High-dose versus low-dose botulinum toxin in anal fissure disease

P. Ravindran, D. L. Chan, C. Ciampa, R. George, G. Punch, S. I. White

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Background: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. Methods: A retrospective case–control study was performed at a single institution over a 6-year period (2009–2014). Patients given high-dose (80–100 IU) BT were compared to low-dose (20–40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. Results: One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4–52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. Conclusions: In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.

Original languageEnglish
Pages (from-to)803-808
Number of pages6
JournalTechniques in Coloproctology
Volume21
Issue number10
DOIs
Publication statusPublished - 1 Oct 2017

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Fissure in Ano
Botulinum Toxins
Recurrence
Injections
Patient Satisfaction
Telephone
Multivariate Analysis
Retrospective Studies
Therapeutics

Cite this

Ravindran, P., Chan, D. L., Ciampa, C., George, R., Punch, G., & White, S. I. (2017). High-dose versus low-dose botulinum toxin in anal fissure disease. Techniques in Coloproctology, 21(10), 803-808. https://doi.org/10.1007/s10151-017-1700-2
Ravindran, P. ; Chan, D. L. ; Ciampa, C. ; George, R. ; Punch, G. ; White, S. I. / High-dose versus low-dose botulinum toxin in anal fissure disease. In: Techniques in Coloproctology. 2017 ; Vol. 21, No. 10. pp. 803-808.
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Ravindran, P, Chan, DL, Ciampa, C, George, R, Punch, G & White, SI 2017, 'High-dose versus low-dose botulinum toxin in anal fissure disease' Techniques in Coloproctology, vol. 21, no. 10, pp. 803-808. https://doi.org/10.1007/s10151-017-1700-2

High-dose versus low-dose botulinum toxin in anal fissure disease. / Ravindran, P.; Chan, D. L.; Ciampa, C.; George, R.; Punch, G.; White, S. I.

In: Techniques in Coloproctology, Vol. 21, No. 10, 01.10.2017, p. 803-808.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - High-dose versus low-dose botulinum toxin in anal fissure disease

AU - Ravindran, P.

AU - Chan, D. L.

AU - Ciampa, C.

AU - George, R.

AU - Punch, G.

AU - White, S. I.

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Y1 - 2017/10/1

N2 - Background: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. Methods: A retrospective case–control study was performed at a single institution over a 6-year period (2009–2014). Patients given high-dose (80–100 IU) BT were compared to low-dose (20–40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. Results: One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4–52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. Conclusions: In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.

AB - Background: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. Methods: A retrospective case–control study was performed at a single institution over a 6-year period (2009–2014). Patients given high-dose (80–100 IU) BT were compared to low-dose (20–40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. Results: One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4–52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. Conclusions: In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.

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DO - 10.1007/s10151-017-1700-2

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JF - Techniques in Coloproctology

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Ravindran P, Chan DL, Ciampa C, George R, Punch G, White SI. High-dose versus low-dose botulinum toxin in anal fissure disease. Techniques in Coloproctology. 2017 Oct 1;21(10):803-808. https://doi.org/10.1007/s10151-017-1700-2