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EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial.

Abstract：

BACKGROUND:Obesity is a disease that is highly prevalent in Brazil, and the associated comorbidities represent a major global public health challenge. Botulinum toxin type A (BTX-A) is a potent neurotoxin and inhibitor of gastric smooth muscle activity. In theory, BTX-A administration should promote early satiety and weight loss because it delays gastric emptying by inhibiting acetylcholine-mediated peristalsis, which is primarily responsible for gastric motility. Because results in the literature are discrepant, the efficacy of intragastric injections of BTX-A as a primary treatment for obesity remains unknown. The objective of this prospective, double-blind, single-center randomized study was to evaluate the effects of endoscopic ultrasound-guided intragastric BTX-A injections, as a bridge to bariatric surgery, in super-obese patients. METHODS:Thirty-two super-obese patients were randomized to one of two groups: BTX-A, in which 200 units of BTX-A were injected into the gastric antrum and body; and control, in which the same injections were performed with 0.9% saline. Weight, body mass index (BMI), and loss of excess weight were measured monthly over a 6-month period. Gastric emptying scintigraphy was performed before and after the procedure. RESULTS:The patients in both groups showed significant weight loss over the course of the study (p < 0.001). There were no statistically significant differences between the groups regarding weight loss, excess weight, total loss of excess weight, total weight loss, or change in BMI. CONCLUSIONS:Intragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

de Moura EGH,Ribeiro IB,Frazão MSV,Mestieri LHM,de Moura DTH,Dal Bó CMR,Brunaldi VO,de Moura ETH,Nunes GC,Bustamante FAC,Dos Passos Galvão Neto M,Matuguma SE,Bernardo WM,Santo MA

doi

10.1007/s11695-018-3470-y

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

32-39

issue

eissn

0960-8923

issn

1708-0428

pii

10.1007/s11695-018-3470-y

journal_volume

pub_type

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EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial.