Botulinum A toxin injected into the gastric wall for the treatment of class III obesity: a pilot study.
BACKGROUND
Obesity represents a major public health problem in western countries. Initial studies suggest that injection of botulinum A toxin (Btx-A) into the antropyloric region inhibits propulsive contractions of the antral pump, with delay in gastric emptying, early satiety and weight loss.


METHODS
After approval by the University Ethics Committee, we prospectively evaluated 12 patients with class III obesity divided into 4 groups of 3 patients each. In groups I and II, 200 U Btx-A were injected into the antropyloric region at 8 and 16 sites, respectively. Groups III and IV received 300 U Btx-A into the antropyloric region at 16 and 24 sites, respectively. Body weight and gastric emptying time (GET) of solids and semi-solids using 13C-octanoic acid breath test and 13C-acetic acid breath test, respectively, were determined before and after injection over a period of 12 weeks.


RESULTS
Pre- and post-treatment body weight or solid and semi-solid GET did not differ significantly between groups (P>0.05). All patients reported a feeling of early satiety. No adverse effects related to BtxA or complications resulting from the endoscopic procedure were observed.


CONCLUSIONS
The injection of different doses of BtxA at different sites in the antropyloric region of patients with class III obesity did not interfere significantly with the solid and semi-solid GET or body weight of these individuals. However, early satiety was reported by all patients, the procedure was safe and no side-effects of the treatment were observed. Further controlled studies involving different methodologies regarding dosage of Btx-A and sites of injection are necessary.
Alfa Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, Brazil. aloisiocardoso@terra.com.br
Aloísio Cardoso
AC
Júnior
Paulo Roberto
PR
Savassi-Rocha
Luiz Gonzaga Vaz
LG
Coelho
Maria Matilde de Mello
MM
Spósito
Walton
W
Albuquerque
Marco Túlio Costa
MT
Diniz
André de Mattos
Ade M
Paixão
Frederico Duarte
FD
Garcia
Leonardo Faria
LF
Lasmar
D000293:Adolescent; D000328:Adult; D001835:Body Weight / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009767:Obesity, Morbid / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D012528:Satiety Response / Q000187:drug effects
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A