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Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia.
J Pediatr Surg. 2017 Jan; 52(1):74-78.JP

Abstract

PURPOSE

Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance.

METHODS

We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05.

RESULTS

Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05).

CONCLUSIONS

US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation.

LEVEL OF EVIDENCE

III.

Authors+Show Affiliations

Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA. Electronic address: jchurc@med.umich.edu.Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27836361

Citation

Church, Joseph T., et al. "Ultrasound-guided Intrasphincteric Botulinum Toxin Injection Relieves Obstructive Defecation Due to Hirschsprung's Disease and Internal Anal Sphincter Achalasia." Journal of Pediatric Surgery, vol. 52, no. 1, 2017, pp. 74-78.
Church JT, Gadepalli SK, Talishinsky T, et al. Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia. J Pediatr Surg. 2017;52(1):74-78.
Church, J. T., Gadepalli, S. K., Talishinsky, T., Teitelbaum, D. H., & Jarboe, M. D. (2017). Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia. Journal of Pediatric Surgery, 52(1), 74-78. https://doi.org/10.1016/j.jpedsurg.2016.10.023
Church JT, et al. Ultrasound-guided Intrasphincteric Botulinum Toxin Injection Relieves Obstructive Defecation Due to Hirschsprung's Disease and Internal Anal Sphincter Achalasia. J Pediatr Surg. 2017;52(1):74-78. PubMed PMID: 27836361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia. AU - Church,Joseph T, AU - Gadepalli,Samir K, AU - Talishinsky,Toghrul, AU - Teitelbaum,Daniel H, AU - Jarboe,Marcus D, Y1 - 2016/10/27/ PY - 2016/10/01/received PY - 2016/10/20/accepted PY - 2016/11/12/pubmed PY - 2017/2/17/medline PY - 2016/11/13/entrez KW - Botulinum toxin (BoTox) KW - Obstructive defecation KW - Ultrasound SP - 74 EP - 78 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 52 IS - 1 N2 - PURPOSE: Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance. METHODS: We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05. RESULTS: Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05). CONCLUSIONS: US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation. LEVEL OF EVIDENCE: III. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/27836361/Ultrasound_guided_intrasphincteric_botulinum_toxin_injection_relieves_obstructive_defecation_due_to_Hirschsprung's_disease_and_internal_anal_sphincter_achalasia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(16)30484-5 DB - PRIME DP - Unbound Medicine ER -