Treatment of achalasia with botulinum toxin injection guided by endoscopic ultrasonography in a patient with esophageal varices

Lozano-Lanagrán, Marta; Lavín-Castejón, Isabel; Alcaín‐Martínez, Guillermo

doi:10.4321/s1130-01082011001200016

Cited by 8 publications

(11 citation statements)

References 4 publications

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“…The benefit of using EUS to guide therapy is not clear and previous case reports have suggested that EUS guidance could conceptually prevent the risk of inadvertent injection of toxin into the varices and can help avoid submucosal and peri-esophageal collaterals. 5,6 Yet, in this cohort, only one patient had EUS-guided BTI with no difference in terms of outcome or complications observed Table 2. Baseline characteristics of achalasia patients with esophageal varices (n ¼ 14) and controls without varices (n ¼ 20).…”

Section: New Cases Permentioning

confidence: 73%

The treatment of achalasia patients with esophageal varices: an international study

et al. 2019

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Background: Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk. Methods: Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group. Results: Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 AE 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; p < 0.0001) at 6 months follow-up, with treatment outcomes resembling those of 20 noncirrhotic achalasia patients who underwent similar therapy. No patients had recorded complications of bleeding or perforation. Conclusion: This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.

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Section: New Cases Permentioning

confidence: 73%

The treatment of achalasia patients with esophageal varices: an international study

et al. 2019

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“…After a review of the English literature, we found 10 cases, 7 of which received treatment [2,3,7]. Two patients underwent surgery due to recurring massive regurgitation of blood with a normal liver [7].…”

Section: Discussionmentioning

confidence: 99%

“…After several successive BTIs without success, a TIPS procedure was performed for portal decompression before proceeding with pneumatic dilation (PD) in the third patient [8]. Three patients were treated with EUS-guided BTI [2,3,5]. The last patient received a laparoscopic Heller myotomy (LHM) [4].…”

Section: Discussionmentioning

confidence: 99%

“…Ten cases have been reported in the English medical literature, seven of which received treatment [2][3][4][5]. However, these treatments often involved various risks and complications, such as risk of hemorrhage after thoracotomy, dysphagia recurrence requiring subsequent myotomy after botulinum toxin injections (BTI), and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS).…”

Section: Introductionmentioning

confidence: 99%

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Peroral Endoscopic Myotomy for the Treatment of Achalasia in a Patient with Esophageal Varices. A Case Report

Shen

Wang

Zhang

et al. 2019

JGLD

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Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient’s achalasia symptoms’ Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient’s health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.Abbreviations: BTI: Botulinum toxin injections; EUS: Endoscopic ultrasonography; GEJ: Gastroesophageal junction; HIFU: High-intensity focused ultrasound; LHM: Laparoscopic Heller myotomy; PD: Pneumatic dilation; POEM: Peroral endoscopic myotomy; TIPS: Transjugular intrahepatic portosystemic shunt.

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“…Previous reports suggest placement of a transjugular intrahepatic portosystemic shunt (TIPS) and surgical myotomy or endoscopy therapy for treatment 1 . For patients who are not candidates for a TIPS, injection of the lower esophageal sphincter with botulinum toxin under endoscopic ultrasound (EUS) has been described 2 3 but it offers only short-term relief.…”

Section: Introductionmentioning

confidence: 99%

Pneumatic dilation for achalasia in a patient with esophageal varices

et al. 2016

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Background and study aims: Previous reports of simultaneous presence of esophageal varices (EV) and achalasia suggest placement of a transjugular intrahepatic portosystemic shunt (TIPS) and surgical myotomy or endoscopic therapy. We report the case of a 64-year-old man who received anticoagulant therapy for a myeloproliferative disorder with extensive portal thrombosis which was a contraindication to placement of a TIPS.

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Treatment of achalasia with botulinum toxin injection guided by endoscopic ultrasonography in a patient with esophageal varices

Cited by 8 publications

References 4 publications

The treatment of achalasia patients with esophageal varices: an international study

The treatment of achalasia patients with esophageal varices: an international study

Peroral Endoscopic Myotomy for the Treatment of Achalasia in a Patient with Esophageal Varices. A Case Report

Pneumatic dilation for achalasia in a patient with esophageal varices

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