Effect of intrapyloric botulinum toxin on postsurgical gastroparesis

Background: Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Lesion of vagal nerve occurs in 4–40% of patients undergoing laparoscopic fundoplication and after mediastinal surgery. Botulinum toxin is a potent inhibitor of neuromuscular transmission and has been used to treat achalasia.

Aim of the study was to determine the effect of intrapyloric botulinum toxin on gastric emptying of patients with postsurgical gastroparesis. Methods: 6 patients (6 female, median age: 56 years, 4/6: postfundoplication and 2/6: mediastinal/lung surgery) reporting early satiety, nausea or vomiting were investigated. Mechanical obstruction of the stomach was closed out by endoscopy and barium passage. Liquid phase gastric emptying was measured by 99mTcsulfur-colloid scintigraphy, and intrapyloric emptying rate and antral T1/2 were calculated. A solid phase gastric emptying coefficient (GEC) and T1/2 were calculated by using 13C-octanoic acid breath test. Control of gastric emptying was performed after two sessions of 200IU BOTOX® intrapyloric injection, 8 weeks after the beginning of the treatment. Results: Intrapyloric emptying rate was 0.6±0.05%/min with a T1/2: 116±18min, GEC: 2.48±0.01 and T1/2: 202±36min for liquid and solid gastric emptying respectively. BOTOX® injection significantly increased intrapyloric emptying rate 1,4±0.03%/min (P≤0.01) and T1/2 decreased to 60±7min (P≤0.001). GEC and T1/2 for solid meal were found to be 3.1±0.17 (P≤0.01) and 120±26min (P≤0.01) respectively.

Conclusion: intrapyloric botulinum toxin enhanced gastric emptying of liquid and solid in patients with postsurgical gastroparesis. Its long term effect however has to be elucidated.

Grant support: ETT550/2003