Role of rectal biopsy in predicting response to intrasphincteric botulinum toxin injection for obstructive symptoms after a pullthrough operation.

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dc.contributor.authorHosseini, Seyed Mohammad Vahiden_US
dc.contributor.authorForoutan, Hamid Rezaen_US
dc.contributor.authorBahador, Alien_US
dc.contributor.authorKhosravi, Mohammad Bagheren_US
dc.contributor.authorGeramizadeh, Bitaen_US
dc.contributor.authorSabet, Babaken_US
dc.contributor.authorZeraatian, Samen_US
dc.contributor.authorRazmi, Tannazen_US
dc.contributor.authorBanani, Seyed Javaden_US
dc.date.accessioned2008-05-13en_US
dc.date.accessioned2009-05-29T03:18:19Z
dc.date.available2008-05-13en_US
dc.date.available2009-05-29T03:18:19Z
dc.date.issued2008-05-13en_US
dc.description.abstractOBJECTIVE: Our aim was to correlate the pathological results and clinical response in patients who underwent botulinum toxin (BT) injection for obstructive symptoms (OS) after a pullthrough operation for Hirschsprung's disease (HD). METHODS: Between August 2002 and February 2006, 16 of 107 HD patients (15%) were referred with persistent OS after pull-through (PT) operation in this center. They underwent rectal biopsy and BT injection in the internal sphincter. Their responses to BT injection were evaluated by the constipation score before, and at 1, 3 and 8 months after the injection, and anorectal manometry (ARM) before and at 2 weeks, and 1 and 8 months after the injection. The association between response to BT and acetylcholinesterase (AChE) staining of rectal biopsy was also assessed. RESULTS: Fourteen of 16 patients (87%) had improvement in bowel function after 2 weeks, and two patients did not respond at all. Six of the 14 patients with early response had recurrence of symptoms after 2-3 months. Eight patients with normal ganglia and negative AChE had good response with no recurrence on follow-up. However, 4 of 6 recurrences were neurogenic dysfunctions and 2 were intestinal neuronal dysplasia (2-4+AChE). Two patients with no response had an aganglionic segment (4+AChE). Four of 6 patients with recurrence showed improvement with BT re-injection and only 2 did not improve. CONCLUSION: A higher degree of AChE staining is associated with lack of response to BT injection. This is also a test for predicting the severity of neurogenic dysfunction in the intestinal wall.en_US
dc.description.affiliationDepartment of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. psrg.sums@yahoo.comen_US
dc.identifier.citationHosseini SM, Foroutan HR, Bahador A, Khosravi MB, Geramizadeh B, Sabet B, Zeraatian S, Razmi T, Banani SJ. Role of rectal biopsy in predicting response to intrasphincteric botulinum toxin injection for obstructive symptoms after a pullthrough operation. Indian Journal of Gastroenterology. 2008 May-Jun; 27(3): 99-102en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/65179
dc.language.isoengen_US
dc.source.urihttps://www.indianjgastro.comen_US
dc.subject.meshAcetylcholinesterase --metabolismen_US
dc.subject.meshAnal Canalen_US
dc.subject.meshBiopsyen_US
dc.subject.meshBotulinum Toxin Type A --therapeutic useen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshCohort Studiesen_US
dc.subject.meshConstipation --etiologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHirschsprung Disease --enzymologyen_US
dc.subject.meshHumansen_US
dc.subject.meshInjections, Intramuscularen_US
dc.subject.meshIntestinal Obstruction --etiologyen_US
dc.subject.meshMaleen_US
dc.subject.meshNeuromuscular Agents --therapeutic useen_US
dc.subject.meshPostoperative Complicationsen_US
dc.subject.meshPredictive Value of Testsen_US
dc.subject.meshRectum --pathologyen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleRole of rectal biopsy in predicting response to intrasphincteric botulinum toxin injection for obstructive symptoms after a pullthrough operation.en_US
dc.typeJournal Articleen_US
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