Systematic review of endoscopic botulinum toxin injections for refractory gastroparesis

Endoscopic botulinum toxin injections (EBTI) are used to treat refractory gastroparesis in various patient populations, but their use still needs to be standardized. The PubMed, Web of Science, and Cochrane databases were searched for studies focusing on using endoscopic, intrapyloric botulinum toxin injections to treat refractory gastroparesis. Reports published more than 5 years ago and studies that evaluated EBTI in conjunction with another treatment were excluded. Case reports were included in this analysis due to the limitations of recently published literature. 57 unique citations were identified and screened, and 31 items were excluded based on the pre-determined exclusion criteria. Of the remaining 26 citations, 6 items met the criteria for final review. Most reports determined that EBTI is promising as a treatment for refractory gastroparesis, but concluded that further, large-scale, randomized control trials should be performed before a definitive conclusion can be made. Our search also found that using EBTI to prevent refractory delayed gastric emptying is a questionable practice and should be used with caution at this time. According to reports published in the past 5 years, it appears that EBTI is an effective treatment for refractory gastroparesis. However, a significant amount of additional investigation is needed before EBTI can be widely recommended as an effective treatment for gastroparesis. Additional large-scale randomized, controlled trials should be conducted as there is insufficient data on the topic to make definitive conclusions.