title: Treatment of obesity by endoscopic gastric intramural injection of botulinum toxin A: a randomized clinical trial.
abstract: OBJECTIVE
  Botulinum toxin A (BTX-A) is an inhibitor of muscular contractions in both striated and smooth muscle. The purpose of this study was to observe the safety and efficacy of endoscopic injections of BTX-A into the gastric wall in obese patients.
  
  
  METHODS
  Twenty obese patients (BMI >28 kg/m2) were randomized into two groups: Group 1 (200 U BTX-A) and Group 2 (300 U BTX-A). For each patient, 20 puncture sites were selected into the gastric wall. Body weights and BMIs were recorded and gastric emptying times were determined before treatment and 1, 4 and 12 weeks after treatment. Blood samples for cholesterol, triglycerides, insulin, leptin, motilin, peptide tyrosine (PYY) and ghrelin levels were obtained before treatment and 1, 4 and 12 weeks after treatment.
  
  
  RESULTS
  Nineteen patients completed the follow-up. Both groups showed significant body weight and BMI decrease (p<0.05) with decreased TG levels. The gastric emptying times were longer than those before treatment in both groups, especially at the 1-week point (p<0.05). A significant decrease in fasting ghrelin levels in all 19 obese patients was found after BTX-A administration 4 weeks later, and PYY levels in all 19 patients decreased, especially at the 12-week point. No severe complications were observed.
  
  
  CONCLUSIONS
  Endoscopic multi-punctures of BTX-A including fundic injections may decrease body weight and BMI by delaying the gastric emptying time. The effect of BTX-A on ghrelin levels may also be involved in the reduction of appetite.
authors.affiliation: Liver Cirrhosis Treatment Center of 302 Military Hospital of China, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Qing-Sen
authors.initials: QS
authors.lastname: Liu
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Liu
authors.forename: Yun-Sheng
authors.initials: YS
authors.lastname: Yang
authors.forename: Dou
authors.initials: D
authors.lastname: Yan
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Peng
authors.forename: Lian-Yong
authors.initials: LY
authors.lastname: Li
authors.forename: Jiang-Yun
authors.initials: JY
authors.lastname: Meng
authors.forename: Xiang-Dong
authors.initials: XD
authors.lastname: Wang
authors.forename: Meng
authors.initials: M
authors.lastname: Ke
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001069:Appetite Regulation / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D005773:Gastroscopy; D054439:Ghrelin / Q000187:drug effects; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011677:Punctures; D013270:Stomach; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
chemical_list: D019440:Anti-Obesity Agents; D015415:Biomarkers; C515349:GHRL protein, human; D054439:Ghrelin; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A