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Published on: November 9, 2016
Comparison of the Results of Ultrasound-Guided Using Surface Probe and Non-Ultrasound-Guided Botulinum Toxin
Masoud Nazem1, Mehrdad Hosseinpour2, Maryam Riahinezhad3
1Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Ultrasound-guided botulinum toxin (BTX) injections into the internal anal sphincter (IAS) significantly improve constipation recovery in children compared to non-guided injections. This method also reduces fecal incontinence incidence.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Minimally Invasive Procedures
Background:
- Functional bowel obstruction in children can be challenging to treat with botulinum toxin (BTX) injections into the internal anal sphincter (IAS) when performed by palpation alone.
- Ultrasound (US) guidance may improve the accuracy and efficacy of BTX injections into the IAS.
Purpose of the Study:
- To compare the effectiveness of US-guided versus non-US-guided BTX injections into the IAS for treating constipation in children.
- To evaluate the impact of US guidance on constipation recovery and fecal incontinence rates.
Main Methods:
- A single-blind randomized clinical trial involving 40 children with constipation.
- Two groups were formed: one received US-guided BTX injection using a surface probe, the other received non-US-guided BTX injection by palpation.
- Outcomes including constipation recovery and fecal incontinence were assessed at two weeks, one month, and three months post-intervention.
Main Results:
- Constipation recovery rates at two weeks and one month were significantly higher in the US-guided group (95%) compared to the non-US-guided group (70% and 75%, respectively; P < 0.05).
- While the US-guided group showed better recovery at three months, the difference was not statistically significant (P > 0.05).
- The incidence of fecal incontinence was significantly lower in the US-guided group (0%) compared to the non-US-guided group (45% at two weeks, decreasing to 30% at three months; P < 0.05).
Conclusions:
- Ultrasound-guided BTX injection into the IAS using a superficial probe is an effective and safe method for improving constipation recovery in children.
- US guidance enhances treatment efficacy and significantly reduces the occurrence of post-procedural fecal incontinence.
Background:
The injection of botulinum toxin (BTX) into the internal anal sphincter (IAS) can temporarily relieve functional bowel obstruction; however, it can be challenging when performed only by touch. Hence, the present study aimed at comparing the results of ultrasound (US)-guided using surface probe and non-US-guided BTX injection into IAS in children with constipation.
Materials And Methods:
The current single-blind randomized clinical trial was conducted on 40 children with constipation who were divided into two groups. In the first group, US-guided BTX injection into the IAS was performed using a surface probe. In the second group, non-US-guided BTX injection was performed only by touching with the index finger. Then, the recovery of constipation and fecal incontinence was checked in the second week as well as the first and third months after the intervention.
Results:
The constipation recovery after BTX injection in the US-guided group in the second week (95%) and the first month (95%) was significantly more than its recovery in the non-US-guided group in the second week (70%) and the first month (75%) (P value < 0.05). In the third month, although the recovery status in the US-guided group was more than that of the non-US-guided group, this difference was not significant (P value > 0.05). In addition, the incidence of fecal incontinence in the non-US-guided group was reported to be 45%, 40%, and 30% in the second week, the first month, and the third month after BTX, respectively, and no cases were reported in the US-guided group (P value < 0.05).
Conclusions:
US-guided BTX injection using a superficial probe is effective and safe for constipation recovery.
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