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Endoscopic Pyloric Injection of Botulinum Toxin-A for the Treatment of Postvagotomy Gastroparesis

2009; Elsevier BV; Volume: 337; Issue: 3 Linguagem: Inglês

10.1097/maj.0b013e318182ee33

1538-2990

Savio Reddymasu, Shailender Singh, Rajakumar Sankula, Teri A.H. Lavenbarg, Mojtaba Olyaee, Richard W. McCallum,

Dysphagia Assessment and Management

To evaluate the efficacy of botulinum toxin-A in the treatment of postvagotomy gastroparesis.This open-labeled trial identified and recruited 11 subjects who developed symptomatic gastroparesis after a vagotomy (9 fundoplication, 1 trauma, and 1 exploratory laparotomy). Gastroparesis was defined as an abnormal solid-phase gastric emptying test using the standardized 4-hour radionuclide eggbeater meal method and vagotomy was confirmed with a sham meal challenge test. To complete the study, subjects should have completed the 6-month follow-up visit after their pylorus was injected with botulinum toxin-A injection in a 4-quadrant manner. Patients either received 100 (n = 2) or 200 (n = 9) units of botulinum toxin. Questionnaires recorded symptom severity of gastroparesis at baseline and at monthly intervals for 6 months after the therapy was completed by the patients.Of the 11 subjects initially recruited, 10 finished the 6-month follow-up visit (7 women). Mean age was 51 years (range, 31-84 years). Mean symptom score at baseline was 16 (95% CI 13-19) and showed a numerical decline to 9 (P > 0.05) over the 6-month period after the procedure (95% CI 5-13). Seven (70%) patients observed >30% improvement in the total symptom score. No complications were recorded.In conclusion, this open-label study in patients with postvagotomy gastroparesis patients reveals a reduction of gastroparetic symptoms at 1 and 3 months after treatment with pyloric injection of botulinum toxin-A, with return of symptoms by 6 months. Thus, botulinum toxin treatment does not produce a sustained reduction in gastroparetic symptoms in this clinical setting.