Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis

Gastrointest Endosc. 2005 Jun;61(7):833-9. doi: 10.1016/s0016-5107(05)00328-7.


Background: Botulinum toxin A injected into the pyloric sphincter has been reported in small case series to treat gastroparesis. This study reviews the use of this treatment in a large number of patients with gastroparesis.

Methods: Patients who underwent pyloric botulinum injection for treatment of gastroparesis were identified. Response was defined as improvement or resolution of the patient's major symptom and/or two minor symptoms for 4 weeks.

Results: Of 115 patients treated, 63 patients met the study criteria. There were 53 women, 10 men, mean age 42 years. Most patients (56%) had idiopathic gastroparesis. Twenty-seven of 63 (43%) patients experienced a symptomatic response to treatment. By stepwise logistic regression, male gender was associated with response to treatment (OR 3.27: 95% CI[1.31, 8.13], p = 0.01). Vomiting as a major symptom was associated with a lack of response (OR 0.16: 95% CI[0.04, 0.67], p = 0.01). Despite the association of male gender with response, the mean duration of response for those patients responding, with a minimum of 3 months' follow-up was 4.9 months (+/-2.7 months) for women and 3.5 months (+/-0.71 months) for men (p = 0.59). The corresponding medians and interquartile ranges (IQR) were 5 (IQR 3-6) for females and 3.5 (IQR 3-4) for males.

Conclusions: Of the patients, 43% had a response to botulinum toxin treatment that lasted a mean of approximately 5 months. Male gender was associated with a response to this therapy; however, durability of response was unrelated to gender. Vomiting as a major symptom predicted no response.

MeSH terms

  • Abdominal Pain / drug therapy
  • Adolescent
  • Adult
  • Aged
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / therapeutic use*
  • Endoscopy, Digestive System*
  • Female
  • Follow-Up Studies
  • Gastric Emptying / drug effects
  • Gastroparesis / drug therapy*
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Nausea / drug therapy
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / therapeutic use*
  • Pylorus / pathology*
  • Remission Induction
  • Retrospective Studies
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • Vomiting / drug therapy


  • Neuromuscular Agents
  • Botulinum Toxins, Type A