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Related Experiment Video

Updated: Aug 23, 2025

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Endoscopic Ultrasound-Guided Botox Injection for Refractory Anal Fissure.

Navkiran Randhawa1, Ahamed Khalyfa2, Rida Aslam3

  • 1Department of Internal Medicine, Pacific Northwest University of Health Sciences, Yakima, WA 98901, USA.

Journal of Clinical Medicine
|October 27, 2022
PubMed
Summary
This summary is machine-generated.

Endoscopic ultrasound-guided botulinum toxin type A injections effectively treat chronic anal fissures. This precise method targets the internal sphincter, offering significant pain relief for refractory cases.

Keywords:
EUSanal fissurebotoxendoscopy

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Medical Imaging

Background:

  • Anal fissures are painful and challenging to treat, often requiring medical therapy or conventional botulinum toxin type A injections.
  • Current endoscopic botulinum toxin type A injection methods lack precision regarding the injection site within the anal sphincter.
  • Uncertainty exists whether conventional injections target the muscle layer or submucosa.

Purpose of the Study:

  • To assess the effectiveness of endoscopic ultrasound (EUS)-guided botulinum toxin type A injections directly into the internal anal sphincter.
  • To evaluate EUS-guided botulinum toxin type A as a treatment for chronic anal fissures refractory to standard therapies.

Main Methods:

  • A cohort of patients with chronic anal fissures, unresponsive to conventional treatments, was enrolled.
  • Endoscopic ultrasound (EUS) was utilized with a linear array echoendoscope and a 25-gauge needle for precise botulinum toxin type A delivery.
  • Patients were monitored at one- and two-month intervals post-injection.

Main Results:

  • Six out of eight patients experienced excellent pain relief at two months, measured by the visual analog scale.
  • One patient showed a moderate response with a 40% reduction in pain scores.
  • No complications were reported, and the reduction in visual analog scale scores was statistically significant (p < 0.01).

Conclusions:

  • Endoscopic ultrasound-guided botulinum toxin type A injection into the internal sphincter is a potentially effective and safe treatment for refractory chronic anal fissures.
  • This technique offers a precise approach for delivering botulinum toxin type A, improving pain management in patients with anal fissures.