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Related Experiment Videos

Botulinum toxin injection after biliary sphincterotomy.

A Gorelick1, J Barnett, W Chey

  • 1Connecticut Gastroenterology Consultants, PC, New Haven, Connecticut, USA.

Endoscopy
|February 7, 2004
PubMed
Summary

Botulinum toxin injections may reduce pancreatitis risk after biliary sphincterotomy in patients with sphincter of Oddi dysfunction (SOD). This study found a trend toward fewer pancreatitis cases with botulinum toxin compared to a saline placebo.

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Area of Science:

  • Gastroenterology
  • Endoscopic procedures
  • Sphincter of Oddi dysfunction

Background:

  • Endoscopic biliary sphincterotomy for Sphincter of Oddi dysfunction (SOD) carries a high risk of post-ERCP pancreatitis.
  • This risk may stem from persistent pancreatic sphincter hypertension.
  • Botulinum toxin is explored as a method to temporarily alleviate this hypertension.

Purpose of the Study:

  • To investigate if botulinum toxin injection can reduce pancreatic sphincter hypertension.
  • To assess the efficacy of botulinum toxin in lowering the incidence of post-ERCP pancreatitis in SOD patients.

Main Methods:

  • Patients with suspected biliary SOD undergoing ERCP with manometry were enrolled.
  • Those with elevated pressures received either botulinum toxin or a saline sham injection post-biliary sphincterotomy.

Related Experiment Videos

  • Botulinum toxin (50 units) was injected into the pancreatic sphincter.

    • Main Results:

    • 26 patients with elevated pressures were randomized: 12 to botulinum toxin, 14 to sham.
    • Pancreatitis occurred in 3/12 (25%) in the botulinum toxin group versus 6/14 (43%) in the sham group.
    • The difference in pancreatitis rates was not statistically significant (P = 0.34).

    Conclusions:

    • Biliary sphincterotomy in SOD patients without pancreatic protection is risky.
    • Botulinum toxin injection post-biliary sphincterotomy is feasible and safe.
    • A trend towards reduced post-ERCP pancreatitis was observed, warranting further investigation.