Endoscopic Ultrasound-Guided Botox Injection for Refractory Anal Fissure

• Published in: Journal of clinical medicine 2022-10, Vol.11 (20), p.6207
• Main Authors: Randhawa, Navkiran, Khalyfa, Ahamed, Aslam, Rida, Roebuck, M Christopher, Inam, Mahnoor, Ayub, Kamran
• Format: Article
• Language: English
• Subjects: Anus; Botulinum toxin; Consent; Defecation; Endoscopy; Ischemia; Narcotics; Pain; Patients; Review boards; Ultrasonic imaging; Visualization
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11206207

Background: Anal fissures cause severe pain and can be difficult to treat. Medical therapy is initially used, followed by sigmoidoscopy-guided botox injections if the medical therapy is not successful. With this technique, however, it is not clear whether botox is injected into the muscle layer or submucosa. Aim: To evaluate the efficacy of EUS-guided botox injection directly into the internal sphincter. Methods: Consecutive patients with chronic anal fissure refractory to conventional endoscopic botulinum toxin type A injection were enrolled in the study. EUS was performed using a linear array echoendoscope, and a 25 G needle was used to inject botox. All patients were followed up at one- and two-month intervals. Results: Eight patients with chronic anal fissures were included in the study. Six patients had an excellent response to botox at the two-month interval using a visual analog pain scale, while one patient had a moderate response with a pain score reduction of 40%. One patient had no response. No complications were noted. An improvement in visual analog scale (pre-score > post-score) was statistically significant at the p < 0.01 level. Conclusion: EUS-guided botox injection into the internal sphincter appears to be a promising technique for patients with refractory anal fissure with pain.