{"id":16330,"date":"2023-06-20T06:30:39","date_gmt":"2023-06-20T06:30:39","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=16330"},"modified":"2023-06-20T20:47:19","modified_gmt":"2023-06-20T20:47:19","slug":"injecao-endoscopica-de-toxina-botulinica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/injecao-endoscopica-de-toxina-botulinica\/","title":{"rendered":"Inje\u00e7\u00e3o Endosc\u00f3pica de Toxina Botul\u00ednica"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>&nbsp;Introdu\u00e7\u00e3o<\/strong>&nbsp;<\/h2>\n\n\n\n<p>Esta revis\u00e3o visa ilustrar a t\u00e9cnica de inje\u00e7\u00e3o endosc\u00f3pica de toxina botul\u00ednica, assim como mostrar seus benef\u00edcios e limita\u00e7\u00f5es. Iniciaremos com o conceito de acal\u00e1sia, para depois ilustrar a forma correta de aplica\u00e7\u00e3o da t\u00e9cnica citada. Ser\u00e3o tamb\u00e9m mostrados efeitos da interven\u00e7\u00e3o e preditores de sucesso em longo prazo, al\u00e9m de eventuais complica\u00e7\u00f5es. <\/p>\n\n\n\n<p>O principal artigo para elabora\u00e7\u00e3o dessa revis\u00e3o foi: <em>Chan Sup Shim, Endoscopic botulinum toxin injection: Benefit and limitation, Gastrointestinal Intervention, Volume 3, Issue 1,2014, Pages 19-23. https:\/\/doi.org\/10.1016\/j.gii.2014.03.001.&nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Acal\u00e1sia<\/strong>&nbsp;<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Conceito<\/strong>&nbsp;<\/h3>\n\n\n\n<p>\u00c9 uma desordem motora esof\u00e1gica que tem como principal sintoma a disfagia, ocorrendo de forma insidiosa. Caracteriza-se pela destrui\u00e7\u00e3o ou aus\u00eancia dos plexos nervosos intramurais do es\u00f4fago. Essa condi\u00e7\u00e3o determina aus\u00eancia de peristaltismo (aperistalse) no corpo do \u00f3rg\u00e3o, bem como o relaxamento incompleto do esf\u00edncter inferior do es\u00f4fago (EIE) em resposta \u00e0 degluti\u00e7\u00e3o. Consequentemente, h\u00e1 estase esof\u00e1gica e incoordena\u00e7\u00e3o motora. De modo progressivo, ocorre dilata\u00e7\u00e3o do \u00f3rg\u00e3o e diminui\u00e7\u00e3o de sua capacidade de contra\u00e7\u00e3o.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Histologia<\/strong>&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Histologicamente observa-se destrui\u00e7\u00e3o do plexo nervoso mioent\u00e9rico (Auerbach).&nbsp;<\/li>\n\n\n\n<li>A degenera\u00e7\u00e3o inflamat\u00f3ria envolve preferencialmente os neur\u00f4nios inibit\u00f3rios, que liberam \u00f3xido n\u00edtrico e pept\u00eddeo vasoativo intestinal, afetando o relaxamento da musculatura lisa.&nbsp;<\/li>\n\n\n\n<li>Os neur\u00f4nios excitat\u00f3rios est\u00e3o relativamente poupados. Eles liberam acetilcolina e causam contra\u00e7\u00e3o da musculatura lisa, contribuindo para o t\u00f4nus do EIE.&nbsp;<\/li>\n\n\n\n<li>A perda da inerva\u00e7\u00e3o inibit\u00f3ria do esf\u00edncter inferior do es\u00f4fago faz a press\u00e3o basal do EIE aumentar, de modo a impedir o relaxamento do mesmo.&nbsp;<\/li>\n\n\n\n<li>No corpo esof\u00e1gico, a destrui\u00e7\u00e3o do plexo nervoso resulta em aperistalse.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/fig-1.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" width=\"435\" height=\"250\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/fig-1.jpg\" alt=\"\" class=\"wp-image-16332\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/fig-1.jpg?v=1687136781 435w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/fig-1-300x172.jpg?v=1687136781 300w\" sizes=\"(max-width: 435px) 100vw, 435px\" \/><\/a><figcaption class=\"wp-element-caption\">Localiza\u00e7\u00e3o dos plexos nervosos na parede do trato gastrointestinal.<\/figcaption><\/figure>\n<\/div>\n\n\n<p>O tratamento usual consiste na dilata\u00e7\u00e3o com bal\u00e3o ou na miotomia do EIE. A inje\u00e7\u00e3o intraesfincteriana de toxina botul\u00ednica (botox) emergiu como uma alternativa \u00e0 dilata\u00e7\u00e3o com bal\u00e3o, agindo atrav\u00e9s do bloqueio da libera\u00e7\u00e3o de acetilcolina nos terminais nervosos.