{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T22:06:21Z","timestamp":1781215581436,"version":"3.54.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007594","name":"Comenius University in Bratislava","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007594","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin J Gastroenterol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>The use of botulinum toxin in the therapy of esophageal motility disorders is reserved for elderly and comorbid patients considered risky for endoscopic or surgical treatment. However, there is a lack of data on the treatment of motility disorders outside the Chicago classification.<\/jats:p>\n          <jats:p>We present the case of a 56-year-old patient with dysphagia and non-cardial chest pain (Eckardt 8). High resolution manometry ruled out achalasia or other motility disorder, but confirmed a localized 7-cm-long spastic segment in the upper to middle third of esophagus. We considered endoscopic or surgical therapy in this location too risky, therefore we decided to apply botulinum toxin into this segment. The spasm on high resolution manometry correlated with the thickened muscularis propria layer according to the endoscopic ultrasound. We used endoscopic ultrasound for the navigation of botulinum toxin application into the muscularis propria layer. We applied 100\u00a0IU of botulinum toxin into four quadrants, 20 and 24\u00a0cm from front teeth (12.5\u00a0IU for 1 application).<\/jats:p>\n          <jats:p>The therapy led to improvement of symptoms (Eckardt 3) and to restitution of propulsive peristalsis with complete elimination of spastic segment. The worsening of symptoms appeared after 2\u00a0years, with subsequent recurrence of motility disorder fulfilling criteria of type II achalasia.<\/jats:p>\n          <jats:p>Presenting this case, we wanted to point at the unique use of botulinum toxin as useful treatment in selected cases of unclassified esophageal motility disorder as a bridge therapy. Moreover, endoscopic ultrasound could be used to guide precise application of botulinum toxin.<\/jats:p>","DOI":"10.1007\/s12328-024-02066-y","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T02:43:44Z","timestamp":1733193824000},"page":"43-47","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic ultrasound navigated application of botulinum toxin in severe esophageal motility disorder"],"prefix":"10.1007","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9606-117X","authenticated-orcid":false,"given":"Diana","family":"V\u00e1\u017eanov\u00e1","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"\u010euri\u010dek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Uhr\u00edk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"B\u00e1nov\u010din","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2066_CR1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.21037\/aoe-2019-ach-09","volume":"3","author":"R Heddle","year":"2020","unstructured":"Heddle R, Cock C. Role of botulinum toxin injection in treatment of achalasia. Ann Esophagus. 2020;3:26.","journal-title":"Ann Esophagus"},{"key":"2066_CR2","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1055\/a-1160-5549","volume":"52","author":"B Weusten","year":"2020","unstructured":"Weusten B, Barret M, Bredenoord, et al. Endoscopic management of gastrointestinal motility disorders\u2014part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52:498\u2013515.","journal-title":"Endoscopy"},{"key":"2066_CR3","first-page":"31","volume":"2018","author":"G Zaninotto","year":"2018","unstructured":"Zaninotto G, Bennett C, The BG, et al. ISDE achalasia guidelines. Dis Esophagus. 2018;2018:31.","journal-title":"Dis Esophagus"},{"key":"2066_CR4","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1038\/ajg.2013.196","volume":"108","author":"MF Vaezi","year":"2013","unstructured":"Vaezi MF, Pandolfino JE, Vela MF. ACG Clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238\u201349.","journal-title":"Am J Gastroenterol"},{"key":"2066_CR5","doi-asserted-by":"publisher","first-page":"e256","DOI":"10.1111\/j.1365-2982.2010.01511.x","volume":"22","author":"DC Sadowski","year":"2010","unstructured":"Sadowski DC, Ackah F, Jiang B, et al. Achalasia: incidence, prevalence and survival. A population-based study: achalasia and epidemiology. Neurogastroenterol Motil. 2010;22:e256\u201361.","journal-title":"Neurogastroenterol Motil"},{"key":"2066_CR6","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1016\/j.cgh.2013.03.021","volume":"11","author":"T Vanuytsel","year":"2013","unstructured":"Vanuytsel T, Bisschops R, Farr\u00e9 R, et al. Botulinum toxin reduces dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11:1115-21.e2.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2066_CR7","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1038\/nrgastro.2011.68","volume":"8","author":"AJ Eckardt","year":"2011","unstructured":"Eckardt AJ, Eckardt VF. Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol. 2011;8:311\u20139.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2066_CR8","doi-asserted-by":"publisher","first-page":"2303","DOI":"10.1007\/s10620-008-0637-8","volume":"54","author":"L Wang","year":"2009","unstructured":"Wang L, Li Y-M, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci. 2009;54:2303\u201311.","journal-title":"Dig Dis Sci"},{"key":"2066_CR9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005046.pub3","author":"JE Leyden","year":"2014","unstructured":"Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2014. https:\/\/doi.org\/10.1002\/14651858.CD005046.pub3.","journal-title":"Cochrane Database Syst Rev."},{"key":"2066_CR10","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/01.sla.0000114217.52941.c5","volume":"23","author":"G Zaninotto","year":"2004","unstructured":"Zaninotto G, Annese V, Costantini M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. 2004;23:364\u201370.","journal-title":"Ann Surg"},{"key":"2066_CR11","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12491","author":"FB van Hoeij","year":"2016","unstructured":"van Hoeij FB, Tack JF, Pandolfino JE, et al. Complications of botulinum toxin injections for treatment of esophageal motility disorders\u2020: Complications of esophageal botox injections. Dis Esophagus. 2016. https:\/\/doi.org\/10.1111\/dote.12491.","journal-title":"Dis Esophagus."},{"key":"2066_CR12","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1055\/s-0030-1256754","volume":"43","author":"JM Dumonceau","year":"2011","unstructured":"Dumonceau JM, Polkowski M, Larghi A, et al. European Society of Gastrointestinal Endoscopy. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011;43:897\u2013912.","journal-title":"Endoscopy."},{"key":"2066_CR13","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/S0016-5107(95)70008-0","volume":"4","author":"LS Miller","year":"1995","unstructured":"Miller LS, Liu JB, Barbarevech CA, et al. High-resolution endoluminal sonography in achalasia. Gastrointest Endosc. 1995;4:545\u20139.","journal-title":"Gastrointest Endosc."},{"key":"2066_CR14","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1097\/MCG.0000000000000317","volume":"49","author":"F Zerbib","year":"2015","unstructured":"Zerbib F, Roman S. Current therapeutic options for esophageal motor disorders as defined by the Chicago Classification. J Clin Gastroenterol. 2015;49:451\u201360.","journal-title":"J Clin Gastroenterol"}],"container-title":["Clinical Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12328-024-02066-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12328-024-02066-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12328-024-02066-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T13:17:04Z","timestamp":1738329424000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12328-024-02066-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,3]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["2066"],"URL":"https:\/\/doi.org\/10.1007\/s12328-024-02066-y","relation":{},"ISSN":["1865-7257","1865-7265"],"issn-type":[{"value":"1865-7257","type":"print"},{"value":"1865-7265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,3]]},"assertion":[{"value":"3 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Me, Diana V\u00e1\u017eanov\u00e1, confirm that all procedures used in my  case report were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later versions.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"Informed consent was obtained from patient who was included in our case report.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}