Obesity Surgery

, Volume 17, Issue 6, pp 732–736 | Cite as

Intragastric Injection of Botulinum Toxin A for the Treatment of Obesity

  • Reinhard Mittermair
  • Christian Keller
  • John Geibel


Botulinum toxin A (BTX-A) is a powerful and long-acting inhibitor of muscular contractions in both striated and smooth muscles. Hypothetically, BTX-A should inhibit the acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility, and thereby induce slowed gastric emptying, earlier satiety and weight loss. The aim of this study was to observe the effects of endoscopic intragastric injections of BTX-A in obese patients.


After approval by the University Ethics Committee, 10 female patients with class I obesity (body mass index 30–35) were double-blind randomized into 2 groups (BTX-A and 0.9% Saline). In Group 1, 200 U BTX-A were injected endoscopically into the antrum and the distal gastric body. In Group 2, 0.9% saline was injected endoscopically into the antrum and the distal gastric body. Body weight and feeling of satiety were recorded monthly over a period of 6 months.


Both groups (BTX-A and 0.9% Saline) showed no significant weight reduction (P > 0.05). One patient in Group 1 and two patients in Group 2 reported a feeling of early satiety. No adverse effects related to BTX-A or complications resulting from the endoscopic procedure were observed.


Intragastric injection of BTX-A for the treatment of obesity does not seem to reduce body weight.

Key words

Obesity botulinum toxin A intragastric injection endoscopy weight loss 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kopelman PG. Obesity as a medical problem. Nature 2000; 404: 635–43.PubMedGoogle Scholar
  2. 2.
    International Association for the Study of Obesity (IASO). Newsletter 4/1997.Google Scholar
  3. 3.
    Wolf AM. What is the economic case for treating obesity? Obes Res 1998; 6: 2–7.Google Scholar
  4. 4.
    Allison DB, Fontaine KR, Manson JE et al. Annual deaths attributable to obesity in the United States. JAMA 1999; 282: 1530–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Colquitt J, Clegg A, Sidhu M et al. Surgery for morbid obesity. Cochrane Database Syst Rev 2003; CD003641.Google Scholar
  6. 6.
    Cullen JJ, Kelly KA. Motility disorders of the gastrointestinal tract: Gastric motor physiology and pathophysiology. Surg Clin North Am 1993; 73: 1145–60.PubMedGoogle Scholar
  7. 7.
    Schiavo G, Rossetto O, Benfenati F et al. Tetanus and botulinum neurotoxins are zinc proteases specific for components of the neuroexocytosis apparatus. Ann N Y Acad Sci 1994; 710: 65–75.PubMedCrossRefGoogle Scholar
  8. 8.
    Hallett M. One man’s poison – clinical applications of botulinum toxin. N Engl J Med 1999; 341: 118–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Pasricha PJ, Ravich WJ, Hendix RT et al. Treatment of achalasia with intrasphincteric injection of botulinum toxin: a pilot trial. Ann Intern Med 1994; 121: 590–1.PubMedGoogle Scholar
  10. 10.
    Maria G, Cassetta E, Gui D et al. A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. N Engl J Med 1998; 338: 217–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Gui D, Rossi S, Runfola M et al. Review article: botulinum toxin in the therapy of gastrointestinal motility disorders. Aliment Pharmacol Ther 2003; 18: 1–16.PubMedCrossRefGoogle Scholar
  12. 12.
    Gui D, De Gaetano A, Spada PL et al. Botulinum toxin injected in gastric wall reduces body weight and food intake in rats. Aliment Pharmacol Ther 2000; 14: 829–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Bentsianov B, Zalvan C, Blitzer A. Noncosmetic uses of botulinum toxin. Clin Dermatol 2004; 22: 82–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Tokunaga T, Nishimura R, Akagi M. Muscarinic cholinergic receptors in human gastric mucosa. Jpn J Surg 1984; 14: 122–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Bigalke H, Habermann E. Blockade by tetanus and botulinum A toxin of postganglionic cholinergic nerve endings in the myenteric plexus. Naunym Schmiedebergs Arch Pharmacol 1980; 312: 255–63.CrossRefGoogle Scholar
  16. 16.
    James AN, Ryan JP, Parkman HP. Inhibitory effects of botulinum toxin on pyloric and antral smooth muscle. Am J Physiol Gastrointest Liver Physiol 2003; 285: 291–7.Google Scholar
  17. 17.
    Rollnik JD, Meier PN, Manns MP et al. Antral injections of botulinum a toxin for the treatment of obesity. Ann Intern Med 2003; 138: 359–60.PubMedGoogle Scholar
  18. 18.
    Gui D, Mingrone G, Valenza V et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther 2006; 23: 675–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Gracis JM, Simpson DM. Botulinum toxin therapy. The Neurol 2000; 6: 98–100.CrossRefGoogle Scholar
  20. 20.
    Cardoso A, Savassi-Rocha P, Vaz Coelho LG et al. Botulinum A toxin injected into the gastric wall for the treatment of class III obesity: a pilot study. Obes Surg 2006; 16: 335–43.CrossRefGoogle Scholar
  21. 21.
    Borodic G, Ferrante R, Pearce L et al. Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections. Mov Disord 1994; 9: 31–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Garcia A, Fulton J. Cosmetic denervation of the muscles of facial expression with botulinum toxin: A dose-response study. Dermatol Surg 1996; 22: 39–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Garcia-Compean D, Mendoza-Fuerte E, Martinez JA et al. Endoscopic injection of botulinum toxin in gastric antrum for the treatment of obesity. Gastroenterol Clin Biol 2005; 29: 789–91.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Reinhard Mittermair
    • 1
    • 4
  • Christian Keller
    • 2
  • John Geibel
    • 3
  1. 1.Department of General and Transplant SurgeryUniversity Hospital, Medical University InnsbruckInnsbruckAustria
  2. 2.Department of Anesthesia and Intensive Care MedicineUniversity Hospital, Medical University InnsbruckInnsbruckAustria
  3. 3.Department of Surgery and Department of Cellular and Molecular PhysiologyYale University School of MedicineNew HavenUSA
  4. 4.Department of General and Transplant SurgeryMedical University InnsbruckInnsbruckAustria

Personalised recommendations