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Background

Pyloric dysfunction contributes to post-operative nausea in bariatric patients. While botulinum toxin injection into the pylorus has been shown to be an effective drainage strategy after esophagectomy, published data supporting this technique after bariatric surgery remains limited. The purpose of this study was to determine if botulinum toxin injection into the pylorus provided relief of symptomatic pyloric dysfunction after bariatric surgery.

Methods

Our institutional database was queried for all patients undergoing esophagogastroduodenoscopy with injection of botulinum toxin into the pylorus. All patients had a history of bariatric surgery. Demographics, clinical factors, and outcomes were evaluated retrospectively for all patients.

Results

We identified 93 patients meeting inclusion criteria from January 1, 2019 to January 30, 2021. Of these patients, 63 (67.7%) had a duodenal switch, 12 (12.9%) had a conversion of a roux en Y gastric bypass to switch, and 18 (19.4%) had a sleeve gastrectomy. 66 (71.0%) patients underwent concurrent dilation. 67 (72.0%) patients reported improvement of their symptoms.

Conclusions

Botulinum toxin injection into the pylorus is effective in symptomatic relief of pyloric dysfunction after bariatric surgery. Further study is needed to better define the patient population, optimal timing, cost effectiveness, and alternative treatments.