Triadafilopoulos G, et al. – Researchers carried out this retrospective open cohort pilot study to investigate the feasibility, safety, and efficacy of endoscopically delivered botulinum neurotoxin (BoNT) injection to the distal esophagus, pylorus or anal canal aiming at relieving regional gastrointestinal symptoms in patients with Parkinson's disease (PD). Endoscopic BoNT injection to the esophagus, pylorus or anal canal was safe, well–tolerated. It led to symptomatic improvement that lasts up to several months. The procedure could be repeated as required and combined with other therapies.

• This study was performed to evaluate the clinical response to endoscopic BoNT injection on selected PD patients with symptoms and identifiable abnormalities on high-resolution manometry and wireless motility capsule, to generate early uncontrolled data on feasibility, tolerability, safety, and efficacy.
• The researchers evaluated baseline symptoms and response to therapy by questionnaires.

• The researchers treated 14 PD patients (10 M:4 F), mean age 73 (range: 62-93).
• Esophageal Botox was administared in 3 patients for ineffective esophageal motility (IEM) (n = 1), esophago-gastric junction outlet obstruction (EGJOO) & IEM (n = 1), and diffuse esophageal spasm (DES) (n = 1).
• They treated 9 patients with pyloric BoNT injection for gastroparesis with mean gastric transit time of 21.2 h; range 5.2–44.2 h.
• For defecatory dyssynergia ((Type I) (n = 1) and overlap (slow-transit and dyssynergic) constipation (n = 1), 2 patients received anal Botox.
• Endoscopic BoNT injection (100-200 units) was well tolerated.
• They found no significant adverse events.