Effect of intragastric injection of botulinum toxin A for the treatment of obesity: a meta-analysis and meta-regression.Bang CS, Baik GH, Shin IS, Kim JB, Suk KT, Yoon JH, Kim YS, Kim DJ. Gastrointest Endosc. 2015 Mar 9. pii: S0016-5107(14)02595-4. [Epub ahead of print]
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.