Effect of botulinum toxin injection on cricopharyngeal dysphagia: a systematic review and meta-analysis.

OBJECTIVE

To evaluate effect of botulinum toxin A (BTX-A) injection on cricopharyngeal dysphagia.

METHODS

We searched for studies of BTX-A injection for cricopharyngeal dysphagia published in PubMed, EMBASE, Web of Science and the Cochrane Library before Mar 2025, extracted all relevant data and calculated the effect size using the standardized mean difference (SMD). Subgroup analyses were also performed.

RESULTS

A total of 16 articles were included in the study. Meta-analysis revealed that BTX-A was effective for cricopharyngeal dysphagia in swallowing function within 3 months (SMD = 2.42, 95%CI:1.73–3.10; Z = 6.90, P < 0.00001; I2 = 89%). Subgroup analysis based on injection guidance revealed that electromyography (EMG) (SMD = 2.95, 95%CI:1.67–4.24; Z = 4.51, P < 0.00001), ultrasound (SMD = 4.04, 95%CI:1.29–6.79; Z = 2.88, P = 0.004) and endoscopy (SMD = 1.73, 95%CI:0.82–2.64; Z = 3.72, P = 0.0002) were effective. Ultrasound guidance seemed better than EMG and endoscopy guidance. Subgroup analysis based on injection dose revealed that ≥ 60u Botox or Hengli (SMD = 1.69, 95%CI:1.23–2.14; Z = 7.28, P < 0.00001) and < 60u (SMD = 5.53, 95%CI:2.25–8.81; Z = 3.30, P = 0.0010) were both effective. In the subgroup analysis based on initiating disease, the mixed etiology or non-stroke group (SMD = 2.69, 95%CI:1.83–3.56; Z = 6.11, P < 0.00001) was superior to that of the stroke group (SMD = 1.49, 95%CI:0.85–2.14; Z = 4.56, P < 0.00001). The results after 3 months of follow-up showed that swallowing function after 3 months was significantly improved compared with that before injection (SMD = 0.87, 95%CI:0.08–1.65; Z = 2.16, P = 0.03).

CONCLUSIONS

The results of this study suggested that BTX-A injection was effective for cricopharyngeal dysphagia. However, more randomized controlled studies with larger samples and long-term follow-up of BTX-A administration are needed.