A systematic review on intrapyloric botulinum toxin injection for gastroparesis.
BACKGROUND
Though trials evaluating the effect of intrapyloric botulinum toxin injection on gastroparesis have been reported, there is no agreement whether botulinum toxin can effectively relieve the symptoms and improve the results of gastric emptying study in patients with gastroparesis. We performed a systematic literature review to address this issue.


METHODS
Databases including PubMed, EMBASE, and the Cochrane Library and Science Citation Index were searched. Two reviewers independently identified relevant trials. Outcome measures were the improvement of subjective symptoms and objective measurement.


RESULTS
15 reports were included; only 2 randomized controlled trials were available. Almost all the non-randomized trials reported significant improvement in subjective symptoms and objective gastric emptying study after botulinum toxin injection. While the 2 randomized controlled trials did not confirm the efficacy of botulinum toxin injection, none of the individual trials showed that there was statistically significant subjective and objective improvement in the active patients when compared with patients receiving placebo.


CONCLUSIONS
Available high-quality trials showed that intrapyloric botulinum toxin injection could not significantly relieve subjective symptoms and improve objective measurement in patients with gastroparesis, and there is no evidence to recommend botulinum toxin injection for the treatment of gastroparesis.
Bai
Yu
Y
Department of Gastroenterology, Evidence-Based Medicine Group, Changhai Hospital, Second Military Medical University, Shanghai, China.
Xu
Mao-Jin
MJ
Yang
Xia
X
Xu
Can
C
Gao
Jun
J
Zou
Duo-Wu
DW
Li
Zhao-Shen
ZS
D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D005746:Gastric Emptying / Q000187:drug effects*; D018589:Gastroparesis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007267:Injections; D011708:Pylorus; D017211:Treatment Failure
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins