Botulinum toxin type A (Dysport) for the treatment of Zenker's diverticulum

Spinelli, Philip R.; Ballardini, G.

doi:10.1007/s00464-002-4247-9

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…However, medical treatment alone for ZD is rarely successful. Recently, several investigators have reported favourable outcomes following botulinum toxin injection, although symptomatic improvement was transient [32,33]. This is a potentially viable treatment option for patients who are unfit for surgery or have small pouches.…”

Section: Endoscopic Stapling Of Zenker's Diverticulum In the United Kmentioning

confidence: 96%

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

Leong

Wilkie

Webb

2012

Eur Arch Otorhinolaryngol

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Endoscopic stapling of Zenker's diverticulum (ZD) is now established practice in the UK and is routinely performed by the vast majority of otolaryngologists. Both The National Confidential Enquiry into Peri-Operative Deaths and the National Institute for Health and Clinical Excellence recommended that the procedure be undertaken at specialist centres and that each department should audit their respective outcomes. Despite the abundance of review articles, it remains unclear what variables a meaningful audit is required to collate and what gold standards every department in the UK undertaking surgery for ZD should aspire to achieve. The objective was to review the outcomes of endoscopic stapling of Zenker's diverticulum at this institution. In addition, a review of other UK departments was undertaken to formulate minimum clinical standards and recommendations of best practice. Review of patient case notes and a structured search of PubMed were used as materials. Fifteen retrospective case series were identified from the literature search which fulfilled the inclusion criteria. Fifty-one patients were identified from the present audit. When these were added to the review, a total of 585 patients were available for meta-analysis. 540 (92.3%) were successfully stapled. Forty-five (7.7%) procedures were abandoned intra-operatively. The most common reason was difficulty assessing the small pouch. The majority of patients (92%) had resumed oral intake by the second post-operative day. Most patients (87%) were discharged by the second post-operative day. Outcomes were good with over 90% reporting resolved or significantly improved symptoms. Minor complications included dental trauma, transient hoarseness and sore throat causing delayed resumption of oral intake. The overall perforation rate was 4.8%. One death was reported. In conclusion endoscopic stapling of pharyngeal pouch is a safe procedure that is associated with good outcomes and low complication rates. No death has been reported since 2000 in the UK. The data presented in this review represent current clinical standards reported over the past 15 years by UK departments and serve as a useful benchmark for any future audits undertaken.

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Section: Endoscopic Stapling Of Zenker's Diverticulum In the United Kmentioning

confidence: 96%

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

Leong

Wilkie

Webb

2012

Eur Arch Otorhinolaryngol

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“…These include patients who have dysphagia associated with neuromyopathy associated with multiple cerebral infarctions [30], oculopharyngeal muscular dystrophy [31], cricopharyngeal spasm [32,33•], dysphagia associated with esophageal diverticuli [34], Zenker's diverticulum [35], and into the larynyx for chronic aspiration [36].…”

Section: Botulinum Toxinmentioning

confidence: 99%

Dysphagia

Ferguson

DeVault

2004

Curr Treat Options Gastro

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Dysphagia is a common complaint that always warrants investigation. The patient's history and preliminary testing can help differentiate between the two types of dysphagia: oropharyngeal or esophageal. Specific treatments for either of these types of dysphagia depend on the underlying etiology. Oropharyngeal dysphagia is often associated with a neuromuscular disorder and is treated with swallowing rehabilitation. Esophageal dysphagia is usually due to an anatomic defect or a motility disorder. Anatomic defects can often be corrected with endoscopic or surgical procedures. Motility disorders often benefit from pharmacologic treatment. Achalasia may be corrected with an endoscopic procedure with pneumatic dilation or, more recently, with injection of botulinum toxin.

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“…Indications not approved by FDA, but studied and reported in the medical literature, include extracervical spasticities, 8,9 especially for patients with cerebral palsy, [10][11][12][13][14][15][16] poststroke spasticity, 17,18 and piriformis syndrome. 19,20 Other reports describe off-label uses for a wide range of neurologic, [21][22][23][24][25][26] dermatologic, [27][28][29][30][31][32] gastrointestinal, [33][34][35][36][37][38][39][40][41][42] and other clinical [43][44][45][46][47][48][49][50][51] disorders, often without controlled clinical trials. Off-label use of a licensed drug or biologic product occurs with a wide range of products.…”

mentioning

confidence: 99%