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Effect of intragastric injection of botulinum toxin A for the treatment of obesity: a meta-analysis and meta-regression

Published:March 10, 2015DOI:https://doi.org/10.1016/j.gie.2014.12.025

      Background

      Controversies persist regarding the effect of intragastric injection of botulinum toxin A for the treatment of obesity.

      Objective

      To assess the efficacy of intragastric botulinum toxin injection for the treatment of obesity.

      Design

      A systematic literature review was conducted by using the core databases. Pre- and posttreatment body weight data were extracted and analyzed by using Hedges’ g. A random-effects model was applied. The methodological quality of the enrolled studies was assessed by the risk of bias table and Newcastle-Ottawa Scale. Publication bias was evaluated via the funnel plot, trim and fill method, Egger’s test, and rank correlation test.

      Setting

      Meta-analysis of 8 studies.

      Patients

      A total of 115 patients (79 treated vs 36 placebo).

      Intervention

      Intragastric botulinum toxin A injection.

      Main Outcome Measurements

      Hedges’ g, calculated from pre- and posttreatment body weight data and comparison of body weight changes between treatment and placebo group.

      Results

      The treatment group was associated with weight loss in a pre/post comparative approach and compared with the placebo group (Hedges’ g: −0.443; 95% confidence interval, −0.845 to −0.040; P = .031; and Hedges’ g: −0.521; 95% confidence interval, −0.956 to −0.085; P = .019). Wide area injection including the fundus or body rather than the antrum only was associated with weight loss. Multiple injections (>10) were associated with weight loss. However, a large amount of botulinum toxin A (500 IU) was not associated with weight loss. Sensitivity analyses showed consistent results. Meta-regression for the botulinum toxin A dose and number of injections showed consistent results. Publication bias was not detected.

      Conclusion

      In this analysis, intragastric injection of botulinum toxin A is effective for the treatment of obesity.

      Abbreviations:

      CI (confidence interval), NOS (Newcastle-Ottawa Scale), RoB (risk of bias), SMD (standardized mean difference)
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