ENDOSCOPIC INTRASPHINCTERIC INJECTION OF BOTULINUM TOXIN FOR THE TREATMENT OF ACHALASIA

Three patients with achalasia were treated with endoscopic injection o f botulinum toxin (BoTx). BoTx (80 U) was injected via a sclerotherapy needle into the lower esophageal sphincter (LES). One patient complai ned of transient heartburn that resolved after omeprazole treatment. T wo patients reported sustained symptomatic improvement. They were able to eat normally 48 h after treatment and have remained symptom free f or 5 and 6.5 months, respectively. In these patients, esophageal manom etry 4 months after treatment showed a marked reduction of resting LES pressure and the appearance of a previously absent LES relaxation aft er swallowing. The third patient had only a transient clinical improve ment, with occasional dysphagia beginning 3 months after treatment. Al l patients showed unchanged aperistalsis of the esophageal body. Its l ess invasive nature compared with other therapeutic alternatives may g ive BoTX injection a role in the treatment of some patients with achal asia.