The most common method for delivering BT involves visual estimation of the location of LES and injection of 1 mL aliquots (20 to 25 units BT/mL) into each of four quadrants approximately 1 cm above the Z-line. The Z-line is the squamocolumnar junction, which corresponds to the gastroesophageal junction in the absence of Barrett’s esophagus.
Initial response rates 70-90%
One Treatment = 50% relapse at 6m
Better outcomes with Vigorous (Type 3) Achalasia + Multiple Rx (esp if repeated at 1m) = 60-85% success at 2 year review