Intrapyloric Botulinum Toxin A Injection for Gastroparesis and Functional Upper Gastrointestinal Symptoms in Children: Mayo Clinic Experience, Review of the Literature, and Meta-analysis,Pediatric Drugs

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Intrapyloric Botulinum Toxin A Injection for Gastroparesis and Functional Upper Gastrointestinal Symptoms in Children: Mayo Clinic Experience, Review of the Literature, and Meta-analysis
Pediatric Drugs ( IF 3.4 ) Pub Date : 2022-06-30 , DOI: 10.1007/s40272-022-00518-x
Yamen Ezaizi _{1,

2,

3} , Bashar Hasan ₄ , Mhd Louai Manini ₂ , Imad Absah ₂

Affiliation

Objective

We aimed to assess the efficacy of intrapyloric botulinum toxin A injection (IPBTI) in children with and without gastroparesis and to perform a meta-analysis and review of the literature.

Methods

We retrospectively searched our electronic health records to identify children (aged < 18 years) who underwent an esophagogastroduodenoscopy with IPBTI between 2007 and 2018 for persistent upper gastrointestinal tract symptoms. We included children with and without gastroparesis and excluded children with a history of gastrointestinal surgery, gastrointestinal obstruction, or mucosal disease that could explain their symptoms. A meta-analysis including our study findings was performed.

Results

We identified 20 children (mean [standard deviation] age, 9.7 [5.8] years; 14 [70%] girls) with upper gastrointestinal symptoms who underwent IPBTI at our institution during the study period. Of the 20 children, 17 (85%) underwent gastric emptying scintigraphy, only nine (53%) of whom had gastroparesis. Response to IPBTI was reported in ten children (50%). Response to IPBTI did not differ by the presence of gastroparesis in included children (p = 0.64). Repeated IPBTI was performed in four children who had a response to the first injection; all four reported no benefit from the second IPBTI. There were no reported complications of IPBTI in our cohort. The meta-analysis indicated that 68% (95% confidence interval 59–78) of patients had a response to IPBTI, regardless of the presence of gastroparesis; 66% (95% confidence interval 53–78) of patients who had gastroparesis had a response to IPBTI.

Conclusions

Intrapyloric botulinum toxin A injection is safe in children and can offer transient relief for patients with refractory upper gastrointestinal symptoms with and without gastroparesis.

中文翻译：

幽门内肉毒杆菌毒素 A 注射治疗儿童胃轻瘫和功能性上消化道症状：梅奥诊所经验、文献回顾和荟萃分析

客观的

我们旨在评估幽门内注射 A 型肉毒杆菌毒素 (IPBTI) 在患有和未患有胃轻瘫的儿童中的疗效，并对文献进行荟萃分析和回顾。

方法

我们回顾性地搜索了我们的电子健康记录，以确定在 2007 年至 2018 年期间接受 IPBTI 食管胃十二指肠镜检查的儿童（年龄 < 18 岁）的持续上消化道症状。我们纳入了患有和不患有胃轻瘫的儿童，并排除了有胃肠道手术史、胃肠道梗阻或可以解释其症状的粘膜疾病的儿童。进行了一项包括我们的研究结果的荟萃分析。

结果

我们确定了 20 名儿童（平均 [标准差] 年龄，9.7 [5.8] 岁；14 [70%] 女孩）在研究期间在我们机构接受了 IPBTI 的上消化道症状。在 20 名儿童中，17 名 (85%) 接受了胃排空闪烁扫描，其中只有 9 名 (53%) 患有胃轻瘫。据报道，有 10 名儿童 (50%) 对 IPBTI 有反应。对 IPBTI 的反应并未因纳入儿童胃轻瘫的存在而不同（p= 0.64)。对第一次注射有反应的四名儿童重复进行了 IPBTI；所有四个报告都没有从第二个 IPBTI 中受益。在我们的队列中，没有报告 IPBTI 的并发症。荟萃分析表明，无论是否存在胃轻瘫，68%（95% 置信区间 59-78）的患者对 IPBTI 有反应；66%（95% 置信区间 53-78）的胃轻瘫患者对 IPBTI 有反应。