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Am J Med Sci. 2009 Mar;337(3):161-4.
Endoscopic pyloric injection of botulinum toxin-A for the treatment of postvagotomy gastroparesis.
Reddymasu SC, Singh S, Sankula R, Lavenbarg TA, Olyaee M, McCallum RW.
Department of Medicine, Division of Gastrointestinal Motility, University of Kansas Medical Center, Kansas City, Kansas 66160-7350, USA.
AbstractOBJECTIVES: To evaluate the efficacy of botulinum toxin-A in the treatment of postvagotomy gastroparesis. METHODS: This open-labeled trial identified and recruited 11 subjects who developed symptomatic gastroparesis after a vagotomy (9 fundoplication, 1 trauma, and 1 exploratory laparotomy). Gastroparesis was defined as an abnormal solid-phase gastric emptying test using the standardized 4-hour radionuclide eggbeater meal method and vagotomy was confirmed with a sham meal challenge test. To complete the study, subjects should have completed the 6-month follow-up visit after their pylorus was injected with botulinum toxin-A injection in a 4-quadrant manner. Patients either received 100 (n = 2) or 200 (n = 9) units of botulinum toxin. Questionnaires recorded symptom severity of gastroparesis at baseline and at monthly intervals for 6 months after the therapy was completed by the patients. RESULTS: Of the 11 subjects initially recruited, 10 finished the 6-month follow-up visit (7 women). Mean age was 51 years (range, 31-84 years). Mean symptom score at baseline was 16 (95% CI 13-19) and showed a numerical decline to 9 (P > 0.05) over the 6-month period after the procedure (95% CI 5-13). Seven (70%) patients observed >30% improvement in the total symptom score. No complications were recorded. CONCLUSIONS: In conclusion, this open-label study in patients with postvagotomy gastroparesis patients reveals a reduction of gastroparetic symptoms at 1 and 3 months after treatment with pyloric injection of botulinum toxin-A, with return of symptoms by 6 months. Thus, botulinum toxin treatment does not produce a sustained reduction in gastroparetic symptoms in this clinical setting.
PMID: 19174691 [PubMed - indexed for MEDLINE]
