Topazian Mark, Camilleri Michael, De La Mora-Levy Jose, Enders Felicity B, Foxx-Orenstein Amy E, Levy Michael J, Nehra Vandana, Talley Nicholas J
Miles and Shirley Fiterman Center for Digestive Diseases, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Obes Surg. 2008 Apr;18(4):401-7. doi: 10.1007/s11695-008-9442-x. Epub 2008 Feb 20.
Gastric injections of botulinum toxin A (BTA) may induce changes in gastric emptying and body weight, but results vary. BTA dose and depth of injection may affect efficacy. This study assessed changes in gastric emptying, satiation, symptoms, and body weight after endoscopic ultrasound (EUS)-guided injection of 100 or 300 U BTA into gastric antral muscularis propria of obese subjects.
Open label study of ten healthy, obese adults (age = 29-49 years, body mass index = 31-54 kg/m(2)) who received 100 U (n = 4) or 300 U (n = 6) BTA and were followed for 16 weeks. Measures included gastric emptying of solids (by scintigraphy), satiation (by maximum tolerated volume [MTV] during nutrient drink test), gastrointestinal symptoms (by the Gastrointestinal Symptom Rating Scale), caloric intake (by food frequency questionnaire), and body weight.
For the entire cohort, MTV decreased from 1,380 cc (range: 474-2,014) at baseline to 620 cc (range: 256-1,180) 2 weeks after BTA injection; decreases were statistically significant in the subjects receiving 300 U BTA (p = 0.03). Average body weight loss was 4.9 (+/-6.3) kg after 16 weeks. Gastric emptying T(1/2) was prolonged in the 300 U BTA group, but not significantly different from baseline (p = 0.17). BTA injections were well tolerated without significant adverse effects.
EUS-guided injection of BTA into gastric muscularis propria can be performed safely with minimal adverse effects. A dose of 300 U BTA significantly enhances satiation, is associated with weight loss, and may slow gastric emptying. Further study of higher dose BTA in obese subjects is warranted.
向胃内注射A型肉毒杆菌毒素（BTA）可能会引起胃排空和体重的变化，但结果各不相同。BTA的剂量和注射深度可能会影响疗效。本研究评估了在内镜超声（EUS）引导下向肥胖受试者胃窦肌层注射100或300 U BTA后胃排空、饱腹感、症状和体重的变化。
对10名健康肥胖成年人（年龄=29 - 49岁，体重指数=31 - 54 kg/m²）进行开放标签研究，这些受试者接受了100 U（n = 4）或300 U（n = 6）的BTA，并随访16周。测量指标包括固体食物的胃排空（通过闪烁扫描法）、饱腹感（通过营养饮料测试中的最大耐受量[MTV]）、胃肠道症状（通过胃肠道症状评分量表）、热量摄入（通过食物频率问卷）和体重。
对于整个队列，MTV从基线时的1380 cc（范围：474 - 2014）降至BTA注射后2周时的620 cc（范围：256 - 1180）；接受300 U BTA的受试者中这种下降具有统计学意义（p = 0.03）。16周后平均体重减轻4.9（±6.3）kg。300 U BTA组的胃排空T(1/2)延长，但与基线相比无显著差异（p = 0.17）。BTA注射耐受性良好，无明显不良反应。
EUS引导下向胃肌层注射BTA可安全进行，不良反应最小。300 U BTA剂量可显著增强饱腹感，与体重减轻相关，并可能减缓胃排空。有必要对肥胖受试者中更高剂量的BTA进行进一步研究。
