Júnior Aloísio Cardoso, Savassi-Rocha Paulo Roberto, Coelho Luiz Gonzaga Vaz, Spósito Maria Matilde de Mello, Albuquerque Walton, Diniz Marco Túlio Costa, Paixão André de Mattos, Garcia Frederico Duarte, Lasmar Leonardo Faria
Alfa Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Obes Surg. 2006 Mar;16(3):335-43. doi: 10.1381/096089206776116408.
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.
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.
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.
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.
肥胖是西方国家的一个主要公共卫生问题。初步研究表明，向胃幽门区域注射A型肉毒杆菌毒素（Btx-A）可抑制胃窦泵的推进性收缩，导致胃排空延迟、早饱感和体重减轻。
经大学伦理委员会批准后，我们对12例III级肥胖患者进行了前瞻性评估，将其分为4组，每组3例。在第一组和第二组中，分别在8个和16个位点向胃幽门区域注射200 U Btx-A。第三组和第四组分别在16个和24个位点向胃幽门区域注射300 U Btx-A。在12周的时间内，分别在注射前后使用13C-辛酸呼气试验和13C-乙酸呼气试验测定体重以及固体和半固体的胃排空时间（GET）。
各组治疗前后的体重或固体和半固体的GET差异均无统计学意义（P>0.05）。所有患者均报告有早饱感。未观察到与BtxA相关的不良反应或内镜操作引起的并发症。
在III级肥胖患者的胃幽门区域不同位点注射不同剂量的BtxA，对这些个体的固体和半固体GET或体重无明显干扰。然而，所有患者均报告有早饱感，该操作安全，未观察到治疗的副作用。有必要开展进一步的对照研究，涉及Btx-A剂量和注射位点的不同方法。