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" width=\"1024\" height=\"482\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-1024x482.png\" alt=\"\" class=\"wp-image-16427\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-1024x482.png 1024w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-300x141.png 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-768x361.png 768w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-1536x723.png 1536w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-1170x551.png 1170w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox-585x275.png 585w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/06\/botox.png 1917w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\"><em>A toxina botul\u00ednica bloqueia a libera\u00e7\u00e3o de acetilcolina na jun\u00e7\u00e3o neuromuscular, diminuindo a contra\u00e7\u00e3o muscular. <\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:61px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Inje\u00e7\u00e3o Endosc\u00f3pica de Toxina Botul\u00ednica<\/strong>\u00a0<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>T\u00e9cnica endosc\u00f3pica de inje\u00e7\u00e3o de botox:<\/strong>&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consiste na inje\u00e7\u00e3o de 100 UI nos quatro quadrantes do EIE (25 UI em cada quadrante), utilizando agulha de escleroterapia. <\/li>\n\n\n\n<li>A inje\u00e7\u00e3o deve ser feita 1 cm proximal \u00e0 jun\u00e7\u00e3o escamocolunar, de forma perpendicular \u00e0 parede esof\u00e1gica, na <strong>camada muscular<\/strong>. <\/li>\n\n\n\n<li>Uma nova inje\u00e7\u00e3o de 100 UI ap\u00f3s 1 m\u00eas pode aumentar a efic\u00e1cia<sup>2<\/sup>.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Para aplica\u00e7\u00e3o de botox, \u00e9 necess\u00e1rio diluir o mesmo com SF 0,9% e misturar suavemente, sem agitar a solu\u00e7\u00e3o.&nbsp;&nbsp;<\/p>\n\n\n\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-4007da4d-24e9-4a0a-b609-32d5b6c00b51\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=4007da4d-24e9-4a0a-b609-32d5b6c00b51\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n\n\n<div style=\"height:62px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Efeitos da interven\u00e7\u00e3o<\/strong>&nbsp;<\/h3>\n\n\n\n<p>Estudos demonstraram que a inje\u00e7\u00e3o de toxina botul\u00ednica (ITB) nos pacientes com acal\u00e1sia proporciona uma melhora sintom\u00e1tica significativa comparativamente ao placebo.&nbsp;&nbsp;<\/p>\n\n\n\n<p>A aplica\u00e7\u00e3o de 100 UI, seguida da repeti\u00e7\u00e3o da dose em um m\u00eas demonstrou ser mais eficiente do que aplica\u00e7\u00f5es \u00fanicas de 50 ou 200 UI<sup>2<\/sup>. Contudo, uma redu\u00e7\u00e3o na efic\u00e1cia da toxina botul\u00ednica tem sido observada no seguimento destes pacientes, provavelmente relacionada \u00e0 produ\u00e7\u00e3o de anticorpos contra a sua mol\u00e9cula.&nbsp;<\/p>\n\n\n\n<p>Estudos mostram que as taxas de resposta 1 m\u00eas ap\u00f3s a administra\u00e7\u00e3o s\u00e3o em m\u00e9dia de 82% (69\u201390%). Aos 6 meses, a taxa de resposta cl\u00ednica cai para 57% (33\u201377%) e, em 12 meses, para 48% (15\u201376%).&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Preditores de sucesso em longo prazo<\/strong>&nbsp;<\/h3>\n\n\n\n<p>A ITB, apesar de menos invasiva que a dilata\u00e7\u00e3o pneum\u00e1tica e miotomia, ainda apresenta piores resultados a longo prazo em rela\u00e7\u00e3o a estes m\u00e9todos. Fatores preditores de melhor resposta \u00e0 toxina botul\u00ednica incluem:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Acal\u00e1sia vigorosa (tipo III);&nbsp;<\/li>\n\n\n\n<li>Pacientes com press\u00e3o do esf\u00edncter esof\u00e1gico inferior n\u00e3o excedendo mais de 50% do limite superior da normalidade, em pacientes sem acalasia vigorosa&nbsp;<\/li>\n\n\n\n<li>Idade maior que 50\/55 anos, sendo a taxa de resposta nesse grupo et\u00e1rio pr\u00f3ximo ao dobro da observada na popula\u00e7\u00e3o mais jovem e ainda mais evidente na acal\u00e1sia cl\u00e1ssica;&nbsp;<\/li>\n\n\n\n<li>Forma do tratamento, com reaplica\u00e7\u00e3o em 4 semanas.