Faramarzi Garousi Farzad, Sedighiyan Mohsen, Ghodsi Maryam
Department of Gastroenterology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition, Bahrami Hospital, Tehran University of Medical Science, Tehran, Iran.
Medicine (Baltimore). 2025 Mar 14;104(11):e41411. doi: 10.1097/MD.0000000000041411.
Obesity is a global health concern, with intragastric balloon (IGB) placement serving as a nonsurgical intervention for weight management. However, intolerance due to severe gastrointestinal side effects often leads to premature removal, limiting its effectiveness. Botulinum toxin A (BTX-A) injection has been proposed as a potential strategy to improve IGB tolerance by modulating gastric motility.
This study reports a case series of patients who developed severe intolerance to IGB placement, including persistent nausea, vomiting, fluid intolerance, dehydration, and reduced urine output, necessitating medical intervention.
Patients were diagnosed with IGB intolerance due to obstructive gastric effects, characterized by impaired gastric emptying and intolerance to oral fluids, leading to dehydration and electrolyte imbalances.
A total of 14 patients with IGB intolerance were treated with 500 U of BTX-A injected around the pyloric canal. Prokinetic drugs were also administered to support gastric motility. Patients were monitored for 6 months following the intervention.
Among the 14 patients, 11 (78.57%) showed a significant improvement in fluid tolerance within 12 hours of BTX-A injection and were able to retain the IGB without additional complications. Three patients (21.43%) did not improve and required early IGB removal. No major adverse effects related to BTX-A injection were observed.
BTX-A injection appears to be a promising adjunctive therapy to improve IGB tolerance in patients experiencing severe intolerance. These findings suggest a potential role for BTX-A in reducing the need for premature balloon removal, thereby enhancing weight loss outcomes. However, further randomized controlled trials with larger sample sizes are needed to confirm its efficacy, optimize dosage, and establish standardized treatment protocols.
肥胖是一个全球性的健康问题，胃内球囊（IGB）置入作为一种非手术的体重管理干预措施。然而，由于严重的胃肠道副作用导致的不耐受常常导致球囊过早取出，限制了其有效性。肉毒杆菌毒素A（BTX-A）注射已被提议作为一种通过调节胃动力来提高IGB耐受性的潜在策略。
本研究报告了一系列对IGB置入产生严重不耐受的患者病例，包括持续性恶心、呕吐、液体不耐受、脱水和尿量减少，需要医疗干预。
患者因梗阻性胃效应被诊断为IGB不耐受，其特征为胃排空受损和对口服液体不耐受，导致脱水和电解质失衡。
共有14例IGB不耐受患者在幽门管周围注射了500 U的BTX-A进行治疗。还给予了促动力药物以支持胃动力。干预后对患者进行了6个月的监测。
在14例患者中，11例（78.57%）在注射BTX-A后12小时内液体耐受性有显著改善，能够保留IGB且无其他并发症。3例患者（21.43%）未改善，需要早期取出IGB。未观察到与BTX-A注射相关的重大不良反应。
BTX-A注射似乎是一种有前景的辅助治疗方法，可提高严重不耐受患者对IGB的耐受性。这些发现表明BTX-A在减少过早取出球囊的必要性方面具有潜在作用，从而提高减肥效果。然而，需要进一步进行更大样本量的随机对照试验来证实其疗效、优化剂量并建立标准化治疗方案。
