Evaluation of the Use of Botulinum Toxin in Children With Achalasia

Hurwitz, Melissa; Bahar, Ron; Ament, Marvin E.; Tolia, Vasundhara; Molleston, Jean P.; Reinstein, L; Walton, J. Mark; Erhart, Nora; Wasserman, Dror; Justinich, Christopher J.; Vargas, Jorge

doi:10.1097/00005176-200005000-00009

Cited by 94 publications

(32 citation statements)

References 38 publications

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“…The diagnosis is usually confirmed by upper gastrointestinal (UGI) contrast study and oesophageal manometry with additional diagnostic investigations including computed tomography (CT) scan and upper gastrointestinal endoscopy. Treatments such as intra-oesophageal botulinum toxin injection and oesophageal dilatation (bougie or balloon) alone are unlikely to provide long-term resolution of symptoms, with most patients clinically relapsing, warranting repeated procedures, and inevitably necessitating oesophageal cardiomyotomy [1,2]. In addition, these techniques can lead to serious complications such as oesophageal perforation [3] and stricture formation, which may jeopardise the outcome of oesophageal cardiomyotomy.…”

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confidence: 99%

Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience

et al. 2009

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confidence: 99%

Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience

et al. 2009

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“…About one half of the patients suffer from recurrent symptoms after several months. 15 Botulinum toxin should be used only for children with achalasia who are poor candidates for either pneumatic dilatation or surgery. Therefore, a safe and efficacious endoscopic modality of treatment is required in pediatric patients with achalasia.…”

Section: Discussionmentioning

confidence: 99%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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Background/AimsAchalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia MethodsThe data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3. ResultsA total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6). Conclusions

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“…Optimal dosing and injection frequency of botulinum toxin to relieve achalasia symptoms in children has not been well defined. After botulinum injection, the mean duration of symptom relief is 4 months, often requiring multiple treatments within a year [11] . In addition, botulinum toxin injection only provides permanent relief in 10%-40% of cases in adult patients [12] thus, will often require definitive surgical management.…”

Section: Endoscopic Therapymentioning

confidence: 99%

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

111

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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Evaluation of the Use of Botulinum Toxin in Children With Achalasia

Cited by 94 publications

References 38 publications

Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience

Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

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