Treatment of Achalasia with Intrasphincteric Injection of Botulinum Toxin: A Pilot Trial

Pasricha, Pankaj J.; Ravich, William J.; Hendrix, Thomas R.; Sostre, Samuel; Jones, Bronwyn; Kalloo, Anthony N.

doi:10.7326/0003-4819-121-8-199410150-00006

Cited by 159 publications

(86 citation statements)

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“…The toxin theoretically relaxes the LES by decreasing unopposed cholinergic stimulation of the LES [75] . Although the effect of botulinum toxin injection generally is shorter than some other procedures, it can be useful under certain conditions.…”

Section: Botulinum Toxin Injectionmentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

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Section: Botulinum Toxin Injectionmentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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“…28 This improves the symptoms of achalasia, decrease LES pressure, increase lower esophageal aperture and improve esophageal emptying. 31 The clinical effects of a single injection are short lived with relapse in more than 50% within 6 months. 28 However, repeated injections may confer clinical benefit in 70% to 90%.…”

Section: Medical Treatmentmentioning

confidence: 99%

“…14,28 Treatment with BTox confers beneficial effects on subsequent pneumatic dilatation which is actually enhanced. 22,31 However, repeated injection of the toxin makes subsequent surgical myotomy more difficult due to adhesions of the muscular layers to mucosal plane with an increased danger of mucosal perforation. 14,33 Given its safety profile, BTox injection may be given to patients who are not candidates for PD or surgery and those whose life expectancy does not exceed 2 years.…”

Section: Medical Treatmentmentioning

confidence: 99%

“…33 This waning of efficacy over time is may be related to development of autoimmune response with production of antibodies against BTox. 31 Predictors of good response to BTox injection are age less than 50 years, vigorous achalasia, an initial clinical response to BTox injection and decrease in LES pressure in response to BTox injection. 22,35 Endoscopic injection of BTox is remarkably safe.…”

Section: Medical Treatmentmentioning

confidence: 99%

“…29,30 In the early nineties, Pasrich and colleagues evaluated the usefulness of intrasphincteric injection of BTox in achalasia patients. 31,32 The rationale was that the selective loss of inhibitory nerves in achalasia upset the excitatory cholinergic influences on the LES. 29 Thus by blocking the release of ACH, locally injected BTox might reduce the LES pressure and improve passive esophageal emptying.…”

Section: Medical Treatmentmentioning

confidence: 99%

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Achalasia: What is the best treatment?

Ahmed

2008

Ann Afr Med

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Background: Achalasia is an infrequent primary motility disorder of the esophagus. Because of uncertain etiology, treatment is only palliative and is directed at decreasing lower esophageal sphincter pressure, improving esophageal emptying and relieving the symptoms of achalasia. Current treatment options include pharmacological, endoscopic and surgical. We undertook a systematic literature review of the management strategies currently available for achalasia. Method: A Medline, PubMed and Cochrane database search was conducted using reference manager 11. Original articles and reviews published in the English literature on the management of achalasia were reviewed. Emphasis was placed on articles published in the last ten years on randomized controlled trials comparing the various forms of treatment. Results: Esophageal manometry is the standard diagnostic evaluation for achalasia. Accurate diagnosis can also be made based on clinical findings and barium esophagogram. Medical treatment with nitrates or calcium channel blockers has variable results in alleviating the symptoms of achalasia but long-term results are disappointing because of tolerance and side effects. Intrasphincteric injection of botulinum toxin, pneumatic dilatation and surgical myotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strength and weaknesses which make their choice suitable in a particular group of patients. While pneumatic dilatation is superior to botulinum toxin injection surgical myotomy provides the best long-term control of symptoms in patients with achalasia. Conclusion: Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated. Key words: Achalasia, Heller's esophagomyotomy, pneumatic dilatationRésumé Contexte: L'achalasie est une rare anomalie motrice de l'oesophage. En raison de son étiologie incertaine, le traitement est seulement palliatif et vise la réduire la pression sphinctérienne du bas oesophage, l'amélioration de la vidange et le soulagement des symptômes de l'achalasie. Les options thérapeutiques courantes font appel aux moyens pharmacologiques, endoscopiques et chirurgicaux. Nous avons effectué une revue systématique de la littérature relative aux stratégies thérapeutiques actuellement disponibles pour l'achalasie. Méthode: Une recherche sur Medline, Pubmed et Cochrane a été faite a l'aide du logiciel Reference Manager 11. Les articles originaux et les rapports portant sur la prise en charge de l'achalasie et publiés en anglaise ont été passés en revue. L'accent a été mis sur les articles publiés au cours des dix dernières années et sur les essais contrôlés comparant les diverses formes de traitement. Résultats: La manométrie oesophagienne est la méthode de diagnostic standard pour l'achalasie. Le dia...

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Laparoscopic Heller Myotomy and Anterior Fundoplication for Achalasia Results in a High Degree of Patient Satisfaction

et al. 2000

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Hypothesis: Laparoscopic Heller myotomy with anterior fundoplication will alleviate the symptoms of achalasia and result in excellent patient satisfaction. Design: Retrospective study of consecutive patients who underwent laparoscopic Heller myotomy with anterior fundoplication for achalasia between October 1995 and July 1999. A telephone survey assessed symptoms and satisfaction. Patients were asked to quantitate their symptoms on a scale of 0 to 3 (0 = none; 1, mild; 2, moderate; and 3, severe). Setting: University referral center. Patients: Twenty-four patients who underwent laparoscopic Heller myotomy with anterior fundoplication for achalasia. Main Outcome Measures: Postoperative symptoms and satisfaction. Results: Twenty-one patients (88%) were successfully contacted. Mean follow-up was 16.5 months. The lapa

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Treatment of Achalasia with Intrasphincteric Injection of Botulinum Toxin: A Pilot Trial

Cited by 159 publications

References 0 publications

Achalasia: A review of Western and Iranian experiences

Achalasia: A review of Western and Iranian experiences

Achalasia: What is the best treatment?

Laparoscopic Heller Myotomy and Anterior Fundoplication for Achalasia Results in a High Degree of Patient Satisfaction

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