Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Botulinum Toxin Injection for the Treatment of Delayed Gastric Emptying Following Pylorus-Preserving Gastrectomy: an Initial Experience

  • Received : 2017.04.13
  • Accepted : 2017.05.22
  • Published : 2017.06.30
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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.

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References

  1. Bollschweiler E, Berlth F, Baltin C, Monig S, Holscher AH. Treatment of early gastric cancer in the Western World. World J Gastroenterol 2014;20:5672-5678. https://doi.org/10.3748/wjg.v20.i19.5672
  2. Oh SY, Lee HJ, Yang HK. Pylorus-preserving gastrectomy for gastric cancer. J Gastric Cancer 2016;16:63-71. https://doi.org/10.5230/jgc.2016.16.2.63
  3. Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 2011;253:928-933. https://doi.org/10.1097/SLA.0b013e3182117b24
  4. Suh YS, Han DS, Kong SH, Kwon S, Shin CI, Kim WH, et al. Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer. Ann Surg 2014;259:485-493. https://doi.org/10.1097/SLA.0b013e318294d142
  5. Nakabayashi T, Mochiki E, Garcia M, Haga N, Suzuki T, Asao T, et al. Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerve. World J Surg 2002;26:577-583. https://doi.org/10.1007/s00268-001-0270-6
  6. Cerfolio RJ, Bryant AS, Canon CL, Dhawan R, Eloubeidi MA. Is botulinum toxin injection of the pylorus during Ivor Lewis [corrected] esophagogastrectomy the optimal drainage strategy? J Thorac Cardiovasc Surg 2009;137:565-572. https://doi.org/10.1016/j.jtcvs.2008.08.049
  7. Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 2005;61:833-839. https://doi.org/10.1016/S0016-5107(05)00328-7
  8. Storr M, Allescher HD, Rosch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injection of botulinum toxin: a prospective study with long term follow-up. Gastrointest Endosc 2001;54:18A. https://doi.org/10.1067/mge.2001.115731
  9. Kolbasnik J, Waterfall WE, Fachnie B, Chen Y, Tougas G. Long-term efficacy of botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol 1999;94:3434-3439. https://doi.org/10.1111/j.1572-0241.1999.01605.x
  10. Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002;97:72-78. https://doi.org/10.1111/j.1572-0241.2002.05423.x
  11. Kim CG, Choi IJ, Lee JY, Cho SJ, Park SR, Lee JH, et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 2010;72:25-32. https://doi.org/10.1016/j.gie.2010.01.039
  12. Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 2002;5:83-89. https://doi.org/10.1007/s101200200014
  13. Jung HJ, Lee JH, Ryu KW, Lee JY, Kim CG, Choi IJ, et al. The influence of reconstruction methods on food retention phenomenon in the remnant stomach after a subtotal gastrectomy. J Surg Oncol 2008;98:11-14. https://doi.org/10.1002/jso.21076
  14. Bae JS, Kim SH, Shin CI, Joo I, Yoon JH, Lee HJ, et al. Efficacy of gastric balloon dilatation and/or retrievable stent insertion for pyloric spasms after pylorus-preserving gastrectomy: retrospective analysis. PLoS One 2015;10:e0144470. https://doi.org/10.1371/journal.pone.0144470

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