Endoscopic Pyloric Injection of Botulinum Toxin-A for the Treatment of Postvagotomy Gastroparesis |
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| Authors: | Savio C Reddymasu Shailender Singh Rajakumar Sankula Teri AH Lavenbarg Mojtaba Olyaee Richard W McCallum |
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| Institution: | 1. Division of Gastroenterology, Jewish General Hospital, Montreal, Canada;3. Division of Gastroenterology, McGill University Health Centre, Montreal, Canada;4. Department of Gastroenterology, Sheba Medical Center Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;6. Prometheus Laboratories Inc, San Diego, California;1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;1. Bariatric and Metabolic International Surgery Center, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan;2. Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan;3. Weight Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan;4. Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan;5. Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Taichung City, Taiwan;6. Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan;7. Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan;1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States;2. Department of Surgery, Boston Children''s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States;3. Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, United States;4. Pediatric Surgical Associates, Children''s Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, United States;5. Department of Surgery, Emerson-Mass General Hospital, Harvard Medical School, 133 Old Road to Nine Acre Corner, Concord, MA 01742, United States;1. Stanford Multidimensional Program for Innovation and Research in the Esophagus (S-MPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA;2. The Parkinson''s Institute and Clinical Center, Sunnyvale, CA, USA |
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| Abstract: | ObjectivesTo evaluate the efficacy of botulinum toxin-A in the treatment of postvagotomy gastroparesis.MethodsThis 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.ResultsOf 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.ConclusionsIn 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. |
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