Botox injection for achalasia: a modified technique

Goldstein, Jeffrey A.; Barkin, Jamie S.

doi:10.1016/s0016-5107(99)70505-5

Cited by 7 publications

(4 citation statements)

References 3 publications

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“…There was also a trend for a more sustained response in the subgroup B as compared to the subgroup A. It suggests that not only a dose of the toxin 6 but, also, the mode of the injection leading to perhaps more adequate infiltration of the LES by BT might determine the overall results of this treatment 12,18 . Whether this administration technique is really superior to the standard injection from the antegrade angle can be a focus of another prospective and randomized study.…”

Section: Discussionmentioning

confidence: 96%

“…We also wanted to determine whether clinical effectiveness of BT injection can be influenced by the technique of administration. Since the standard injection from the antegrade angle only may not result in adequate infiltration of the sphincter by toxin we investigated whether injecting BT into the LES from both antegrade and retroflexed angles can improve the outcome 12 . Some of our patents were treated by another approach combining BT injection with subsequent balloon dilatation as this combination might have a synergic effect 13 .…”

Section: Introductionmentioning

confidence: 99%

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Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study

Martínek¹,

Široký²,

Plottová

et al. 2003

Diseases of the Esophagus

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Botulinum toxin (BT) injection is an alternative treatment of achalasia. The aim of the study was to examine outcomes of patients treated with BT in the Czech Republic. Since 1997, 49 patients with achalasia have been treated with BT. We prospectively evaluated the effect of BT injection on 41 patients during a median follow-up of 24 months (range 9-62). Esophageal manometry was performed before and at 3-5 months after the injection. In 16 patients, BT was injected from the antegrade angle only (subgroup A), in 15 patients, BT was injected from both retrograde and antegrade angles (subgroup B) and, in 10 patients, BT injection was combined with subsequent balloon dilatation (subgroup C). Immediate clinical response was achieved in 93% of patients. Clinical remission was sustained beyond 3 months in 83% of patients (responders). Fourteen responders (41%) did not experience a relapse during the median of 22 months. Twenty responders (59%) experienced symptomatic relapse approximately 8 months after the injection. Ten relapsers underwent BT reinjection, five (50%) of them were asymptomatic for another 14 months. The remaining five (50%) patients reported a second relapse approximately 6 months after the reinjection. Median duration of the symptom-free period was 11.5 months after the first BT injection, and 10.5 months after the second (P = 0.21). We did not find any significant predictor of a favorable outcome; responders tended to be older and to have a lower basal lower-esophageal-sphincter pressure. Patients in subgroup C were more likely to be in remission at 1 and 2 years as compared with patients in subgroup A. BT injection is an effective treatment of achalasia in the short term. However, almost 70% of patients experience a relapse within 2 years. BT injection should therefore be reserved for patients at risk for more invasive procedures or for patients who prefer this treatment.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study

Martínek¹,

Široký²,

Plottová

et al. 2003

Diseases of the Esophagus

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“…In one report, the authors increased the accuracy of the injection using an ultrasound-guided technique; however, these were rather technical notes without clinically relevant results [10]. In a letter, Goldstein and Barkin [11] described a modified technique of BT injection with retroflexion of the endoscope. Injection of BT under retrograde vision may make the procedure more accurate, leading to improved treatment efficacy.…”

Section: Discussionmentioning

confidence: 99%

A Modified Method of Botulinum Toxin Injection in Patients with Achalasia: a Pilot Trial

2003

Endoscopy

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Combining injection of BT into the LES from both direct vision and retrovision was feasible, safe and produced a rapid response which was sustained for more than 1 year in the majority of patients. This method of BT administration might be superior to the traditional injection from direct view only, and a randomized and prospective study comparing those techniques of administration should be performed.

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“…13,31 Traditionally, the injection has been directed to the distal gastroesophageal region utilizing a 5 mm sclerotherapy needle-sheathed catheter positioned at an oblique angle. Recently, Goldstein and Barkin 32 have proposed a modified technique, which involves the passage of the endoscope into the stomach and the use of retroflexion that provides direct visualization of the LES junction and possibly a better delivery of the toxin. Proper visualization of the LES region is essential to assess the integrity of the gastroesphageal mucosa, rule out secondary causes of achalasia (e.g., malignancy, strictures), and to exclude coexistent disorders (hiatal hernia, epiphrenic diverticulum) that may modify the injection technique.…”

Section: B O T U L I N U M T O X I Nmentioning

confidence: 99%