Endoscopic Injections of Botulinum Toxin Type A in the Piglet Esophagus Is Safe and Feasible but Did Not Result in any Significant Structural Changes 3 Days after Injection

Abstract

I read with interest the article entitled: “Endoscopic Injections of Botulinum Toxin Type A in the Piglet Esophagus Is Safe and Feasible but Did Not Result in any Significant Structural Changes 3 Days after Injection” by Morten Rose, Patrick Clarke, Ashton H. Pike, Peter Zvara, Henrik D. Schrøder, Eva K. Hejboel, Niels Qvist, Mark B. Ellebæk (1), which was published in the June 10, 2022 issue of the European Journal of Pediatric Surgery. The article was very well developed for which I must congratulate you, however, I cannot let it pass that it was on the third day after intramural injection with botulinum toxin type-A (BTX-A) that the esophagus was harvested and tested in a stretch-tension machine to evaluate elongation and maximum load, followed by histological examination. As reported in the international literature the toxin has a reversible paralytic effect that usually peaks about 1–2 weeks after injection. Therefore, it is suggested to wait for 1 to 2 weeks to manipulate the tissue post-injection because of this theoretical peak in efficacy.