Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia

Leyden, J; Moss, Alan C.; MacMathúna, Padraic

doi:10.1002/14651858.cd005046.pub3

Cited by 74 publications

(41 citation statements)

References 29 publications

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“…So far, BTX injection in the LES or in the wall of the distal esophagus was considered safe. The main reported adverse effect was transient chest and/or epigastric pain in the days following the injection . However, several case reports pointed out the potential infectious risks related to this procedure: severe mediastinitis, esophageal ulceration, and transient acute gastroduodenal dilation .…”

Section: Discussionmentioning

confidence: 99%

“…This substance interferes with neural transmission by blocking the release of acetylcholine at the neuromuscular junction, causing muscle paralysis . Endoscopic BTX injection in the lower esophageal sphincter (LES) has been used for years to treat achalasia . A Cochrane meta‐analysis concluded that it was safer than pneumatic balloon dilation in achalasia .…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic BTX injection in the lower esophageal sphincter (LES) has been used for years to treat achalasia . A Cochrane meta‐analysis concluded that it was safer than pneumatic balloon dilation in achalasia . It is known as an easy and safe endoscopic technique, which does not require a steep learning curve and can be performed in nonspecialist centers .…”

Section: Introductionmentioning

confidence: 99%

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Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases?

et al. 2014

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Endoscopic injections of botulinum toxin in the cardia or distal esophagus have been advocated to treat achalasia and spastic esophageal motility disorders. We conducted a retrospective study to evaluate whether manometric diagnosis using the Chicago classification in high-resolution manometry (HRM) would be predictive of the clinical response. Charts of patients with spastic and hypertensive motility disorders diagnosed with HRM and treated with botulinum toxin were retrospectively reviewed at two centers. HRM recordings were systematically reanalyzed, and a patient's phone survey was conducted. Forty-five patients treated between 2008 and 2013 were included. Most patients had achalasia type 3 (22 cases). Other diagnoses were jackhammer esophagus (8 cases), distal esophageal spasm (7 cases), esophagogastric junction outflow obstruction (5 cases), nutcracker esophagus (1 case), and 2 unclassified cases. Botulinum toxin injections were performed into the cardia only in 9 cases, into the wall of the distal esophagus in 19 cases, and in both locations (cardia and distal esophagus) in 17 cases. No complication occurred in 31 cases. Chest pain was noticed for less than 7 days in 13 cases. One death related to mediastinitis occurred 3 weeks after botulinum toxin injection. Efficacy was assessed in 42 patients: 71% were significantly improved 2 months after botulinum toxin, and 57% remained satisfied for more than 6 months. No clear difference was observed in terms of response according to manometric diagnosis; however, type 3 achalasia previously dilated and with normal integrated relaxation pressure (4s-integrated relaxation pressure< 15 mmHg) had the worst outcome: none of these patients responded to the endoscopic injection of botulinum toxin. Endoscopic injections of botulinum toxin may be effective in some patients with spastic or hypercontractile esophageal motility disorders. The manometric Chicago classification diagnosis does not seem to predict the results. Prospective randomized trials are required to identify patients most likely to benefit from esophageal botulinum toxin treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases?

et al. 2014

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“…Medicine is available for mild achalasia . Patients with endoscopic pneumatic dilation and botulinum toxin injection treatment usually relapse in 1 year . Surgical treatment causes big injury and more complications and patients are reluctant to receive this treatment .…”

Section: Discussionmentioning

confidence: 99%

Clinical remission following endoscopic placement of retrievable, fully covered metal stents in patients with esophageal achalasia

2013

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Metal stents may represent an alternative therapy in the treatment of achalasia. We therefore evaluated the effectiveness of retrievable, fully covered metal stents in patients with achalasia. Fifty-nine patients with achalasia were treated with retrievable, fully covered metal stents. Symptoms using a global symptom score (0-10), lower esophageal sphincter (LES) resting pressure, LES relaxation, and simultaneous contraction of the esophagus were analyzed before and 1 week and 1 month after intervention. Complications and treatment outcomes were followed up at 6, 12, 18, and 24 months postoperatively. Stent placement was successful, and clinical symptoms resolved (P < 0.01) in all patients. Regurgitation, dysphagia and chest pain improved significantly (all P < 0.01). Therapy improved LES resting pressure (51.4 ± 9.7 mmHg pretherapy vs. 20.9 ± 8.1 mmHg post-therapy), LES relaxation (58.1 ± 17.1% pretherapy vs. 84.5 ± 18.9% post-therapy), and simultaneous contraction of the esophagus (36.1 ± 8.6% pretherapy vs. 69.4 ± 23.1% post-therapy) 1 month after stent placement (all P < 0.01). The cumulative clinical remission rates 6, 12, 18, 24, 30, and 36 months after stent removal were 90.9%, 81.8%, 76.4%, 69.1%, 65.5%, and 49.1%, respectively. All patients tolerated stent placement. Twelve patients (25.5%) complained of substernal pain and five (10.6%) had substernal burning. Stents migrated in four patients (8.5%). Insertion of retrievable, fully covered metal stents is an effective and safe treatment in patients with achalasia.

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“…BTI has been clearly shown to be inferior in terms of therapeutic efficacy to both PD and myotomy [Leyden et al 2006;Wang et al 2009]. The most compelling aspects of BTI for achalasia are ease of technique and the paucity of and mild degree of complications.…”

Section: Botulinum Toxin Injectionmentioning

confidence: 99%

Endoscopic approaches to treatment of achalasia

Stavropoulos

Friedel

Modayil

et al. 2012

Therap Adv Gastroenterol

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Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

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Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia

Abstract: Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia.

Cited by 74 publications

References 29 publications

Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases?

Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases?

Clinical remission following endoscopic placement of retrievable, fully covered metal stents in patients with esophageal achalasia

Endoscopic approaches to treatment of achalasia

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