Outcome of Gastric Fundus and Pylorus Botulinum Toxin A Injection in Obese Patients Class I-II with Normal Pyloric Orifice Structure: A Retrospective Analysis

Abstract

Background: Any deterioration in pyloric muscle activity has the potential to influence gastric emptying. In such a case, gastric emptying time would also be changed due to the paralysis of pyloric muscles, which is the botulinum toxin's effect mechanism. This study aimed to investigate how the pyloric orifice structure influences the success of intragastric botulinum toxin type A injection (GBI) therapy in Class I-II obese patients for weight loss.Methods: The GBI applied patients were categorized according to pyloric orifice structure during upper gastrointestinal system endoscopy: Group A: the patients whose pylorus had normal peristaltic activity and closed completely and Group B: the patients whose pylorus did not close properly or were nonperistaltic. We measured the body mass index (BMI) of the patients before and 6 months after the procedure and expressed postprocedure weight loss in terms of the percentage of excess BMI (E-BMI%) loss. We compared preprocedure and sixth-month BMI and E-BMI% values. We applied the Student's t-test to analyze the differences among study groups, and p < 0.05 was accepted as statistically significant.Results: Seventy-seven patients completed the 6-month follow-up period. The measurements without considering the pyloric orifice structure showed that the mean BMI decrease in female patients (from 36.4 +/- 5.4 to 32 +/- 7.2 kg/m(2)) was significant (p < 0.05). And the BMI and E-BMI% loss in Group A were statistically significant (p < 0.05).Conclusion: We advise being selective and applying GBI to class I-II obese patients with normal pyloric orifice structure.