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Intragastric Injection of Botulinum Toxin A for the Treatment of Obesity

Background

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.

Methods

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.

Results

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.

Conclusion

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

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References

  1. 1.

    Kopelman PG. Obesity as a medical problem. Nature 2000; 404: 635–43.

    PubMed  CAS  Google Scholar 

  2. 2.

    International Association for the Study of Obesity (IASO). Newsletter 4/1997.

  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.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Colquitt J, Clegg A, Sidhu M et al. Surgery for morbid obesity. Cochrane Database Syst Rev 2003; CD003641.

  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.

    PubMed  CAS  Google 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.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Hallett M. One man’s poison – clinical applications of botulinum toxin. N Engl J Med 1999; 341: 118–20.

    PubMed  Article  CAS  Google 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.

    PubMed  CAS  Google 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.

    PubMed  Article  CAS  Google 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.

    PubMed  Article  CAS  Google 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.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bentsianov B, Zalvan C, Blitzer A. Noncosmetic uses of botulinum toxin. Clin Dermatol 2004; 22: 82–8.

    PubMed  Article  Google Scholar 

  14. 14.

    Tokunaga T, Nishimura R, Akagi M. Muscarinic cholinergic receptors in human gastric mucosa. Jpn J Surg 1984; 14: 122–6.

    PubMed  Article  CAS  Google 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.

    Article  CAS  Google 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.

    PubMed  Google 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.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Gracis JM, Simpson DM. Botulinum toxin therapy. The Neurol 2000; 6: 98–100.

    Article  Google 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.

    Article  Google 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.

    PubMed  Article  CAS  Google 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.

    PubMed  Article  CAS  Google 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.

    PubMed  CAS  Article  Google Scholar 

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Correspondence to Reinhard Mittermair.

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Mittermair, R., Keller, C. & Geibel, J. Intragastric Injection of Botulinum Toxin A for the Treatment of Obesity. OBES SURG 17, 732–736 (2007). https://doi.org/10.1007/s11695-007-9135-x

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Key words

  • Obesity
  • botulinum toxin A
  • intragastric injection
  • endoscopy
  • weight loss