Botox: Should It Ever Be Used? (Surgery Perspective)

Botox was first described for its use in achalasia in 1995, demonstrating that it could be safely used to temporarily improve the outflow obstruction and relieve patient symptoms such as dysphagia, regurgitation and chest pain for several months. Though highly effective, Botox loses efficacy long-term compared to other endoscopic or surgical treatments, with the majority requiring repeated injections. Therefore, Botox is not favored as a long-term treatment strategy for patients with otherwise surgically treatable achalasia. It instead serves as an alternative to bridge patients to definitive treatment, to treat poor surgical candidates, and to confirm achalasia diagnosis in complex patients.