Postsurgical Refractory Gastroparesis: Response to Botulinum Toxin Therapy

Gastroparesis is a complex dysmotility disorder characterized by chronic dyspepsia and delayed gastric emptying in the absence of mechanical obstruction. Postsurgical gastroparesis is the third most common cause and accounts for 13% of total cases. Studies have shown that catheter ablation procedures for atrial fibrillation can rarely result in gastroparesis, secondary to damage to the vagus nerve. Once the diagnosis is confirmed, treatment options include: dietary management, prokinetic drugs, and new invasive treatments. Botulinum toxin injection is an emerging pyloric intervention, increasingly used in the management of gastroparesis refractory to pharmacological therapy. It is given as an injection into the pyloric sphincter, with the help of an endoscope. Botulinum toxin acts by inhibiting smooth muscle contraction through a decreased response to acetylcholine. Here we report a case of postsurgical gastroparesis that responded well to botulinum toxin therapy.