Advice

Appendix: Search strategy and evidence selection

Appendix: Search strategy and evidence selection

Search strategy

General background, guidelines and technology assessments:

MEDLINE (via Ovid)

Search A

  1. Fissure in Ano/ (1843)

  2. (anal adj3 fissure?).ti,ab. (1230)

  3. (ano adj3 fissure?).ti,ab. (162)

  4. 1 or 2 or 3 (2192)

  5. exp Botulinum Toxins/ (11133)

  6. botulinum.ti,ab. (12814)

  7. botox.ti,ab. (1200)

  8. 5 or 6 or 7 (14908)

  9. 4 and 8 (254)

  10. limit 9 to english language (217)

  11. exp review/ (1771023)

  12. (scisearch or psychinfo or psycinfo or medlars or embase or psychlit or psyclit or cinahl or pubmed or medline).ti,ab,sh. (73418)

  13. ((hand adj2 search$) or (manual$ adj2 search$)).ti,ab,sh. (6353)

  14. ((electronic or bibliographic or computeri?ed or online) adj4 database$).ti,ab. (14224)

  15. (pooling or pooled or mantel haenszel).ti,ab,sh. (46986)

  16. (peto or dersimonian or der simonian or fixed effect).ti,ab,sh. (2736)

  17. or/12-16 (125274)

  18. 11 and 17 (55617)

  19. Meta Analysis/ (39043)

  20. (meta-analys$ or meta analys$ or metaanalys$).ti,ab,sh. (68825)

  21. ((systematic$ or quantitativ$ or methodologic$) adj5 (review$ or overview$ or synthesis$)).ti,ab,sh. (55348)

  22. (integrative research review$ or research integration).ti,ab,sh. (84)

  23. or/19-22 (107040)

  24. 18 or 23 (135381)

  25. clinical trials, phase iv/ or clinical trials, phase iii/ or randomized controlled trials/ or multicenter studies/ (241765)

  26. (random$ or placebo$ or ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$))).ti,ab,sh. (886718)

  27. 25 or 26 (984664)

  28. (animal$ not human$).sh. (3710933)

  29. 27 not 28 (878711)

  30. (cost$ or economic$).tw. (431037)

  31. 24 or 29 or 30 (1347346)

  32. 10 and 31 (67)

Search B

  1. Fissure in Ano/ (1843)

  2. (anal adj3 fissure?).ti,ab. (1230)

  3. (ano adj3 fissure?).ti,ab. (162)

  4. 1 or 2 or 3 (2192)

  5. (azzalure or bocouture or dysport or vistabel or xeomin).ti,ab. (413)

  6. 4 and 5 (11)

  7. limit 6 to english language (8)

Embase (via Ovid)

Search A

  1. anus fissure/ (2000)

  2. (anal adj3 fissure?).ti,ab. (1431)

  3. (ano adj3 fissure?).ti,ab. (124)

  4. 1 or 2 or 3 (2178)

  5. botulinum toxin/ or botulinum toxin a/ or botulinum toxin b/ (19977)

  6. botulinum.ti,ab. (14657)

  7. botox.ti,ab. (1858)

  8. 5 or 6 or 7 (22187)

  9. 4 and 8 (506)

  10. limit 9 to english language (407)

  11. exp review/ (1750373)

  12. (scisearch or psychinfo or psycinfo or medlars or embase or psychlit or psyclit or cinahl or pubmed or medline).ti,ab,sh. (90895)

  13. ((hand adj2 search$) or (manual$ adj2 search$)).ti,ab,sh. (7504)

  14. ((electronic or bibliographic or computeri?ed or online) adj4 database$).ti,ab. (18372)

  15. (pooling or pooled or mantel haenszel).ti,ab,sh. (53649)

  16. (peto or dersimonian or der simonian or fixed effect).ti,ab,sh. (3445)

  17. or/12-16 (150805)

  18. 11 and 17 (58187)

  19. Meta Analysis/ (69883)

  20. (meta-analys$ or meta analys$ or metaanalys$).ti,ab,sh. (100322)

  21. ((systematic$ or quantitativ$ or methodologic$) adj5 (review$ or overview$ or synthesis$)).ti,ab,sh. (94387)

  22. (integrative research review$ or research integration).ti,ab,sh. (88)

  23. or/19-22 (165836)

  24. 18 or 23 (193865)

  25. clinical trials, phase iv/ or clinical trials, phase iii/ or randomized controlled trials/ or multicenter studies/ (33087)

  26. (random$ or placebo$ or ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$))).ti,ab,sh. (1006122)

  27. 25 or 26 (1009768)

  28. (animal$ not human$).sh. (2489727)

  29. 27 not 28 (911422)

  30. (cost$ or economic$).tw. (484076)

  31. 24 or 29 or 30 (1460803)

  32. 10 and 31 (132)

  33. limit 32 to exclude medline journals (14)

Search B

  1. Fissure in Ano/

  2. (anal adj3 fissure?).ti,ab.

  3. (ano adj3 fissure?).ti,ab.

  4. 1 or 2 or 3

  5. (azzalure or bocouture or dysport or vistabel or xeomin).ti,ab.

  6. 4 and 5

  7. limit 6 to english language

  8. limit 7 to exclude medline journals (0)

Cochrane Central Register of Controlled Trials (CENTRAL)

#1 MeSH descriptor: [Fissure in Ano] explode all trees

#2 anal fissure*:ti

#3 #1 or #2

#4 botulinum:ti

#5 #3 and #4

CRD HTA, DARE and EED database

1 MeSH DESCRIPTOR fissure in ano EXPLODE ALL TREES

2 (anal fissure):TI

3 #1 or #2

4 (botulinum):TI

5 #3 and #4

Grey literature and ongoing trials

Manufacturers' websites

Allergan

Merzpharma

Ipsen

Galderma

Evidence selection

We aimed to identify the best available evidence for using botulinum toxin injections to treat chronic anal fissure in any age group. The literature search focused on identifying randomised control trials (RCTs) and systematic reviews.

A 2012 Cochrane systematic review was identified that included very relevant evidence on the efficacy of botulinum toxin injections compared with the main comparators of: GTN, placebo and surgery. The review was current as of 12 September 2011 and searched for randomised control trials. This closely mirrored our own literature search approach, which returned overlapping results with the Cochrane review. Hence, the data and study descriptions described in the Cochrane review provide the main evidence source for this document. We did not review the studies included in the Cochrane review in full text.

We looked for other studies published after the Cochrane review and identified 4 RCTs, 1 systematic review and 1 cost analysis. These were obtained in full text and were reviewed to supplement the main evidence provided by the Cochrane review.

Botulinum toxin used as a second-line therapy for anal fissure after 0.4% GTN was of particular interest as this was the likely place of botulinum toxin in the treatment pathway. However, only 1 study (Lindsey et al. 2003) was identified that related specifically to this use of botulinum toxin. Although it was a non-randomised study using 0.2% GTN, it was included in the review. No RCTs or systematic reviews were identified for this specific line of treatment and no further searches were undertaken to identify additional relevant non-randomised literature.