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Volk A, Distler M, Müssle B, et al. Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula. Innov Surg Sci. 2018;3(1):69-75doi: 10.1515/iss-2017-0040.
Volk, A., Distler, M., Müssle, B., Berning, M., Hampe, J., Brückner, S., Weitz, J., & Welsch, T. (2018). Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula. Innovative surgical sciences, 3(1), 69-75. https://doi.org/10.1515/iss-2017-0040
Volk, Andreas, et al. "Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula." Innovative surgical sciences vol. 3,1 (2018): 69-75. doi: https://doi.org/10.1515/iss-2017-0040
Volk A, Distler M, Müssle B, Berning M, Hampe J, Brückner S, Weitz J, Welsch T. Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula. Innov Surg Sci. 2018 Jan 18;3(1):69-75. doi: 10.1515/iss-2017-0040. eCollection 2018 Mar. PMID: 31579768; PMCID: PMC6754046.
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Innov Surg Sci. 2018 Jan 18;3(1):69-75. doi: 10.1515/iss-2017-0040. eCollection 2018 Mar.

Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula.

Innovative surgical sciences

Andreas Volk, Marius Distler, Benjamin Müssle, Marco Berning, Jochen Hampe, Stefan Brückner, Jürgen Weitz, Thilo Welsch

Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  2. Department of Internal Medicine, Section of Gastroenterology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  3. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Dresden, Fetscherstraße 74, 01307 Dresden, Germany.

PMID: 31579768 PMCID: PMC6754046 DOI: 10.1515/iss-2017-0040

Abstract

BACKGROUND: A postoperative pancreatic fistula (POPF) is the most common and potentially life-threatening surgical complication in pancreatic surgery. One possible pharmacological treatment could be the endoscopic injection of botulinum toxin (BTX) into the sphincter of Oddi to prevent POPF. Promising data reported a significantly reduced rate of clinically relevant POPF. We analyzed the effect of BTX injection in our patients undergoing distal pancreatectomy (DP).

METHODS: A retrospective analysis of patients undergoing DP was performed. Patients with preoperative endoscopic injection of BTX into the sphincter of Oddi were included. The end points were postoperative outcomes including POPF. BTX patients were compared with a historical cohort and matched in a 1:1 ratio using a propensity score analysis.

RESULTS: A total of 19 patients were treated with endoscopic injection of BTX before open (n=8) or laparoscopic (n=11) DP. The median age of the patients was 67 years and the mean body mass index was 25.9 kg/m

CONCLUSION: The present study could not reproduce the published results of a significant lowering of grade B/C POPF. The explanations could be the timing of BTX injection before surgery and the endoscopic technique of BTX injection. However, the conflicting results after BTX injection in two high-volume centers prompt a randomized controlled multicenter trial with trained endoscopists.

©2018 Volk A., et al., published by De Gruyter, Berlin/Boston.

Keywords: botulinum toxin injection; distal pancreatectomy; postoperative pancreatic fistula

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