Comparison between Pneumatic Balloon Dilation and Intrasphincteric Injection of Botulinum Toxin for Treatment of Achalasia

song, Chi Wook; Um, Soon Ho; Hyun, Jin Hai

Abstract

BACKGROUND/AIMS: Preliminary studies have suggested that intrasphincteric injection of the lower esophageal sphincter(LES) with botulinum toxin(BoTx) is a safe and effective alternative to pneumatic balloon dilation(BD) in the treatment of achalasia. We have compared the efficacy between BoTx and BD in an ongoing prospective study.
METHODS
In a randomized trial, 16 patients with achalasia received either intrasphincteric injection of BoTx(100 units) or BD(Rigiflex 3.0 cm in diameter). Among 8 patients treated with BoTx, 3 to them had been treated unsuccessfu]- ly beforehand with BD. After one month and after three months, Treatment responses were assessed on the basis of changes in the symptom scores and parameters of esophageal manometric study.
RESULTS
Both BoTx without prior BD(n=5) and BD group(n=8) showed a decreased symptom score, LES pressure and gastroesophageal pressure gradient(GEPG) at 1 month also decreased. LES pressure at 3 months increased in the BoTx group. No patient treated within the BD group failed at 3 months, but 1(20%)patient in the BoTx without previous BD did fail. The failed BoTx group with prior BD didnt show a decreased symptom score. LES pressure and GEPG also didnt decrease and 2(66.7%) patients failed at 3 months after treatment. No significant complications were seen in both the BoTx and the BD group.
CONCLUSIONS
Both BoTx injection and BD were effective treatments for achalasia. BD may provide a more effective long term treatment, as compared to BoTx, for achalasia. However BoTx injection in patients who failed prior BD showed a poor response and a high failure rate. Long term evaluation of safety and efficacy will be required to fully understand the utility of BoTx injection vs BD for achalasia.