title: Comparison between botulinum injection and removable covered self-expanding metal stents for the treatment of achalasia.
abstract: BACKGROUND
  Intrasphincteric injection of botulinum toxin (BTX) and removable self-expanding metal stents (SEMS) have both been used for the treatment of achalasia.
  
  
  OBJECTIVE
  To compare the effectiveness and long-term outcome of SEMS placement and BTX injection in patients with achalasia.
  
  
  METHODS
  A total of 110 patients with newly diagnosed achalasia were enrolled in the study between July 2003 and December 2009. The patients received either BTX injection (n = 51) or SEMS placement (n = 59). Clinical symptoms, objective parameters, and long-term clinical outcomes were evaluated after 7 and 30 days and then every 6 months until withdrawal from the study. The mean duration of follow-up was 28 months (range 10-36 months).
  
  
  RESULTS
  Improvements in global symptom and dysphagia scores and in basal lower esophageal sphincter pressure were significantly more marked in the SEMS group than in the BTX group (all P < 0.05). After 12 months, the remission rate in the SEMS group (81.28 %) was statistically significantly higher than that in the BTX group (64.58; P < 0.05). At 36 months, the remission rates in the two groups were 49.1 and. 4.2 %, respectively (P < 0.01). The symptom-free interval was 831 ± 46 days in the SEMS group and 522 ± 42 days in the BTX group (P < 0.01). No side effects were reported with BTX treatment. In the SEMS group there were 13 episodes of chest pain, nine cases of regurgitation, and four stent migrations. No serious complications occurred.
  
  
  CONCLUSIONS
  Removable SEMS was associated with better long-term outcomes than BTX injection in patients with achalasia.
authors: Department of Gastroenterology, First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, China.
authors: Xiao Bo
authors: XB
authors: Cai
authors: Yan Miao
authors: YM
authors: Dai
authors: Xin Jian
authors: XJ
authors: Wan
authors: Yue
authors: Y
authors: Zeng
authors: Feng
authors: F
authors: Liu
authors: Dong
authors: D
authors: Wang
authors: Hui
authors: H
authors: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
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