorsey ER, Constantinescu R, Thompson JP. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007 2007; 68: 384-386
    PubMedSearch in Google Scholar
  • 4 Suttrup I, Warnecke T. Dysphagia in Parkinson's Disease. Dysphagia 2016; 31: 24-32
    CrossrefPubMedSearch in Google Scholar
  • 5 Menezes C, Melo A. Does levodopa improve swallowing dysfunction in Parkinson's disease patients?. J Clin Pharm Ther 2009; 34: 673-676
    CrossrefPubMedSearch in Google Scholar
  • 6 Ali GN, Wallace KL, Schwartz R. et al. Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease. Gastroenterology 1996; 110: 383-392
    CrossrefPubMedSearch in Google Scholar
  • 7 Alfonsi E, Versino M, Merlo IM. et al. Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes. Neurology 2007; 68: 583-589
    CrossrefPubMedSearch in Google Scholar
  • 8 Knigge MA, Thibeault SL. Swallowing outcomes after cricopharyngeal myotomy: A systematic review. Head Neck 2018; 40: 203-212
    CrossrefPubMedSearch in Google Scholar
  • 9 Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 1999; 116: 455-478
    CrossrefPubMedSearch in Google Scholar
  • 10 Born LJ, Harned RH, Rikkers LF. Cricopharyngeal dysfunction in Parkinson's disease: role in dysphagia and response to myotomy. Movement Disorders 1996; 11: 53-58
    CrossrefPubMedSearch in Google Scholar
  • 11 Brigand C, Ferraro P, Martin J. et al. Risk factors in patients undergoing cricopharyngeal myotomy. Br J Surg 2007; 94: 978-983
    CrossrefPubMedSearch in Google Scholar
  • 12 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Jacobs CC, Perbtani Y, Yang D. et al. Per-oral endoscopic myotomy for esophagogastric junction outflow obstruction: a multicenter pilot study. Clin Gastroenterol Hepatol 2021; 19: 1717-1719
    CrossrefPubMedSearch in Google Scholar
  • 14 Khashab MA, Stein E, Clarke JO. et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc 2013; 78: 764-768
    CrossrefPubMedSearch in Google Scholar
  • 15 Wahba G, Bouin M. Jackhammer esophagus: A meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes. Neurogastroenterol Motil 2020; 32: e13870
    CrossrefPubMedSearch in Google Scholar
  • 16 Yang JN, Novak S, Ujiki M. et al. An international study on the use of peroral endoscopic myotomy in the management of Zenker's diverticulum. Gastrointest Endosc 2020; 91: 163-168
    CrossrefPubMedSearch in Google Scholar
  • 17 Wallace KL, Middleton S, Cook IJ. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology 2000; 118: 678-687
    CrossrefPubMedSearch in Google Scholar
  • 18 Szczesniak MM, Maclean J, Zhang T. et al. The normative range for and age and gender effects on the Sydney Swallow Questionnaire (SSQ). Dysphagia 2014; 29: 535-538
    CrossrefPubMedSearch in Google Scholar
  • 19 Plowman-Prine EK, Sapienza CM, Okun MS. et al. The relationship between quality of life and swallowing in Parkinson's disease. Mov Disord 2009; 24: 1352-1358
    CrossrefPubMedSearch in Google Scholar
  • 20 McHorney CA, Robbins J, Lomax K. et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 2002; 17: 97-114
    CrossrefPubMedSearch in Google Scholar
  • 21 Omari TI, Ciucci M, Gozdzikowska K. et al. High-resolution pharyngeal manometry and impedance: protocols and metrics-recommendations of a high-resolution pharyngeal manometry international working group. Dysphagia 2020; 35: 281-395
    CrossrefPubMedSearch in Google Scholar
  • 22 Ferris L, Doeltgen S, Cock C. et al. Modulation of pharyngeal swallowing by bolus volume and viscosity. Am J Physiol Gastrointest Liver Physiol 2021; 320: G43-G53
    CrossrefPubMedSearch in Google Scholar
  • 23 Zhang L, Wu P, Szczesniak M. et al. Clinical utility of cricopharyngeal distensibility measurements during endoscopic myotomy for Zenker’s diverticulum. Gastrointest Endosc 2021; 93: 390-397
    CrossrefPubMedSearch in Google Scholar
  • 24 Wu P, Szczesniak MM, Maclean J. et al. Clinical utility of functional imaging probe in management of dysphagia following head and neck cancer therapies. Endoscopy 2017; 49: 1-8
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Goetz CG, Tilley BC, Shaftman SR. et al. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008; 23: 2129-2170
    CrossrefPubMedSearch in Google Scholar
  • 26 Martinez-Martin P, Rodriguez-Blazquez C, Mario A. et al. Parkinson's disease severity levels and MDS-Unified Parkinson's Disease Rating Scale. Parkinsonism Relat Disord 2015; 21: 50-54
    CrossrefPubMedSearch in Google Scholar
  • 27 Yadlapati R, Kahrilas PJ, Fox MR. et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motility 2021; 33: e14058
    CrossrefPubMedSearch in Google Scholar
  • 28 Jacob P, Kahrilas P, Logemann J. et al. Upper esophageal sphincter opening and modulation during swallowing. Gastroenterology 1989; 97: 1469-1478
    CrossrefPubMedSearch in Google Scholar
  • 29 Katzka DA, Camilleri M. Treating the pylorus in gastroparesis: The new riddle wrapped in the ultimate enigma?. Gastrointest Endosc 2020; 91: 1300-1302
    CrossrefPubMedSearch in Google Scholar
  • 30 Williams RB, Wallace KL, Ali GN. et al. Biomechanics of failed deglutitive upper esophageal sphincter (UES) relaxation in patients with neurogenic dysphagia. Am J Physiol 2002; 283: G16-G26
    PubMedSearch in Google Scholar
  • 31 Simons JA. Swallowing dysfunctions in Parkinson's disease. Int Rev Neurobiol 2017; 134: 1207-1238
    CrossrefPubMedSearch in Google Scholar
  • 32 Keage M, Corben L, Vogel A. A systematic review of self-reported swallowing assessments in progressive neurological disorders. Dysphagia 2015; 31: 27-46
    CrossrefPubMedSearch in Google Scholar
  • 33 Omari TI, Ferris L, Dejaeger E. et al. Upper esophageal sphincter impedance as a marker of sphincter opening diameter. Am J Physiol Gastrointest Liver Physiol 2012; 302: G909-G913
    CrossrefPubMedSearch in Google Scholar
  • 34 Bopeththa BVKM, Hewavithana PB, Hewapathirana HLI. et al. Myasthenic crisis following iodinated contrast material (iohexol) aspiration: a case report. J Med Case Rep 2019; 13: 166
    CrossrefPubMedSearch in Google Scholar