Operating Room or In‐Office Injection for Retrograde Cricopharyngeal Dysfunction Botulinum Toxin Injection
Bibliographic record
Abstract
BACKGROUND: Retrograde Cricopharyngeal Dysfunction (RCPD), also known as "No Burp Syndrome," is a rare condition characterized by the inability to burp due to cricopharyngeus muscle dysfunction. Patients experience bloating, chest and abdominal discomfort, gurgling sounds, and excessive flatulence, which significantly impact quality of life. OBJECTIVE: To compare the clinical outcomes and side effect profiles of botulinum toxin injection for RCPD when performed in-office versus in the operating room. METHODS: A clinical review of patients with RCPD was conducted, focusing on diagnosis based on history and physical examination. Botulinum toxin was administered to the cricopharyngeus muscle either in-office or in the operating room. Success rates, complications, and patient tolerance were analyzed and compared across both procedural settings. RESULTS: Botulinum toxin injection proved effective in both settings, with similar success rates in restoring the ability to burp and relieving associated symptoms. In-office procedures offered advantages in convenience and recovery time, while operating room procedures allowed for greater procedural control under general anesthesia. Side effect profiles differed slightly, with transient throat discomfort more commonly reported in in-office cases. CONCLUSION: Both in-office and operating room botulinum toxin injections are effective treatment options for RCPD. The choice of setting should be guided by patient preference, comorbidities, and resource availability, as each approach offers distinct advantages and risk considerations. LEVEL OF EVIDENCE: The retrospective case series by Bastian et al. Wajsberg et al. Hoesli et al. and Doruk and Pitman are level III evidence. The prospective cohort study of Doruk et al. is level II evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.018 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".