Botulinum Toxin as a Treatment for Refractory Gastroparesis: a Literature Review

Gastroparesis (GP) is a disorder of gastrointestinal motility which leads to delayed gastric emptying in the absence of mechanical obstruction. Treatment is limited as many patients are refractory to dietary modification and the use prokinetic medications carry significant adverse risks. These limitations necessitate more research into experimental therapies. The purpose of this article is to summarize the known information and guidelines on the diagnosis and management of GP and to review the latest literature on experimental treatments.

Based on the current available literature, there is conflicting data regarding the efficacy of intra-pyloric botulinum injections (IPBIs) for refractory gastroparesis. There have been many open-label trials showing good clinical response, but the only two randomized controlled trials on the matter showed no objective improvement gastric emptying studies. However, both studies were likely underpowered and changes in gastric emptying may not correlate with symptom improvement. As such, these discouraging findings should not be used to exclude botox from the armamentarium of therapies for refractory GP. More large-scale, double-blinded, multicenter randomized control trials are needed to further validate the long-term efficacy and safety of IPBI, as well as gastric peroral endoscopic myotomy (G-POEM), as compared to gastric electrical stimulation (GES) or surgical intervention (i.e., laparoscopic pylorotomy) for refractory gastroparesis.