EVALUATION OF BOTULINUM TOXIN INJECTION AS A BRIDGE THERAPY TO PERORAL ENDOSCOPIC MYOTOMY.

Abstract

Objectives: To evaluate whether botulinum toxin injection (BTI) prior to peroral endoscopic myotomy (POEM) in patients with esophageal motility disorders affects POEM feasibility, safety, and efficacy.

Patients and methods: Single-center retrospective analysis of consecutive POEM performed from July 2019 to July 2024 with ≥ 6-month follow-up. POEM indications were achalasia (97%) and esophagogastric junction outflow obstruction (EGJOO) (3%). Clinical success (Eckardt score [ES] post-POEM ≤3), technical success, safety, submucosal fibrosis in lower esophageal sphincter and adverse events (AE) (bleeding, capnoperitoneum and mucosal defects) were compared between two groups: A) patients with BTI prior to POEM, and B) patients whom POEM was the first treatment.

Results: A total of 69 POEM were performed. Indications included type I achalasia (n=10), type II (n=43), type III (n=14) and EGJOO (n=2). A) 10 patients with prior BTI, and B) 59 treatment-naïve patients. There were no significant differences in baseline characteristics between groups. The specific indication for BTI as bridging therapy was 30%. Clinical success was comparable, 100% in the BTI group vs 96% in treatment-naïve group (p=1). Submucosal fibrosis was more frequently observed in patients with previous LES BTI, however, this difference was not statistically significant: 30% in prior BTI vs 11.6% in naïve, p= 0.26. AE rates were comparable in both groups.

Conclusion: BTI appears to be a suitable bridging therapy for patients awaiting POEM, without adversely affecting its feasibility, safety, and efficacy.