Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of XXXX .

@entity1318 @entity384 @entity1 @entity1282
As the few randomized controlled trials available in the literature comparing botulinum toxin (BT) injection with established endoscopic treatment of @entity1318 , i.e. @entity384 , showed conflicting results, we conducted a prospective randomized trial. Seventeen consecutive @entity1 with @entity1318 diagnosed during a period between December 1997 and February 2000 were randomized into two treatment groups [ @entity384 by Rigiflex dilator (n=10), BT injection by sclerotherapy needle into four quadrants of lower esophageal sphincter (LES) (n=7) 80 units in five cases, 60 units in two cases] after @entity1282 grading, endoscopy, barium esophagogram, and manometry, all of which were repeated 1 week after treatment. @entity1 were followed up clinically for 35.2+/-14 weeks. Chi-squares, Wilcoxon rank-sum test, Kaplan-Meier method and log-rank tests were used for statistical analysis. After 1 week, 6/7 (86%) BT-treated vs. 8/10 (80%) dilatation-treated @entity1 improved (P=NS). There was no difference in LES pressure and maximum esophageal diameter in the barium esophagogram in the two groups before therapy. Both therapies resulted in significant reduction in LES pressure. The cumulative @entity1282 -free state using the Kaplan-Meier method decreased progressively in BT-treated compared with dilatation-treated @entity1 (P=0.027). Two @entity1 with tortuous megaesophagus, one of whom had failed dilatation complicated by perforation previously, improved after BT. One other @entity1 in whom @entity384 had previously failed improved in a similar manner. BT is as good as @entity384 in achieving an initial improvement in @entity1282 of @entity1318 . It is also effective in @entity1 with tortuous megaesophagus and previous failed @entity384 . However, @entity1282 often recurs during 1-year follow up.
