Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study

Background A potential approach to the treatment of morbid obesity is reduction of gastric emptying to achieve satiety. Botulinum toxin A (Btx-A) is a long-acting inhibitor of acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility. Aim To investigate whether botulinum toxin A, injected in the antrum of obese patients, delays gastric emptying. Methods In a double_blind study, 18 healthy obese subjects (body mass index > 30) were randomized into three groups (BTX133, BTX200 and Saline); they received Btx-A133U, Btx-A200U, or saline under endoscopic control. Gastric emptying was tested by scintigraphy before and 10 days after treatment. Body weight variations and appetite sensation were recorded after 5 weeks. Results Fourteen patients completed the study. The botulinum toxin A-treated groups showed weight reduction, which was not statistically significant. The effects on gastric emptying were variable. Most of the botulinum toxin A treated patients reported a reduced appetite. Conclusion This pilot clinical trial suggests potential activity of botulinum toxin A for the manipulation of appetite.