Retrospective Study
Volume 5 Issue 8 - 2018
Intrapyloric Botulinum Toxin Injection for Refractory Gastroparesis May Offer Symptoms Improvement and Reduce Hospital Visits: A Single Center Experience
Kanwarpreet Tandon1, Andrew Ukleja2*, Amareshwar Podugu1, Baker Alkhairi1, Aleksandra Murawska1 and Alison Schneider1
1Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, USA
2Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
*Corresponding Author: Andrew Ukleja, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Received: March 30, 2018; Published: July 09, 2018
Citation: Andrew Ukleja., et al. “Intrapyloric Botulinum Toxin Injection for Refractory Gastroparesis May Offer Symptoms Improvement and Reduce Hospital Visits: A Single Center Experience”. EC Gastroenterology and Digestive System 5.8 (2018): 566-573.
Abstract
Aim: To evaluate the long-term outcomes of intrapyloric Botulinum toxin (BTX) injections in patients with well documented gastroparesis by gastric emptying test.
Methods: Retrospective chart review of patients diagnosed with gastroparesis who received BTX injections from January 2008 to July 2012 was performed. Demographics, comorbidities, diagnosis, past surgical history, the amount of BTX injected, procedural complications, medication use, emergency center and hospital visits were collected. A questionnaire with cardinal symptom index score and overall improvement scale was mailed to all patients. In cases with no mail response, patients were contacted by phone. Overall improvement after BTX injections, as well as adverse effects related to BTX injections, number of visits to emergency room (ER) and hospitalizations, need for gastric electrical stimulator placement were analyzed.
Results: Twenty five of thirty two patients [19 females (F), 6 males (M)] with gastroparesis responded to the questionnaire and were included in the study. The mean age was 46.1 years (range 21 - 71). Causes of gastroparesis were: idiopathic (IGP) 17 patients (13 females, 4 males); diabetic (DGP) 6 patients (4 females, 2 males); postsurgical (PGP) 2 females. The number of BTX injections per patient were: Single -15 patients (13F, 2M); Two - 5 patients (4F, 1M); Three - 3 patients (1F, 2M); Four-2 patients (1F, 1M). The mean follow-up was 31 months (range 13 - 42). Overall symptomatic improvement (by percentage) was: None (2F), 25% (5F), 50% (8F, 2M), 75% (3F, 4M), 100% (1F). Symptom improvement > 50% based on GP etiology was: 82% (14/17) patients with IGP, 67% (4/6) patients with DGP, 0% (0/2) patients with PGP. Reduced ER/hospital visits reported in 6 (24%) patients. Gastric electrical stimulator was implanted in 7 (28%) patients because of lack of long-term symptomatic improvement.
Conclusions: Approximately 72% of our GP patients noticed clinically significant (> 50%) symptomatic improvement after botox therapy. The subgroup of GP patients who benefited the most were males and patients with IGP. There may be still a role for BTX therapy in properly selected patients with refractory GP.
Keywords: Gastroparesis; Endoscopy; Botulinum Toxin; Botox; Refractory Gastroparesis
Copyright: © 2018 Andrew Ukleja., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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