[Intrasphincteric injection of botulinum toxin in patients with esophageal achalasia].
BACKGROUND
Intrasphincteric injection of botulinum toxin (BoTx) has demonstrated to be effective in the short-term treatment of achalasia.


OBJECTIVE
To assess the efficacy, safety and long-term outcome of BoTx injection into the lower esophageal sphincter (LES) of patients with achalasia.


METHODS
Eight patients received 80 units of BoTx. Assessment of response was based on changes in the symptom scores (0-9) and esophageal manometric studies.


RESULTS
Six out of 8 patients (75%) had sustained clinical improvement after therapy. This effect was maintained for a mean time of 17.8 months. The symptom score decreased from a mean of 6.7 to 0.5 (p < 0.01) and after treatment, LES pressure decreased from 63 to 25.5 mm Hg (p = 0.07). There were no serious adverse effects. Five of the six responders have relapsed. Two of these patients received a second BoTx injection with satisfactory results, two went to surgery and one refused other type of therapy and died of pneumonia.


CONCLUSIONS
Intrasphincteric BoTx injection is a simple, safe and effective method of treatment in patients with achalasia, with a duration of response averaging 1.5 years. Its use may be suggested in some patients with high surgical risk and those who refuse a more invasive therapy. It is also useful in malnourished patients to attain an adequate nutritional status before surgery.
Zapata
R
R
Departamento de Gastroenterología, Facultad de Medicina, P Universidad Católica de Chile, Santiago de Chile.
Carvajal
S
S
Alvarez
M
M
González
R
R
Chianale
J
J
Rollán
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D004931:Esophageal Achalasia / Q000188:drug therapy*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins