Meta-Analysis
Copyright ©The Author(s) 2019.
World J Gastroenterol. Jul 7, 2019; 25(25): 3268-3280
Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3268
Table 1 Study characteristics of included studies
StudyStudy designInclusion periodSample size, nMale (%)Syndromal patients (%)Total follow-up in monthsNumber of BT injections needed per patientAge at first BT injection (yr)Type BTMean dose (IU/injection)Guidance at BT injectionDefinition of outcomesImprovement in obstructive symptoms < 1 moProlonged improvement in obstructive symtpomsImprovement of enterocolitisComplications/adverse effectsDecrease in mean resting pressure on anorectal manometry (mmHG)
Basson (2014)Retrospective2010-20141167NR12-721pt: 1BTI5pt: 2BTI4pt: 3BTI1pt: 4BTI5Dysport200PalpationSuccessful-Improvement-FailedFavorable: successful/improvement10/11 (91%)5/11 (45%)NR1 (transient soiling)NR
Chumpitazi (2008)Retrospective1998-200730801041.2 ± 4.92.7 ± 0.25BotoxNRPalpationPoor-Fair-Good-Excellent Favorable: Excellent/good27/30 (90%)11/30 (37%)NR8 (7 transients soiling, 1 anal pain)NR
Chumpitazi (2011)Retrospective1998-201637802341.4 ± 4.52.8 ± 0.3NRBotox100NRPoor-Fair-Good-Excellent Favorable: Excellent/good33/37 (90%)NANRNRNR
Church (2016)Retrospective2010-201530NRNR2087% in total:With US: 2Without US: 13.1NR40US-guidedImprovement of symptomsNANR3/4 (75%)NRNR
Han-Geurts (2014)Retrospective2002-2013337907.3 yr (1-24)2 (1-5)3.6Dysport200NRPoor-Fair-Good-Excellent Favorable: Excellent/good25/33 (76%)17/33 (52%)7/19 (37%)2NR
Hemanshoo Thakkar (2017)Retrospective2002-20146NRNR6 yr (1-12)3Dysport200US-guidedShort-term: postoperative complications < 30 dLong-term: Rintala Bowel Function Score (BFS)1/6 (17%)NRNRNRNR
Hosseini (2008)Prospective2002-20061662NR8 pt: 1-3NRDysportNRNRImprovement in Constipation score (good/recurrence/non-responders)14/16 (88%)8/16 (50%)NRNRNR
Jiang (2009)Prospective2000-20082365NR12NRBotox120PalpationPoor-Moderate-Excellent Favorable: Moderate/ExcellentNR21/23 (91%)NR9 (anal pain)8-30
Koisuvalo (2009)Retrospective2005-200816 *6212.519 (3-43)2 (1-4)4NR100NRNo effect-Little effect-Significant effect-Symptoms dissapearedFavorable: Significant effect/symptoms dissapeared10/16 (63%)3/8 (38%)1/4 (25%)4 (increased soiling)28-31 (2 w); 8-24 (8 m)
Langer (1997)ProspectiveNR450253 pt: 1, 1 pt 26BotoxNRPalpationImprovement of obstructive symptoms, presence of incontinence3/4 (75%)1/4 (25%)NR1 (transient incontinence)NR
Langer (2004)RetrospectiveNR14NRNR244 pt: 1, 9pt: 1-44NR150NRImprovement of obstructive symptoms, presence of incontinence9/14 (64%)4/14 (29%)NRNRNR
Minkes (2000)ProspectiveNR1878NR8: 1; 10: 2-6NRBotox60PalpationNo response-Significant response12/18 (67%)5/18 (28%)NR4 (transient incontinence)35-37
Patrus (2010)Retrospective1998-2008227855.0 ± 2.9 yr (0-10)2 (1-23)8.4NR120NRImprovement of obstructive symptoms, presence of incontinence18/22 (81%)6/22 (27%)NR0NR
Wester (2015)Retrospective2007-20141883333, 8 yr (0, 1-8, 3)3 (1-13)2.4Botox100PalpationGood-InsufficientNR13/18 (72%)NRNRNR
Table 2 Main findings and risk of bias analysis
EffectNo. of studiesEvent rate (95%CI)Heterogeneity (I2)Significant predictorsEggers interceptFail safe, n
Improvement of obstructive symptoms14ER = 0.66 95%CI: 0.55-0.75a49.5%None-0.4243
Decreasing enterocolitis incidence3ER = 0.58, 95%CI: 0.27-0.84b71.0%NA3.270
Adverse effects9ER = 0.17, 95%CI: 0.10-0.29c52.1%NA-2.78 b101
Table 3 Quality of included studies
StudySelectionComparibilityOutcomeTotal
Basson (2014)203Poor
Chumpitazi (2008)303Poor
Chumpitazi (2011)303Poor
Church (2016)202Poor
Han-Geurts (2014)203Poor
Hemanshoo Takkar (2017)303Poor
Hosseini (2008)302Poor
Jiang (2009)303Poor
Koisuvalo (2009)303Poor
Langer (1997)303Poor
Langer (2004)302Poor
Minkes (2000)302Poor
Patrus (2010)303Poor
Wester (2015)303Poor