{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:19:56Z","timestamp":1791346796712,"version":"4.3.1"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n Retrograde cricopharyngeal dysfunction (RCPD) is defined by the inability to burp, sometimes with gurgling, chest\/abdominal discomfort, and excessive flatulence. Treatment involves cricopharyngeal Botulinum Toxin\u2010A (BonT\u2010A) injection. However, the optimal dose and route are unclear. We quantitatively summarize the efficacy, safety, and optimization of BonT\u2010A injections for RCPD.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n PubMed, Embase, Scopus; till October 19, 2024.<\/jats:p>\n <\/jats:sec>\n \n Review Methods<\/jats:title>\n \n We included randomized and non\u2010randomized studies, published as full\u2010length peer\u2010reviewed articles, that investigated the efficacy and safety of BonT\u2010A injections for RCPD among participants of all ages. Two blinded authors selected studies, extracted data, and evaluated bias (ROBINS\u2010I), following a PROSPERO\u2010registered protocol (\n CRD42024606413<\/jats:ext-link>\n ). We pooled logit\u2010transformed proportions using random\u2010effects inverse\u2010variance meta\u2010analyses, identified associated factors using meta\u2010regression, and quantitatively analyzed publication bias.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From 189 records, we included 13 single\u2010arm case series (\n N<\/jats:italic>\n \u2009=\u2009699), with some concerns for bias. Pooled early (1\u20134\u2009weeks) and sustained (mean 3\u201329\u2009months) overall symptom relief were 91.45% (95% CI\u2009=\u200983.66%\u201395.72%,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200972%) and 79.90% (95% CI\u2009=\u200970.76%\u201386.72%,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200953%) respectively. Complications were minor; the most common was transient dysphagia (51.04%, 95% CI\u2009=\u200937.61%\u201364.32%,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200971%). Injections under direct rigid\u2010endoscopic visualization were associated with greater (\n p<\/jats:italic>\n \u2009=\u20090.0096) early success (92.19%, 95% CI\u2009=\u200988.29%\u201394.86%,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200918%) than percutaneous electromyography\u2010guided injections (85.03%, 95% CI\u2009=\u200921.90%\u201399.14%,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200978%). Higher BonT\u2010A dose (from 50 to 100 units) was associated with higher (\n p<\/jats:italic>\n \u2009=\u20090.0382) sustained success (71.36%\u201392.79%); diminishing returns were projected for subsequent increments. Publication bias was not evident.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Cricopharyngeal BonT\u2010A injections are safe and efficacious in RCPD. Larger doses of 100 units, injected under direct rigid\u2010endoscopic visualization, may improve and maintain success. Randomized studies are needed to confirm causality.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lary.32296","type":"journal-article","created":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T08:45:03Z","timestamp":1749285903000},"page":"4030-4041","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Botulinum Toxin Injection in Retrograde Cricopharyngeal Dysfunction: A Meta\u2010Analysis"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-477X","authenticated-orcid":false,"given":"Wei Xin","family":"Yeo","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9411-6164","authenticated-orcid":false,"given":"Benjamin Kye Jyn","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Singapore General Hospital Singapore Singapore"},{"name":"Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2311-7845","authenticated-orcid":false,"given":"Esther Yanxin","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9413-6173","authenticated-orcid":false,"given":"Stephanie Yan Yu","family":"Yeap","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhou Hao","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/wjo2.127"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31157"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016\u20105085(89)90822\u20106"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016\u20105085(87)90445\u20108"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X19834553"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13020413"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/oto2.70014"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.01.012"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm23099"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12193"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31591"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30871"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X20938342"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2022.111261"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010021\u201006790\u2010w"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14250"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30346"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/01455613231162203"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X21989587"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.735"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010024\u201008619\u20108"}],"container-title":["The 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