{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T11:31:20Z","timestamp":1771327880353,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Anal fissures cause severe pain and can be difficult to treat. Medical therapy is initially used, followed by sigmoidoscopy-guided botox injections if the medical therapy is not successful. With this technique, however, it is not clear whether botox is injected into the muscle layer or submucosa. Aim: To evaluate the efficacy of EUS-guided botox injection directly into the internal sphincter. Methods: Consecutive patients with chronic anal fissure refractory to conventional endoscopic botulinum toxin type A injection were enrolled in the study. EUS was performed using a linear array echoendoscope, and a 25 G needle was used to inject botox. All patients were followed up at one- and two-month intervals. Results: Eight patients with chronic anal fissures were included in the study. Six patients had an excellent response to botox at the two-month interval using a visual analog pain scale, while one patient had a moderate response with a pain score reduction of 40%. One patient had no response. No complications were noted. An improvement in visual analog scale (pre-score &gt; post-score) was statistically significant at the p &lt; 0.01 level. Conclusion: EUS-guided botox injection into the internal sphincter appears to be a promising technique for patients with refractory anal fissure with pain.<\/jats:p>","DOI":"10.3390\/jcm11206207","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T04:40:36Z","timestamp":1666586436000},"page":"6207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Endoscopic Ultrasound-Guided Botox Injection for Refractory Anal Fissure"],"prefix":"10.3390","volume":"11","author":[{"given":"Navkiran","family":"Randhawa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Pacific Northwest University of Health Sciences, Yakima, WA 98901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3835-1853","authenticated-orcid":false,"given":"Ahamed","family":"Khalyfa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, A.T. Still University, Kirksville, MO 63501, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rida","family":"Aslam","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Franciscan Health Olympia Fields, Olympia Fields, IL 60461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4102-4925","authenticated-orcid":false,"given":"M. Christopher","family":"Roebuck","sequence":"additional","affiliation":[{"name":"Rx Economics, Hunt Valley, MD 21031, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4240-3442","authenticated-orcid":false,"given":"Mahnoor","family":"Inam","sequence":"additional","affiliation":[{"name":"Southwest Gastroenterology, Oak Lawn, IL 60453, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamran","family":"Ayub","sequence":"additional","affiliation":[{"name":"Silver Cross Hospital, New Lenox, IL 60451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4292\/wjgpt.v2.i2.9","article-title":"Identifying the best therapy for chronic anal fissure","volume":"2","author":"Madalinski","year":"2011","journal-title":"World J. Gastrointest. Pharmacol. 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