Outcome of Gastric Fundus and Pylorus Botulinum Toxin A Injection
Condition: Obesity
Study type: Observational

Summary: 
      Newly, botulinum toxin A application into the stomach has been proposed as a treatment method
      in obesity. It impacts through acetylcholine receptors located in smooth muscle cells and
      suppresses stomach motility. This method aims to decrease gastric emptying time and thus to
      extend the duration of feeling full. This effect of intragastric botulinum toxin A injection
      (GBI) makes it easier to adhere to dietary prescriptions, which is the cornerstone of any
      obesity treatment method.

      Endoscopic inspections and the complicatedness in literature results, cases that have not
      succeeded in losing weight after GBI might have pylorus contractility problems. Any
      deterioration in pylorus activity is recognized to have the potential to influence gastric
      emptying. In such a case, gastric emptying time would also be altered due to the paralysis of
      pylorus muscles, which is one of the effect mechanisms of botulinum toxin A.

      The pyloric orifice structure may have a crucial role in the success or failure of GBI
      therapy for obesity treatment.
    

Detailed description: 
      The prevalence of obesity has doubled globally in the last four decades to the extent that
      nearly one-third of the world population is now classified as overweight/obese. Obesity
      causes adverse impacts on almost every physiological system in the human body and comprises
      an important public health problem. It is associated with an increased risk of many
      developing co-morbid conditions, such as diabetes mellitus, cardiovascular disease, several
      types of cancers, musculoskeletal disorders, and poor mental health.

      Current treatment options for patients with obesity include lifestyle intervention, obesity
      pharmacotherapy, and bariatric surgery. The components of lifestyle intervention involve
      diet, exercise, and behavior modification and should be recognized as the cornerstone of any
      obesity treatment method; however, the impact of lifestyle intervention is limited in
      patients with morbid obesity.

      Surgical therapies with laparoscopic approach are accepted as the most effective and
      persistent obesity-treatment methods, with a significant reduction in complication rates and
      postoperative recovery. Gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and
      biliopancreatic diversion are commonly performed bariatric surgical procedures worldwide.
      But, the idea of scarless methods in which the video-endoscopy device is used as the primary
      carrier device, expecting to achieve results at least as good as laparoscopic procedures, has
      significantly developed within the last decade. Additionally, the development of effective
      and safe, newer endoscopic bariatric procedures provides another adjunctive treatment for
      patients with obesity who cannot handle this disease with lifestyle modification alone or who
      is not a candidate for surgical procedures. Endoscopic therapies, such as intra-gastric
      balloons, duodenojejunal bypass liners such as the EndoBarrier, and endoscopic suturing
      platforms, have also become proposed alternatives to surgery, considering their
      minimally-invasive advantages. However, given the lack of long-term data at present, the role
      of such devices continues to be determined.

      Newly, botulinum toxin A application into the stomach has been proposed as a treatment method
      in obesity. It impacts through acetylcholine receptors located in smooth muscle cells and
      suppresses stomach motility. This method aims to decrease gastric emptying time and thus to
      extend the duration of feeling full. This effect of intragastric botulinum toxin A injection
      (GBI) makes it easier to adhere to dietary prescriptions, which is the cornerstone of any
      obesity treatment method.

      Endoscopic inspections and the complicatedness in literature results, cases that have not
      succeeded in losing weight after GBI might have pylorus contractility problems. Any
      deterioration in pylorus activity is recognized to have the potential to influence gastric
      emptying. In such a case, gastric emptying time would also be altered due to the paralysis of
      pylorus muscles, which is one of the effect mechanisms of botulinum toxin A.

      The pyloric orifice structure may have a crucial role in the success or failure of GBI
      therapy for obesity treatment.

      The present study aims to explore whether there is a correlation between weight loss after
      GBI and pyloric orifice structure.
    

Observational model: Other
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Medical records of patients who underwent intragastric botulinum toxin A from June 2019
        through June 2020 at the Okan University Hospital in Istanbul were retrospectively
        evaluated.