Network meta-analysis of balloon dilation plus adjunctive therapies for post-stroke cricopharyngeal achalasia efficacy.
A systematic review and network meta-analysis assessed 36 articles covering 13 interventions for patients with post-stroke cricopharyngeal achalasia. The study compared balloon dilation combined with repetitive transcranial magnetic stimulation (rTMS), electromyographic biofeedback (EMGBF), acupuncture, tongue pressure resistance feedback (TPRF), botulinum toxin type A (BTX-A), and transcranial direct current stimulation (tDCS). No comparator group was reported in the included evidence.
Regarding the primary outcome of effective rate, balloon dilation combined with rTMS demonstrated the highest value at 91.8%, followed by balloon dilation combined with EMGBF at 82.8% and balloon dilation combined with acupuncture at 79.4%. These rankings were based on SUCRA values. For the videofluoroscopic swallowing study (VFSS) score, balloon dilation combined with acupuncture achieved 92.0%, followed by balloon dilation combined with TPRF at 79.6% and balloon dilation combined with BTX-A at 78.4%.
Secondary outcomes included the Functional Oral Intake Scale (FOIS) score and the Standardized Swallowing Assessment (SSA) score. For FOIS, balloon dilation combined with BTX-A scored 87.4%, followed by tDCS at 83.0% and acupuncture at 76.8%. Conversely, for SSA scores, balloon dilation combined with acupuncture scored 80.0%, followed by BTX-A at 69.5% and rTMS at 68.5%. All results were derived from SUCRA values without reported absolute numbers or confidence intervals.
Safety and tolerability data were not reported, including adverse events, serious adverse events, discontinuations, or general tolerability. Key limitations included small sample sizes of included studies, inadequate allocation concealment and blinding, and potential publication bias for some outcomes. The practice relevance indicates that intervention efficacy varied across different outcome measures. Clinicians should interpret these findings with caution given the methodological constraints and lack of safety information.
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