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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

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Abstract

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.

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Acknowledgments

Alyssa B. Quiggle, Ph.D., Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff at Mayo Clinic provided proofreading and administrative and clerical support.

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Authors and Affiliations

  1. Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

    Yamen Ezaizi

  2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Bashar Hasan

  3. Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Yamen Ezaizi, Mhd Louai Manini & Imad Absah

  4. Pediatric Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Yamen Ezaizi

Authors
  1. Yamen Ezaizi
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  2. Bashar Hasan
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Contributions

BH, IA, MLM, YE: conception and planning of work or acquisition, analysis and interpretation of the data; drafting and/or critical revision of the manuscript; and approving final version of the manuscript.

Corresponding author

Correspondence to Yamen Ezaizi.

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Funding

No external funding was received for the conduct of this study or the preparation of this article.

Conflict of interest

BH, IA, MLM, and YE have no conflicts of interest that are directly relevant to the contents of this study.

Ethics approval

The Mayo Clinic Institutional Review Board approved all aspects of this study.

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Not applicable.

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Not applicable.

Availability of data and material

All relevant data supporting the findings of this study are reported within the article.

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Ezaizi, Y., Hasan, B., Manini, M.L. et al. Intrapyloric Botulinum Toxin A Injection for Gastroparesis and Functional Upper Gastrointestinal Symptoms in Children: Mayo Clinic Experience, Review of the Literature, and Meta-analysis. Pediatr Drugs 24, 539–545 (2022). https://doi.org/10.1007/s40272-022-00518-x

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  • DOI: https://doi.org/10.1007/s40272-022-00518-x

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