Intraoperative Pyloric Botulinum Toxin Injection for Post Total Pancreatectomy With Islet Autotransplantation...

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Endocrinology

Background:

• Acute Recurrent Pancreatitis (ARP) and Chronic Pancreatitis (CP) significantly impact children's quality of life, leading to pain and malnutrition.
• Total Pancreatectomy with Islet Autotransplantation (TPIAT) is a last resort for severe pancreatitis, but surgery can worsen gastroparesis.
• Botulinum toxin (BT) injections are a potential treatment for pediatric gastroparesis.

Purpose of the Study:

• To evaluate the efficacy of pyloric Botulinum toxin (BT) injections in managing post-operative gastroparesis in pediatric patients undergoing TPIAT.
• To compare outcomes between pediatric TPIAT patients who received BT injections and those who did not.

Main Methods:

• A retrospective cohort study (Level of Evidence: III) compared 20 pediatric patients who received pyloric BT during TPIAT with 20 who did not.
• Outcomes assessed included time to full oral nutrition, weight change, emesis days, gastrostomy tube dependence, and length of stay.
• Patients underwent TPIAT between 2021 and 2023.

Main Results:

• Patients receiving BT injections achieved full oral nutrition significantly faster (29.4 vs. 40.9 days, p < 0.01) and required fewer gastrostomy tube days (7.2 vs. 10.1 days, p < 0.01).
• No significant differences were observed in emesis days, percent weight change at discharge, or length of stay between the groups.
• The study population predominantly consisted of patients with Chronic Pancreatitis (80% in the BT group, 65% in the non-BT group).

Conclusions:

• Pyloric BT injections appear to be a promising intervention for mitigating postoperative gastroparesis symptoms in pediatric TPIAT patients.
• This study represents the first pediatric investigation into the impact of BT on gastroparesis morbidity following TPIAT.
• Further research is warranted to confirm these findings in a larger cohort.