Evaluation of scar formation after botulinum toxin injection or Forced balloon dilation to the lower esophageal sphincter

Abstract

Botulinum toxin injection and forced balloon dilatation caused significant inflammation in the esophagus of the swine, which would be consistent with the injury caused by reflux. Forced balloon dilatation and botulinum toxin caused fibrosis and may increase surgical risk.

Temporary placement of a paclitaxel or rapamycin-eluting stent is effective to reduce stenting induced inflammatory reaction and scaring in benign cardia stricture models

“…Recently, paclitaxel or rapamycin-coated eluting-stents have been used in human coronary arteries to prevent neointima formation, the leading cause of restenosis via inhibiting migration and proliferation of the smooth muscle cells in the media (14,19). The oesophagus tissue repair procedure after temporary stent placement was also a kind of inflammatory reaction mainly mediated by various cell growth factors (like vascular endothelial growth factor and transforming growth factor, type beta) to induce proliferation and migration of fib hjroblasts, infiltration of mononuclear cells, plasma cells and lymph cells, and the deposition of extracellular matrix (7,8). Thus, drug-eluting techniques may be applied to cardia stents, prolonging the stenting period, reducing scar tissue formation and improving long-term outcome.…”

“…The tissue repair induced by stent dilation involves an inflammatory reaction mainly mediated by various cell growth factors that induce proliferation and migration of fibroblasts, infiltration of mononuclear cells, plasma cells and lymph cells, and the deposition of extracellular matrix, which has a great similarity to arterial wall repair after stenting (7,8).…”

Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia

“…In our animal study, botulinum toxin injection and forced balloon dilation caused scarring. We believe these therapies obliterate the plane usually easy to discern between the mucosa and muscular layers of the esophagus [13].…”

Prevention of Post-operative Leak Following Laparoscopic Heller Myotomy

“…23 Botulinum toxin injection and pneumatic dilation cause severe inflammation of the GE junction in animal studies. 20 It has been speculated that previous endoscopic treatments may, therefore, make dissection more difficult and increase operative risk of mucosal injury during myotomy. Contradictory reports exist in the literature regarding the effect of pre-operative endoscopic therapies on surgical difficulty of myotomy or outcomes.…”

“…15 Laparoscopic Heller myotomy has emerged as the preferred first line treatment for patients with achalasia, 3 with reported success of 85-93%. [16][17][18][19][20][21][22] Gastroesophageal reflux is the most common consequence of myotomy, thus, a prophylactic antireflux fundoplication is commonly performed concomitantly with myotomy. 23 Botulinum toxin injection and pneumatic dilation cause severe inflammation of the GE junction in animal studies.…”