Endoscopic intrapyloric injection of botulinum toxin A in the treatment of children with gastroparesis: a retrospective, open-label study - 15/01/12
Reprint requests: Leonel Rodriguez, MD, MS, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115Résumé |
Background |
Botulinum toxin A has been used in children to treat spastic disorders and recently for GI conditions. Open-label studies in adults with gastroparesis have reported an improvement in symptoms and gastric emptying after endoscopic intrapyloric botulinum injections (IPBIs), although placebo-controlled trials have shown conflicting results. Only a single case report of IPBI is available in children.
Objective |
To determine the long-term clinical outcomes and predictive factors for IPBI response in children with gastroparesis refractory to medical therapy.
Design |
Retrospective review.
Setting |
Single tertiary care center.
Patients |
Children with refractory gastroparesis symptoms undergoing IPBIs.
Interventions |
IPBIs.
Main Outcome Measurements |
Clinical improvement and predictive factors for response.
Results |
A total of 70 injections were given to 47 patients (mean age 9.98 ± 6.5 years; 23 female patients) with follow-up in 45 patients. IPBI failed in 15 patients and was successful in 30 patients. The median duration of response to the first IPBI was 3.0 months (95% CI, 1.2-4.8). A total of 29 patients received a single IPBI, and 18 received multiple IPBIs. Older age and vomiting predicted response to initial IPBI, and male sex predicted response to repeat IPBI. Only 1 patient reported exacerbation of vomiting after IPBI resolving within a week.
Limitations |
The open-label and retrospective nature of the study.
Conclusion |
IPBI is safe and may be effective in the management of children with symptoms of gastroparesis. Subgroups identifying who responded to the first IPBI include older patients and those presenting with vomiting, whereas male patients responded better to repeat IPBIs.
Le texte complet de cet article est disponible en PDF.Abbreviations : GES, IPBI, PPAHM
Plan
| DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. This work was supported by NIH grants K23DK073713 (Dr. Rosen) and K24DK082792A (Dr. Nurko). |
|
| See CME section; p. 399. |
|
| If you would like to chat with an author of this article, you may contact Dr Rodriquez at leonel.rodriguez@childrens.harvard.edu. |
Vol 75 - N° 2
P. 302-309 - février 2012 Retour au numéro
Article précédent
- Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery
- Bo Kyung Kim, Sung Pil Hong, Hyun Mi Heo, Jin Young Kim, Hyuk Hur, Kang Young Lee, Jae Hee Cheon, Tae Il Kim, Won Ho Kim
- High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction
- Stavros N. Stavropoulos, Gene Y. Im, Zahra Jlayer, Michael D. Harris, Teodor C. Pitea, George K. Turi, Peter F. Malet, David M. Friedel, James H. Grendell
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?