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Endoscopy 2023; 55(06): 508-514
DOI: 10.1055/a-1986-4292
Original article

Response to botulinum toxin may predict response to peroral pyloromyotomy in patients with gastroparesis

Vaibhav Wadhwa
1   Center for Interventional Gastroenterology, University of Texas Health Science, Houston, Texas, United States
,
Adalberto Gonzalez 
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Francisco Azar
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Harjinder Singh
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Kapil Gupta
3   Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Hong Liang
4   Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida, United States
,
Alison Schneider
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Jeffery Ponsky
5   Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Tolga Erim
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
John Rodriguez
5   Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Fernando J. Castro
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
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Abstract

Background Patients with gastroparesis who have undergone prior intrapyloric botulinum toxin injection (BTI) may seek an opinion regarding peroral pyloromyotomy (POP). There are only two small reports assessing the role of BTI as a predictor for successful treatment with POP.

Methods We performed a retrospective cohort study to assess whether symptomatic improvement after BTI predicts a response to POP. We included 119 patients who had undergone both BTI and POP at Cleveland Clinic Ohio or Cleveland Clinic Florida from January 2016 to September 2019.

Results 65.5 % of patients had symptomatic improvement after BTI. Gastroparesis Cardinal Symptom Index (GCSI) scores were available for 74 patients, with 64 % achieving a response to POP, defined as a decrease in mean GCSI ≥ 1. In multivariable analysis, response to BTI (odds ratio [OR] 7.7 [95 %CI 2.2–26.1]) and higher pre-POP GCSI score (OR 2.3 [95 %CI 1.2–4.6]) were independent predictors of response to POP.

Conclusions Clinical improvement after BTI is a predictor of response to POP in patients with gastroparesis. This information may aid in improving patient selection for POP.

Tables 1 s–7 s



Publication History

Received: 20 February 2022

Accepted after revision: 23 November 2022

Accepted Manuscript online:
23 November 2022

Article published online:
10 February 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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