Endoscopic intragastric injection of botulinum toxin A in obese patients on bariatric surgery waiting lists: A randomised double-blind study (IntraTox study)

Sánchez-Torralvo, Francisco José; Pedreño, Luis Vázquez; Marín, Montserrat Gonzalo; Tapia, María José; Lima, Fuensanta; Fuentes, Esther; García, Pilar Caro; Ruiz, Javier Moreno; Cañete, Alberto Rodríguez; Valdés, Sergio; Olveira, Gabriel

doi:10.1016/j.clnu.2020.10.008

Cited by 10 publications

(24 citation statements)

References 33 publications

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“…The intragastric puncture sites were the antrum only in three studies 16,23,25 and the antrum plus other sites in the other studies. 22,26,29 Half of the studies used EUS-guided endoscopic injection of BTA for objective identification of the gastric muscle layer. 25,26,29 Three studies had combined diet control in both the intervention and control groups.…”

Section: Resultsmentioning

confidence: 99%

“…22,26,29 Half of the studies used EUS-guided endoscopic injection of BTA for objective identification of the gastric muscle layer. 25,26,29 Three studies had combined diet control in both the intervention and control groups. 22,26,29 The duration of follow-up ranged from 5 to 24 weeks.…”

Section: Resultsmentioning

confidence: 99%

“…25,26,29 Three studies had combined diet control in both the intervention and control groups. 22,26,29 The duration of follow-up ranged from 5 to 24 weeks. No serious adverse events related to the procedure were reported in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…37,38 To date, only three studies have analyzed the changes in neurohormones after intragastric BTA treatment, and two of them showed insignificant differences in ghrelin, leptin, GLP-1, and insulin between pretreatment and post-treatment. 19,29 Moreover, the fundus, in charge of prandial and postprandial gastric accommodation, plays a vital role in the early sensation of fullness. Some studies failed to achieve significant weight loss with intragastric BTA injection into only the antrum.…”

Section: Discussionmentioning

confidence: 99%

“…As the cut-off BTA reached 200 U, the absolute weight loss significantly decreased, whereas a BTA equal or great than 200 U is the most frequently used dose in human studies. 16,[19][20][21][22][23][24][25][26][27][28][29][30] Control of diet is defined as patients receiving restricted diets, indication for a diet, or diet counseling, whereas studies that did not report, or only recorded it by use of a questionnaire, a diet diary were defined as without control of diet. The maximum follow-up duration was 24 weeks in the included studies, and the patients were divided into three groups according to the follow-up duration.…”

Section: Methodsmentioning

confidence: 99%

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Intragastric injection of botulinum toxin A for weight loss: A systematic review and meta‐analysis of randomized controlled trials

Yen

Wang

Sung

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Intragastric botulinum toxin A (BTA) injection is a potential treatment for weight reduction in obese patients. Current studies yielded conflicting results. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of intragastric BTA injection for weight management. Methods: We searched several databases to identify RCTs evaluating intragastric BTA injections for obesity. We applied random-effects models for all meta-analyses due to heterogeneity in the included studies. The mean difference (MD) and 95% confidence interval (CI) were calculated for continuous outcomes. Results: A total of 6 RCTs including 192 subjects met the inclusion criteria and were included for the meta-analysis. Although the pooled data from six studies showed no difference in the absolute weight loss between intragastric BTA injection and control, subgroup analysis showed a significantly decreased absolute weight after a BTA injection dose ≥ 200 U (MD, À2.04 kg; 95% CI, À3.96 to À0.12) and after multiple injection regions in the stomach combined with diet control (MD, À4.44 kg; 95% CI, À6.54 to À2.33 kg) compared with the control. Regarding absolute weight loss, the impact of endoscopic ultrasound-guided injection and follow-up duration showed no difference. Intragastric BTA injection had a significant change in body mass index (MD, À1.25 kg/m 2 ; 95% CI, À2.18 to À0.32 kg/m 2 ) and prolonged gastric half-emptying time (MD, 11.37 min; 95% CI, À3.69 to 19.06 min). Conclusion: Intragastric BTA injection is effective for obesity treatment, and adequate doses (≥ 200 U), multiple gastric injection regions, and combined diet control are crucial. However, given the small sample size and limited power, caution should be exercised.

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