Omar Tageldin, MD, Muhammad Farhan Ashraf, MBBS, Yousef Nassar, MD, Asra Batool, MD; Albany Medical Center, Albany, NY
Introduction: Gastroparesis (GP) is one of the common conditions managed by Gastroenterologists. GP is defined as delayed gastric emptying without anatomical obstruction. Common causes of GP are diabetes mellitus (DM), post-gastric surgery due to vagal nerve injury or idiopathic. Management of GP can be challenging particularly after failure of dietary modifications and medical therapies. Endoscopic Botulinum toxin A injection is now considered in the management of refractory GP. Our study aimed to assess the subjective response to intrapyloric endoscopic Botox injection in refractory GP patients. Methods: Adult patients (≥18 years) with refractory GP who underwent one or more Botox injection at Albany Medical Center gastroenterology department from 10/2014 to 10/2019 were included in this study. Using CPT codes, 43 patients were identified in the EMR. Five of these patients were excluded as their age was < 18 at time of injection. Electronic charts were reviewed to assess documented response of the injection. Patients who did not follow up after the injection were contacted via phone and consent was obtained by the phone to assess for their response to this therapy. Results: Our analysis included 38 patients with GP refractory to medical management who underwent Botox injection. Patient’s ages ranged between 18 to >89 years old and the male to female ratio was 1:6.6. 12 patients had diabetic GP, 3 had post-surgical and 23 had idiopathic GP. 13 patients had more than one injection. 27 (71%) patients reported subjective symptoms improvement while 8 (21%) reported no improvement after the injection. 16/23 (69.6%) patients with idiopathic GP reported improvement of symptoms. 9/12 (75%) patients with diabetic GP reported improvement. 2/3 (66.7%) patients with post-surgical GP reported improvement. When comparing the response of patients to Botox injection with diabetic GP compared to other etiologies of gastroparesis, there was no significant difference (71% vs 69.6% P=0.71). Discussion: Intrapyloric endoscopic Botox injection is a safe, minimally invasive technique in management of refractory GP patients. Our retrospective study showed promising results in these patients, showing there is no difference in response between patients with diabetic and nondiabetic GP to Botox injection and is effective in both groups. Although it’s not recommended yet by GI societies, we believe it can be considered in refractory GP awaiting further large randomized controlled studies.
Disclosures: Omar Tageldin indicated no relevant financial relationships. Muhammad Farhan Ashraf indicated no relevant financial relationships. Yousef Nassar indicated no relevant financial relationships. Asra Batool indicated no relevant financial relationships.