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

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.