MTP6.04 Botulinum toxin versus topical ointments (diltiazem, GTN) for the management of symptomatic chronic anal fissures: a systematic review and meta-analysis

Introduction The objective of this study is to compare the effectiveness of botulinum toxin (BT) injections and topical ointments GTN or diltiazem for patients with symptomatic chronic anal fissures. Methods Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find relevant randomized, controlled trials comparing treatment with BT injections versus topical ointments in patients with symptomatic chronic anal fissures. Data were analyzed using Review Manager Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results A total of 6 randomized, control trials were included recruiting 416 patients with symptomatic chronic anal fissures which was treated either by BT injections or topical GTN or diltiazem ointments. In the random effect model analysis, no statistically significant difference was found in the number of patients with healed anal fissures between BT injections and topical ointments [Risk ratio: 1.09, 95% confidence interval 0.84, 1.42, z=0.68, p=0.5). Conclusion BT injections in the internal anal sphincter and topical use of GTN or diltiazem ointments are equally effective in the management of chronic anal fissures, with no significant difference in outcomes between the two options. These findings suggest that treatment choice can be guided by patient preference, cost, and provider expertise.