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p>Outros fatores como sexo, dura\u00e7\u00e3o da doen\u00e7a, caracter\u00edsticas radiogr\u00e1ficas basais e gravidade dos sintomas iniciais n\u00e3o demonstraram ser preditores de resposta ao tratamento.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Complica\u00e7\u00f5es<\/strong>&nbsp;<\/h3>\n\n\n\n<p>As complica\u00e7\u00f5es da administra\u00e7\u00e3o da toxina botul\u00ednica incluem principalmente a dor tor\u00e1cica transit\u00f3ria e azia, sendo reportados casos isolados de bloqueio card\u00edaco, reten\u00e7\u00e3o urin\u00e1ria e pneumot\u00f3rax.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Benef\u00edcios e limita\u00e7\u00f5es<\/strong>&nbsp;<\/h3>\n\n\n\n<p>A ITB, apesar de apresentar menor efic\u00e1cia terap\u00eautica que os demais m\u00e9todos, \u00e9 comumente utilizada como terapia inicial pela sua facilidade t\u00e9cnica e baixa taxa de complica\u00e7\u00f5es, sendo preferencialmente reservada para pacientes com comorbidades importantes, em espera para tratamento cir\u00fargico ou que se recusam outros m\u00e9todos de tratamento. Destaca-se, por\u00e9m, o aumento da taxa de perfura\u00e7\u00e3o esof\u00e1gica quando o paciente \u00e9 submetido, posteriormente, \u00e0 dilata\u00e7\u00e3o pneum\u00e1tica.&nbsp;<\/p>\n\n\n\n<p>Ap\u00f3s a aplica\u00e7\u00e3o da toxina botul\u00ednica, os pacientes com acal\u00e1sia devem ser monitorados regularmente, pesquisando poss\u00edveis complica\u00e7\u00f5es, como dilata\u00e7\u00e3o esof\u00e1gica maci\u00e7a e carcinoma esof\u00e1gico.&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Chan Sup Shim, Endoscopic botulinum toxin injection: Benefit and limitation, Gastrointestinal Intervention, Volume 3, Issue 1,2014, Pages 19-23. <a href=\"https:\/\/doi.org\/10.1016\/j.gii.2014.03.001\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1016\/j.gii.2014.03.001<\/a>.&nbsp;<\/li>\n\n\n\n<li>V.&nbsp;Annese,&nbsp;G.&nbsp;Bassotti,&nbsp;G.&nbsp;Coccia,&nbsp;M.&nbsp;Dinelli,&nbsp;V.&nbsp;D&#8217;Onofrio,&nbsp;G.&nbsp;Gatto,&nbsp;<em>et al. <\/em>A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group, Gut,&nbsp;46&nbsp;(2000), pp.&nbsp;597-600.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-background\" style=\"background-color:#c8cad5\">Passos HL, Bernardes FV, Martins BC. Inje\u00e7\u00e3o Endosc\u00f3pica de Toxina Botul\u00ednica. Endoscopia Terapeutica 2023, vol 1. Disponivel em: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?p=16330\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/endoscopiaterapeutica.net\/pt\/injecao-endoscopica-de-toxina-botulinica\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;Introdu\u00e7\u00e3o&nbsp; Esta revis\u00e3o visa ilustrar a t\u00e9cnica de inje\u00e7\u00e3o endosc\u00f3pica de toxina botul\u00ednica, assim&hellip;<\/p>\n","protected":false},"author":5639,"featured_media":16335,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[555],"tipo":[153],"volume":[263],"class_list":["post-16330","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-555","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Inje\u00e7\u00e3o Endosc\u00f3pica de Toxina Botul\u00ednica &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/injecao-endoscopica-de-toxina-botulinica\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Inje\u00e7\u00e3o Endosc\u00f3pica de Toxina Botul\u00ednica\" \/>\n<meta property=\"og:description\" content=\"&nbsp;Introdu\u00e7\u00e3o&nbsp; Esta revis\u00e3o visa ilustrar a t\u00e9cnica de inje\u00e7\u00e3o endosc\u00f3pica de toxina botul\u00ednica, assim como mostrar seus benef\u00edcios e limita\u00e7\u00f5es.\" \/>\n<meta property=\"og:url\" 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