J Gastric Cancer.  2017 Jun;17(2):173-179. 10.5230/jgc.2017.17.e18.

Botulinum Toxin Injection for the Treatment of Delayed Gastric Emptying Following Pylorus-Preserving Gastrectomy: an Initial Experience

• Lee JH
• Kim CG
• Kim YW
• Choi IJ
• Lee JY
• Cho SJ
• Kim YI
• Eom BW
• Yoon HM
• Ryu KW

• KMID: 2383740
• DOI: http://doi.org/10.5230/jgc.2017.17.e18

Abstract

PURPOSE
To report our experience of endoscopic botulinum toxin injection in patients who experienced severe delayed gastric emptying after pylorus-preserving gastrectomy (PPG).
MATERIALS AND METHODS
We reviewed the medical records of 6 patients who received the botulinum toxin injection. They presented with severe delayed gastric emptying in the early postoperative period. Endoscopic botulinum toxin was administered as 4 injections of 25−50 IU into each of the 4 quadrants of the prepyloric area.
RESULTS
All botulinum toxin injections were successful without any complications, enabling 5 patients to tolerate soft solid diets and one to tolerate a soft fluid diet within 10 days. The endoscopic criteria of 4 patients improved. Symptom recurrence caused 2 patients to undergo repeat injections that were successful. The median follow-up period was 27 months, and all patients could ingest normal regular diets at the last follow-up.
CONCLUSIONS
Endoscopic botulinum toxin injection is a feasible treatment option for early delayed gastric emptying after PPG.

Keyword

Surgery; Gastric stasis; Gastrectomy; Complications; Endoscopy; Botulinum toxins

MeSH Terms

Botulinum Toxins*
Diet
Endoscopy
Follow-Up Studies
Gastrectomy*
Gastric Emptying*
Gastroparesis
Humans
Medical Records
Postoperative Period
Recurrence
Botulinum Toxins

Figure

• 

  Fig. 1 Endoscopic botulinum toxin injection into the pylorus area. Botulinum toxin (25−50 IU per site; total, 100−200 IU) is injected into each quadrant of the pylorus area using a standard sclerotherapy needle via capped endoscopy.

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  Fig. 2 Upper gastrointestinal series and follow-up simple X-ray after botulinum toxin injection. (A) Pre-injection, (B) 2 days post-injection, (C) 4 days post-injection, and (D) 7 days post-injection. The nearly closed pylorus gradually opened (blue arrow), and the residual food in the stomach decreased after botulinum toxin injection. After 1 week, the pylorus widely opened, and the residual food emptied.

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