Long-term results of endoscopic injection of botulinum toxin in elderly achalasic patients with tortuous megaesophagus or epiphrenic diverticulum.

Abstract

BACKGROUND AND STUDY AIMS:

Recent studies suggest that endoscopic injection of botulinum toxin (BTX) for achalasia is a safe procedure giving short-term relief of symptoms mainly in elderly patients (> 50 years). The aim of the study was to evaluate the clinical efficacy of periodic BTX treatments in high risk achalasia patients.

PATIENTS AND METHODS:

A total of 20 consecutive achalasia patients, aged > 60 years (11 women; 71+/-11 years), with general (ASA class III or IV) and local risk factors (i.e. tortuous megaesophagus or epiphrenic diverticulum) for complications associated with pneumatic dilation, were treated by local injection of 100 U of BTX into the gastric cardia, using the four-quadrant technique. The patients were prospectively followed for a median period of 2 years (range 5-48 months), using a symptom score (1-14 points) and barium esophagograms.

RESULTS:

Symptomatic improvement (decrease of the symptom score > or = 3 points) was found in 16/20 patients (80%), 6 weeks after the first BTX injection, and the cardia diameter increased from 2.1+/-0.7 to 3.2+/-1.2 mm (P < 0.01) (data are means +/- SD). Those patients who initially responded to BTX treatment developed a symptomatic relapse after a median follow-up of 5+/-2 months. They were treated by subsequent BTX re-injections (2.5+/-1 sessions per patient, range 1-5) resulting in longer lasting symptom relief (10+/-3 months, P < 0.05 vs. initial BTX injection). At completion of the study, 14/20 high risk achalasia patients (70 %) treated with periodic BTX injections are still in clinical remission. One further patient died without relapse 6 months after a single BTX treatment as a consequence of progressive heart failure. Four patients who did not respond to BTX injection were successfully and uneventfully treated by careful pneumatic dilation (n = 3) or percutaneous endoscopic gastrostomy (n = 1).

CONCLUSION:

Endoscopic botulinum toxin injection has reasonable long-term efficacy and safety in elderly achalasia patients who are at increased risk with regard to pneumatic dilation.

• Authors: T Wehrmann, H Kokabpick, V Jacobi, H Seifert, B Lembcke, W F Caspary
• Journal: Endoscopy (Endoscopy) Vol. 31 Issue 5 Pg. 352-8 (Jun 1999) ISSN: 0013-726X [Print] Germany
• PMID: 10433043 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Anti-Dyskinesia Agents
• Botulinum Toxins

Topics

• Aged
• Aged, 80 and over
• Anti-Dyskinesia Agents (administration & dosage, therapeutic use)
• Botulinum Toxins (administration & dosage, therapeutic use)
• Cardia
• Diverticulum, Esophageal (complications, diagnostic imaging, drug therapy)
• Endoscopy, Digestive System
• Esophageal Achalasia (complications, diagnostic imaging, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Injections (methods)
• Male
• Middle Aged
• Prospective Studies
• Radiography
• Safety
• Treatment Outcome