論文の公開元へEfficacy of endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope in patients with sporadic inclusion body myositis: four retrospective case reviews
概要
Sporadic inclusion body myositis (s-IBM) is an acquired degenerative inflammatory myopathy
that leads to slowly progressive muscle weakness and atrophy of the limbs, face, and pharynx.
A recent study revealed approximately 1000–1500 patients with s-IBM in Japan.1 Dysphagia is
a frequent and life-threatening symptom in these patients; indeed, Lots et al reported the occurrence of clinical dysphagia in 40% of patients with s-IBM as the disease progressed.2 Aspiration
pneumonia is a common cause of death in patients with s-IBM.3,4 A recent study revealed an
increased risk of mortality in patients with s-IBM relative to that of an age-matched comparison
population, particularly in those with impaired swallowing and subsequent aspiration pneumonia.5
Dysphagia in s-IBM is caused by chronic inflammation of pharyngeal constrictor and cricopharyngeal muscles. Compared to those associated with other inflammatory myopathies, dysfunction
of the upper esophageal sphincter occurs frequently in s-IBM. Non-surgical treatments for s-IBM,
which are feasible in the early stages of the disease, include intravenous immunoglobulin therapy,
speech and language therapy including Mendelsohn’s maneuver, balloon dilation, and botulinum
toxin injection.6-8 However, balloon dilation and botulinum toxin injection, although less invasive,
are temporary measures that are not sufficient for patients with severe dysphagia.
Cricopharyngeal myotomy (CPM) is a surgical procedure used to treat dysphagia that involves
cutting the cricopharyngeal muscle and is often performed in patients with cricopharyngeal
achalasia of neurogenetic origin or head and neck resection. Several studies have indicated
that CPM is effective in patients with s-IBM with severe dysphagia. However, most patients in
previous studies received transcervical CPM. Transcervical CPM has been a traditional surgical
approach for cricopharyngeal dysfunction for more than 60 years, but it requires an external neck
incision, longer hospital stay, and carries the risk of recurrent laryngeal nerve or great vessel
injury, esophageal perforation, and fistula.9 Considering the slowly progressive neuromuscular
nature of s-IBM and risks of transcervical CPM, surgical indications for severe dysphagia in
patients with s-IBM remain unclear.
Endoscopic CPM has been introduced as an alternative surgical procedure to transcervical
CPM. Although endoscopic CPM is a safe and minimally invasive technique, it has not gained
wide usage because of the narrow surgical field and the low usability of surgical instruments
using a direct laryngoscope. Recently, we developed a new, safe endoscopic CPM using a
curved rigid laryngoscope for patients with severe dysphagia.10 This procedure allows the wide
expansion of the hypopharynx, and can provide a wider surgical field than obtained by using
a direct laryngoscope. Herein, we retrospectively review our experience with CPM to evaluate
its safety as well as postsurgical changes in swallowing function during the follow-up period in
patients with s-IBM. This study was approved by the Ethics Review Committee of the Nagoya
University Hospital (2022-0061). ...
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