In-office transnasal esophagoscope-guided botulinum toxin injection of the lower esophageal sphincter.

Abstract:

PURPOSE OF REVIEW:Thin caliber transnasal esophagoscopes allow for a rapidly expanding array of office-based esophageal procedures, including botulinum toxin injections, in unsedated patients. RECENT FINDINGS:While botulinum toxin has been used in the esophagus and lower esophageal sphincter for many years, there is no current description of performing this procedure in an unsedated patient using transnasal esophagoscopy. Indications include achalasia, hypertensive lower esophageal sphincter, distal esophageal spasm, nutcracker esophagus and obstructing muscular rings. There is a paucity of data in the literature pertaining to spastic esophageal motility disorders and muscular rings. Randomized controlled trials of achalasia treatments suggest that botulinum toxin injections should be reserved for patients who are poor surgical candidates and/or have failed pneumatic dilation. SUMMARY:In-office transnasal esophagoscopy-guided lower esophageal sphincter botulinum toxin injection has not been described in the literature. Indications include esophageal spasm, muscular rings and achalasia, with recent data suggesting that botulinum toxin should not be an initial therapy for most patients with achalasia.

authors

Rees CJ

doi

10.1097/MOO.0b013e3282f1bf39

subject

Has Abstract

pub_date

2007-12-01 00:00:00

pages

409-11

issue

6

eissn

1068-9508

issn

1531-6998

pii

00020840-200712000-00008

journal_volume

15

pub_type

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