Endoscopic Ultrasound-Guided Gastric Botulinum Toxin Injections in Obese Subjects: A Pilot Study

Topazian, Mark; Camilleri, Michael; Mora-Levy, Jose De La; Enders, Felicity; Foxx‐Orenstein, Amy E.; Levy, Michael J.; Nehra, Vandana; Talley, Nicholas J.

doi:10.1007/s11695-008-9442-x

Cited by 42 publications

(30 citation statements)

References 30 publications

(43 reference statements)

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“…In addition, this study found a prolonged gastric emptying time and reduced maximal gastric capacity for liquids [67]. Similar results have been found in an open label study of 10 obese adults who received 100 units (4 patients) or 300 units (6 patients) of BoNT-A and were followed for 16 weeks [68]. …”

Section: Clinical Studies Of Intragatsric Bont-a For Obesitysupporting

confidence: 76%

Botulinum Toxin A for Controlling Obesity

Pero

Coretti

Lembo

2016

Toxins

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Rapid growth of the overweight population and the number of obese individuals in recent decades suggests that current strategies based on diet, exercise, and pharmacological knowledge are not sufficient to address this epidemic. Obesity is the result of a high caloric intake and energy storage, not counterbalanced by an equally important energy expense. Botulinum toxin type A (BoNT-A) use is rapidly expanding to include treatment of a variety of ophthalmological, gastrointestinal, urological, orthopedic, dermatological, secretory, painful, and cosmetic disorders. Many studies evaluating the effect of BoNT-A in gastric antrum e/o fundus for the treatment of obesity have been published. This treatment modality was based on the observation that gastric injection of BoNT-A in laparatomized rats induced a significant reduction of food intake and body weight. These studies have been published yielding debated results. Differences in the selection of patients, the doses of BoNT-A, the method of administration of the toxin, and the instruments of evaluation of some parameters among these studies may be the cause. In this review, it will study the state-of-the-art use of BoNT-A in obesity basic science models and review the clinical evidence on the therapeutic applications of BoNT-A for obesity.

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Section: Clinical Studies Of Intragatsric Bont-a For Obesitysupporting

confidence: 76%

Botulinum Toxin A for Controlling Obesity

Pero

Coretti

Lembo

2016

Toxins

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“…Injections were performed via a 25 gauge EUS needle under real-time EUS guidance, targeting the gastric muscularis propria as previously described. 10 Three rings of injections were performed around the antral circumference, with 5 equally spaced 2 mL injections in each ring. The rings were 1 to 2 cm apart, and the most distal ring was 2 to 3 cm proximal to the pylorus.…”

Section: Methods and Proceduresmentioning

confidence: 99%

Gastric Antral Injections of Botulinum Toxin Delay Gastric Emptying but Do Not Reduce Body Weight

Topazian

Camilleri

Enders

et al. 2013

Clinical Gastroenterology and Hepatology

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Background & Aims Gastric injections of botulinum toxin A (BTA) have been reported to delay gastric emptying, increase satiation, and reduce body weight, but there are few data from randomized, placebo-controlled studies. Methods We enrolled 60 obese participants in a 24-week, double-blind, randomized, placebo-controlled, concealed allocation trial to compare the effects of gastric antral injections of BTA (100 U, 300 U, or 500 U) and saline placebo. The study was conducted at an outpatient clinical research unit. Participants were given one set of injections of BTA or placebo into the gastric antral muscularis propria, using endoscopic ultrasound guidance. Gastric emptying of solids (GES) was measured by scintigraphy; we also measured body weight, satiation (maximum tolerated volume in a caloric liquid drink test), calorie intake (by food frequency questionnaire), gastrointestinal symptoms, and psychologic aspects of eating behavior (by rating scale). Results Compared with baseline values, 2 weeks after injections, the mean t1/2 for GES increased by 0.8, 14, 24, and 14 minutes among subjects given placebo, 100 U, 300 U, or 500 U of BTA, respectively (P=.24 overall, P=.04 for the group given 300 U vs placebo); 16 weeks after the injections, mean body weights were reduced by 2.2, 0.2, 2.3, and 3.0 kg in these groups, respectively. There were no statistically significant differences in mean body weight change, satiation volume, caloric intake, gastrointestinal symptoms, or psychological aspects of eating behavior among groups. Conclusions Gastric antral injections of BTA may delay gastric emptying at a dose of 300 U, but do not cause early satiety, altered eating behaviors, or loss of body weight. Clinicaltrials. gov identifier: NCT00976443

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“…Gastric antral injection of BOTOX appeared promising, as it also delayed gastric emptying and induced satiation in an open-label trial 62 ; however, in a 4-month trial, despite documentation of delay in gastric emptying, there was no significant reduction in body weight. 63 A recently published meta-analysis and meta-regression of 4 randomized, controlled trials evaluating antral BOTOX injection suggested overall benefit (Hedges’ g −0.521; 95% CI, −0.845 to −0.040, P = .031), but 3 of the 4 trials were individually nonsignificant.…”

Section: Novel Devices Proposed In Obesity Treatment and Their Potentmentioning

confidence: 96%

Gastrointestinal traits: individualizing therapy for obesity with drugs and devices

Camilleri

Acosta

2016

Gastrointestinal Endoscopy

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Objectives The objectives were to review the discrepancy between numbers of people requiring weight loss treatment and results, and to assess the potential effects of pharmacological treatments (recently approved for obesity) and endoscopically deployed devices on quantitative gastrointestinal traits in development for obesity treatment. Methods We conducted a review of relevant literature to achieve our objectives. Results The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9% (116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss ~5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These gastrointestinal and behavioral traits identify sub-phenotypes of obesity based on recent research. Conclusions The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative gastrointestinal and behavioral traits measured in obese patients.

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Endoscopic Ultrasound-Guided Gastric Botulinum Toxin Injections in Obese Subjects: A Pilot Study

Cited by 42 publications

References 30 publications

Botulinum Toxin A for Controlling Obesity

Botulinum Toxin A for Controlling Obesity

Gastric Antral Injections of Botulinum Toxin Delay Gastric Emptying but Do Not Reduce Body Weight

Gastrointestinal traits: individualizing therapy for obesity with drugs and devices

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