Intrapyloric Injection of Botulinum Toxin A for the Treatment of Persistent Gastroparesis Following Successful Pancreas Transplantation

Abstract

Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. Patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months followup. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

“…Improved nausea, fullness, bloating, and eructation have been observed in patients with idiopathic gastroparesis as well as disease due to diabetes, Nissen fundoplication, esophagectomy, and pancreatic transplantation [7][8][9][10][11][12][13][14][15]20]. Additional benefits include weight gain and improved quality of life [10].…”

“…On manometric and scintigraphic testing, intrapyloric botulinum toxin injection reduces pyloric motor activity and accelerates gastric emptying in many gastroparesis patients [6][7][8][9][10][11]. Uncontrolled case series report symptom reductions after pyloric botulinum toxin injection in patients with refractory gastroparesis [7][8][9][10][11][12][13][14][15]. However, two small controlled trials have observed no benefits from this therapy compared with placebo [16,17].…”

Gastric emptying and glycaemia in health and diabetes mellitus

“…177 Uncontrolled studies of endoscopic injections of botulinum toxin reported symptomatic improvement, as well as acceleration of gastric emptying in diabetic, [178][179][180][181] idiopathic [180][181][182] and postsurgical [183][184][185][186] gastroparesis; how ever, these bene fits have not been confirmed in subsequent blinded sham-controlled trials. 187,188 Accordingly, this approach cannot currently be recommended for t reatment of diabetic gastroparesis.…”

A Systematic Review on Intrapyloric Botulinum Toxin Injection for Gastroparesis

“…Among the 210 initially potentially relevant studies, 195 were animal studies, duplicates, abstracts, editorials, or reviews and letters to the editor. Finally, 15 trials were included [13,14,15,16,17,25,26,27,28,29,30,31,32,33,34], among these trials there were only 2 RCTs [32,33], and the remaining 13 trials were non-randomized. The basic characteristics of the included studies are summarized in table 1.…”