BACKGROUND/ PURPOSE: Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch. METHODS: Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device. RESULTS: The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001). CONCLUSION: Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
BACKGROUND/ PURPOSE: Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch. METHODS: Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device. RESULTS: The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001). CONCLUSION: Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
Authors: Emma Svensson; Peter Zvara; Niels Qvist; Lars Hagander; Sören Möller; Lars Rasmussen; Henrik Daa Schrøder; Eva Kildall Hejbøl; Niels Bjørn; Súsanna Petersen; Kristine Cederstrøm Larsen; Jan Krhut; Oliver J Muensterer; Mark Bremholm Ellebæk Journal: Int J Surg Protoc Date: 2021-08-11