Treatment with botulinum toxin of octo‐nonagerians with oesophageal achalasia: a two‐year follow‐up study

Bassotti, Gabrio; D'Onofrio, V.; Battaglia, Edda; Fiorella, Sara; L, Dughera; Iaquinto, Gaetano; Mazzocchi, Alessandro; Morelli, Antonio; Annese, Vito

doi:10.1111/j.1365-2036.2006.02907.x

Cited by 25 publications

(10 citation statements)

References 31 publications

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“…A single injection of botulinum toxin has been shown to be effective in approximately 85% of patients with achalasia, but its effect diminishes over time (50% at 6 months and 30% at 1 year) [9,13,14], and universal symptomatic relapse occurs at 2 years [15].This treatment effect can be maximized by repeat injections [16], but its long-term effectiveness remains limited. The best results of botulinum toxin have been achieved in older patients [17] who tend to have higher lower esophageal pressures than younger patients [18], patients with vigorous achalasia, and patients whose LES pressures do not exceed C50% of the upper limit of normal [14,19]. In contrast, a lack of an initial symptomatic response and residual LES pressure C18 mmHg after botulinum toxin indicates patients unlikely to respond to further treatment with botulinum toxin [20].…”

Section: Botulinum Toxin Injectionsmentioning

confidence: 83%

“…Other predictors of treatment failure with balloon dilation include the presence of pulmonary symptoms and failed response to the first or second initial dilations [29,34,35]. Some authors have recommended the routine use of manometry before and after intervention, because high initial LES pressures (e.g., [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] or a reduction of LES pressure \ 50% after the first dilation have been found to be predictors of poor outcomes [29,35].…”

Section: Dilatationmentioning

confidence: 99%

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SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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Section: Botulinum Toxin Injectionsmentioning

confidence: 83%

Section: Dilatationmentioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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“…Moreover, Bassotti et al [31] used a different modality of administration and reported an 80% success rate at 12 months in patients receiving two injections of botulinum toxin within a 4-week interval, thus arousing new interest in this therapy. It is essential to carry out more high-quality studies to identify the efficacy of repeated botulinum toxin injection treatment and botulinum toxin injection combined with other treatment methods.…”

Section: Discussionmentioning

confidence: 97%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

133

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Pharmacological therapy, botulinum toxin injection, pneumatic dilatation, and surgical myotomy are the primary therapeutic modalities for achalasia, for which laparoscopic myotomy is recommended as state-of-the-art therapy. However, its efficacy and safety remain unclear compared with other approaches in the treatment of achalasia. We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials, LILACS-Latin American, Caribbean health science literature, and Science Citation Index Expanded) for randomized controlled trials to evaluate which therapeutic measures are temporary and reversible and which measures are definitive and effective by pooling data including remission rate, relapse rate, complications, and adverse effects. Seventeen studies with 761 patients met our inclusion criteria. There was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention [relative risk (RR) 2.20, 95% confidence interval (CI) 1.51-3.20], Pneumatic dilation had lower relapse rate than did botulinum toxin injection (RR 0.12, 95% CI 0.04-0.32). Compared with pneumatic dilation, laparoscopic myotomy further increased remission rate (RR 1.48, 95% CI 1.48-1.87), and reduced clinical relapse rate (RR 0.14, 95% CI 0.04-0.58), and there was no difference in complication rate (RR 1.48, 95% CI 0.37-5.99). Based on limited randomized and controlled trials, laparoscopic myotomy is the preferred method for patients with achalasia. Future trials should investigate whether laparoscopic myotomy combined with different modalities of fundoplication is superior to isolated laparoscopic myotomy.

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“…However, Bassotti et al [56] using a different BoTx regimen, consisting of two injections within a 4-wk period, reported a success rate 80% at 12 mo. These findings may encourage new interest in this therapy.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Wang

Li²,

Li³

et al. 2008

WJG

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AIM:To evaluate the effect of different approaches in the treatment of achalasia in China. METHODS:We performed a systematic review and meta-analysis of Chinese literature by searching the Chinese Biomedical Database and Chinese scientific Journals database (up to March 2008). All cohort studies (controlled or uncontrolled) in which the patients were observed for more than a year were reviewed in detail. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence interval (CI) for controlled trials. The efficacy in uncontrolled trials was assessed by a pooled estimate of response rate with individual studies weighted in proportion to the sample size. RESULTS: Seven controlled trials compared the effect of botulinum toxin injection (BoTx) with pneumatic dilation (PD

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Treatment with botulinum toxin of octo‐nonagerians with oesophageal achalasia: a two‐year follow‐up study

Abstract: SUMMARY BackgroundTreatment of oesophageal achalasia with intrasphincteric injections of botulinum toxin has proved to be a successful alternative treatment modality. However, little is known about its long-term effects in very old patients.

Cited by 25 publications

References 31 publications

SAGES guidelines for the surgical treatment of esophageal achalasia

SAGES guidelines for the surgical treatment of esophageal achalasia

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

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