Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

Aim: To evaluate the technical feasibility, safety, and short-term efficacy of botulinum toxin injection for pancreatic sphincter of Oddi dysfunction and to analyse whether the symptomatic response to botulinum toxin might be a predictor of outcome for endoscopic sphincterotomy. Methods: Fifteen consecutive patients (nine female, aged 38 +/- 12 years) w ith frequent attacks (median four) of acute pancreatitis within 6 months, a nd manometrically proven pancreatic sphincter of Oddi dysfunction underwent endoscopic injection of 100 units of botulinum toxin into the major papill a. All patients underwent prospective follow-up thereafter and in cases of recurrent pancreatitis manometry this was repeated and pancreatic sphincter otomy was performed. Results: No side-effects occurred after botulinum toxin injection in any pa tient. Within 3 months after botulinum toxin treatment, 12 out of 15 patien ts remained asymptomatic (80% primary response). Only one out of three pati ents without symptomatic benefit showed continued elevated pancreatic sphin cter pressure at manometry and only this patient benefited from pancreatic sphincterotomy later on. Eleven of the 12 patients initially responding to botulinum toxin injection developed a symptomatic relapse 6 +/- 2 months af ter botulinum toxin treatment. These patients then achieved long-term clini cal remission from pancreatic or combined (biliary and pancreatic, n=5) sph incterotomy (median follow-up, 15 months). Conclusion: Endoscopic botulinum toxin injection into the papilla of Vater is a safe procedure for treatment of pancreatic sphincter of Oddi dysfuncti on that may provide short-term relief in about 80% of the patients. Those p atients who respond to botulinum toxin may subsequently gain definitive cur e from sphincterotomy.