Korean Journal of Gastrointestinal Endoscopy 1997;17(6): 750-759.
원저 : 식도 위장관 ; 일차성 식도 이완 불능증에서 내시경적 보툴리늄 독소 주입 치료의 평가 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Trial of Endoscopic Botulinum Toxin Injection for the Treatment of Primary Achalasia )
함정식, 장재영, 최우봉, 임희혁, 홍수진, 문종호, 조영덕, 김진오, 조주영, 김연수, 이준성, 이문성, 황성규, 심찬섭 (Jeong Sik Ham, Jae Young Jang, Woo Bong Choi, Hee Hyeok Lim, Su Jin Hong, Jong Ho Moon, Young Duk Cho, Jin Oh Kim, Joo Young Cho, Yoen Soo Kim, Joon Seong Lee, Moon Sung Lee, Sung Kyu Whang and Chan Sup Shim)
Abstract
Primary achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. Traditional treatment methods are balloon dilatation and myotomy, but these methods have critical complications and even fatal including esophageal perforation, gastroesophageal reflux, and continuing dysphagia. Botulinum toxin, which has been used for dystonias of skeletal muscles, is presented as a new alternative treatment method for achalasia, aimed to lowering of LES pressure by Pasricha et al. They also reported that endoscopic botulinum toxin injection into LES was effective, safe, and simple method without any significant complication. We report 7 cases of primary achalasia treated with endoscopic botulinum toxin injection, who showed clinical improvement without any complication. We compared results of pre-treatment with those of post-treatment using botulinum toxin in the aspects of clinical, radiological, manometrical recording in these cases. Symptomatic improvement was shown in 4 cases(57.1%), symptom score was decreased from 7.43+- 0.53 to 4.43+- 2.51(p=0.03), The luminal diameter at esophagogastric junction increased from a mean of 3.21+-> 0,99 mm to 5.14+- 0.90 mm (p=0.015), and luminal diameter at esophageal body decreased from a mean of 40.29+- 19.37 mm to 32.71+-15.45 mm (p=0.015). In follow up manometric recording, peristaltic waves at the body were recovered in 2 cases(28.6%), gastroesophageal pressure gradient(AP) was non-significantly decreased from 6.30+-4.0 mmHg to 3.12+-4.47 mmHg (p=0.45). One patient complained of transient chest pain within one hour after the botulinum toxin injection, but she did not need any medication. We concluded that botulinum injection was a simple, safe, and effective therapeutic method for primary achalasia, even though further evaluatian should be performed in the much more cases and the results of long term follow-up, and cost-effectiveness of this method. (Korean J Gastrointest Endosc 17: 750-759, 1997)
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