Abstract
BackgroundObesity is rapidly emerging as one of the greatest challenges of human health. Many randomized trials and open-label human studies described conflicting results of gastric intra-muscular injections of botulinum toxin type A (BTA). Endoscopic ultrasound (EUS) guidance can assure BTA injection into the subserosal layer and muscularis propria of the gastric wall which may optimize the efficacy of injection. The aim of the study is to assess the efficacy and safety of EUS-guided gastric BTA injections in weight reduction for obese subjects.ResultsThe present study included 25 patients (2 males and 23 females with mean age 35.84 ± 7.776). For nutrient drink tests, median maximum tolerated volumes (MTVs) decreased from 720 cc (range 480–1680) as a baseline value 2 weeks before BTA injection to 360 cc (range 140–820) at 16 weeks after injection. Mean body weight reduction was 11.92 kg (10.8%) after 16 weeks of BTA injection. Mean body weight continued to decrease during the study period from a baseline value of 110 to 98 kg with significant reduction of mean BMI from baseline value of 41.2 to 36.7 at 16 weeks after BTA injection (p < 0.001). The study was completed without major adverse events.ConclusionEUS-guided BTA injection into the antral subserosa and muscularis propria could be an effective technique for weight reduction, or as a bridge for surgery, which can be done safely with minimal complications.Trial registrationNCT03901040
Highlights
Obesity is rapidly emerging as one of the greatest challenges of human health
Satiation For nutrient drink tests, median maximum tolerated volume (MTV) decreased from 720 cc as a baseline value 2 weeks before botulinum toxin type A (BTA) injection to 360 cc at 4 weeks, and 360 cc at 16 weeks after injection (Fig. 2)
Mean body weight continued to decrease during the study period from a baseline value of 110 to 98 kg with significant reduction of mean Body mass index (BMI) from baseline value of 41.2 to 36.7 at 16 weeks after BTA injection (p < 0.001) (Figs. 3 and 4)
Summary
Many randomized trials and open-label human studies described conflicting results of gastric intra-muscular injections of botulinum toxin type A (BTA). Three small randomized trials and many open-label human studies described conflicting results, with many studies showing no or little weight reduction after injection of BTA into the gastric wall [6,7,8,9,10,11] and one randomized controlled trial showing significant. Gameel et al The Egyptian Journal of Internal Medicine (2020) 32:29 reduction in body weight and gastric emptying [12] In these studies, different doses of BTA (100 to 300 U) were used, and different sites (antrum only versus antrum, body, and fundus) were injected. The depth of injection into the gastric wall was mostly unidentified in these studies
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