A Systematic Review on Intrapyloric Botulinum Toxin Injection for Gastroparesis

Background: Though trials evaluating the effect of intrapyloric botulinum toxin injection on gastroparesis have been reported, there is no agreement whether botulinum toxin can effectively relieve the symptoms and improve the results of gastric emptying study in patients with gastroparesis. We performed a systematic literature review to address this issue. Methods: Databases including PubMed, EMBASE, and the Cochrane Library and Science Citation Index were searched. Two reviewers independently identified relevant trials. Outcome measures were the improvement of subjective symptoms and objective measurement. Results: 15 reports were included; only 2 randomized controlled trials were available. Almost all the non-randomized trials reported significant improvement in subjective symptoms and objective gastric emptying study after botulinum toxin injection. While the 2 randomized controlled trials did not confirm the efficacy of botulinum toxin injection, none of the individual trials showed that there was statistically significant subjective and objective improvement in the active patients when compared with patients receiving placebo. Conclusions: Available high-quality trials showed that intrapyloric botulinum toxin injection could not significantly relieve subjective symptoms and improve objective measurement in patients with gastroparesis, and there is no evidence to recommend botulinum toxin injection for the treatment of gastroparesis. Copyright (C) 2009 S. Karger AG, Basel